Central Retinal Vein Occlusion: The Effect of Antiplatelet and Anticoagulant Agents

2021 ◽  
pp. 247412642110285
Author(s):  
George N. Thomas ◽  
Sieh Yean Kiew ◽  
Pali Singh ◽  
Pauline Dmitriev ◽  
Akshay S. Thomas ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Retinal Vein Occlusion ◽  
Central Retinal Vein Occlusion ◽  
Antiplatelet Agent ◽  
Final Visit ◽  
Vein Occlusion ◽  
Anticoagulant Agents ◽  
Significant Difference ◽  
Central Retinal Vein ◽  
Macular Ischemia

Purpose: This work evaluates the effect of antiplatelet and anticoagulant agents on clinical outcomes, optical coherence tomography (OCT) parameters, and macular ischemia in eyes with central retinal vein occlusion (CRVO). Methods: A retrospective longitudinal cohort study was performed to evaluate patients with CRVO. Demographics, OCT parameters before and after treatment, macular ischemia on fluorescein angiography, and clinical outcomes including the number of injections received were analyzed. Results: A total of 365 patients with CRVO were identified. The average follow-up was 36 months. Antiplatelet or anticoagulant agent use was not associated with a significant difference in visual acuity (VA), prevalence of macular edema, or central subfield thickness on OCT at presentation or final visit. The use of 81-mg aspirin alone was associated with an increased prevalence of foveal hemorrhage at presentation. Patients who were taking an antiplatelet agent, an anticoagulation agent, or both and had an ischemic CRVO with logMAR VA of less than 1.0 experienced improved VA at the final study visit. Patients given antiplatelet or anticoagulant agents had a similar incidence of neovascular sequelae compared with patients not administered these agents. Conclusions: In eyes with CRVO, the use of antiplatelet or anticoagulant agents at CRVO onset was not associated with significantly different functional outcomes, except in ischemic CRVO eyes with VA of less than 20/200. The use of 81-mg aspirin was associated with foveal hemorrhage at CRVO presentation. Otherwise, the use of any antiplatelet agent or anticoagulation was not associated with any CRVO structural outcomes.

Sex Differences in Presentation, Treatment Patterns, and Clinical Outcomes in Central Retinal Vein Occlusion

2020 ◽  
Vol 51 (5) ◽  
pp. 279-285
Author(s):  
Delaram Mirzania ◽  
Akshay S. Thomas ◽  
Adam L. Rothman ◽  
Duncan Berry ◽  
Sandra Stinnett ◽  
...  
Keyword(s):  
Sex Differences ◽  
Clinical Outcomes ◽  
Retinal Vein Occlusion ◽  
Central Retinal Vein Occlusion ◽  
Treatment Patterns ◽  
Vein Occlusion ◽  
Central Retinal Vein

Nonresponsiveness, Resistance to the Treatment, Drug Switch and Combined Treatments in Macular Edema Secondary to Central Retinal Vein Occlusion

2019 ◽  
pp. 45-49
Keyword(s):  
Macular Edema ◽  
Retinal Vein Occlusion ◽  
Central Retinal Vein Occlusion ◽  
Vegf Receptor ◽  
Combined Treatments ◽  
Vein Occlusion ◽  
Vitreoretinal Traction ◽  
Retinal Vascular Disease ◽  
Central Retinal Vein ◽  
Macular Ischemia

Retinal vein occlusion (RVO) is the second most common retinal vascular disease following diabetic retinopathy. Visual loss in central retinal vein occlusion (CRVO) may occur due to retinal ischemia, macular ischemia, macular edema, or neovascular complications. In CRVO, macular edema can develop due to increased vascular permeability due to inflammation and elevated VEGF levels, and breakdown of the blood-retina barrier. In cases with CRVO, resistance, and/or nonresponsiveness to the treatment develops in about one of three of the cases. The presence of the relative afferent pupillary defect, vitreoretinal traction, poor macular and peripheral retinal perfusion, high blood urea and creatinine levels, ineffectiveness to other cytokines and factors, delay in the initiation of the treatment, VEGF receptor up-regulation, advanced age are risk factors for non-responsiveness. Positive results on visual acuity, central macular thickness, and the number of injections can be obtained by replacing one Anti-VEGF agent with another and/or by combined treatments with steroids in the treatment of the resistant/non-responsive cases.

scholarly journals Using ultra-widefield red channel images to improve the detection of ischemic central retinal vein occlusion

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260383
Author(s):  
Akinori Sato ◽  
Ryo Asaoka ◽  
Shin Tanaka ◽  
Koichi Nagura ◽  
Yui Tanaka ◽  
...  
Keyword(s):  
Retinal Vein Occlusion ◽  
Central Retinal Vein Occlusion ◽  
Linear Mixed Model ◽  
Fundus Images ◽  
Vein Occlusion ◽  
Fundus Imaging ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Central Retinal Vein

Purpose To examine the usefulness of red channel fundus imaging to detect the ischemic status in eyes with central retinal vein occlusion (CRVO). Methods Ultra-widefield (UWF) fundus images were obtained from 42 eyes with CRVO. Twenty-one eyes were ischemic, and 21 eyes were non-ischemic. Rubeosis was found in 11 ischemic eyes. UWF images were split into red and green channels using ImageJ software. Both the color and red channel images were used to predict the presence or absence of ischemia when examined by masked graders. The sensitivity and specificity of UWF imagings for the detection of ischemia were calculated in Group A (total 42 eyes), Group B (32 eyes excluding non-rubeotic ischemic CRVO) and Group C (31 eyes excluding rubeotic ischemic CRVO), respectively. Moreover, a linear mixed model was conducted to investigate the relationship between the type of images and the accuracy of prediction in each group. Results No significant difference in the sensitivity of color fundus imaging was seen between Group A and Group B. By contrast, a significant difference in the sensitivity of red channel imaging was seen between Group A and Group B (p = 0.031). The accuracies of the predictions were not associated with the type of image in Group A and Group B, but were significantly associated in Group C (p = 0.026). Conclusions UWF red channel imaging enabled more accurate detection of the ischemic status, compared with color fundus images, especially in non-rubeotic CRVO eyes.

EVALUATION OF MACULAR ISCHEMIA IN EYES WITH CENTRAL RETINAL VEIN OCCLUSION

Retina ◽  
2018 ◽  
Vol 38 (8) ◽  
pp. 1571-1580 ◽  
Author(s):  
Rima Ghashut ◽  
Yuki Muraoka ◽  
Sotaro Ooto ◽  
Yuto Iida ◽  
Yuko Miwa ◽  
...  
Keyword(s):  
Retinal Vein Occlusion ◽  
Central Retinal Vein Occlusion ◽  
Vein Occlusion ◽  
Central Retinal Vein ◽  
Macular Ischemia

Hypercoagulability and High Lipoprotein(a) Levels in Patients with Central Retinal Vein Occlusion

1994 ◽  
Vol 72 (01) ◽  
pp. 039-043 ◽  
Author(s):  
Francesco Bandello ◽  
Silvana Vigano’ D’Angelo ◽  
Mariella Parlavecchia ◽  
Alessandra Tavola ◽  
Patrizia Della Valle ◽  
...  
Keyword(s):  
Retinal Vein Occlusion ◽  
Central Retinal Vein Occlusion ◽  
Specific Treatment ◽  
Fibrin Deposition ◽  
Heparin Cofactor Ii ◽  
Lipoprotein A ◽  
Vein Occlusion ◽  
Acute Event ◽  
D Dimer ◽  
Central Retinal Vein

SummaryA series of coagulation parameters and lipoprotein(a) (Lp(a)) were explored in plasma from 40 patients with central retinal vein occlusion (CRVO, non-ischemic type n = 12; ischemic type n = 28) free of local and systemic predisposing factors, 1 to 12 months after the acute event. Forty age- and sex-matched patients with cataract served as controls. Prothrombin fragment 1.2 (FI.2), D-dimer, FVII:C - but not FVII: Ag - were higher and fibrinogen was lower in CRVO patients than in controls. Patients with non-ischemic CRVO had higher FI .2 and FVII:C and lower heparin cofactor II than patients with ischemic CRVO. Lp(a) levels greater than 300 mg/1 were observed in 12 patients with CRVO and in 4 controls (30% vs 10%, p <0.025). Patients with high Lp(a) - consistently associated with the S2 phenotype - had higher FVII:C, FVII:C/Ag ratio, and fibrinogen than the remaining CRVO patients. Plasma FI.2 and D-dimer correlated fairly in controls (r = 0.41) and patients with normal Lp(a) levels (r = 0.55), but they did not in the group of patients with high Lp(a) (r = 0.19), where the latter parameter was negatively related to D-dimer (r = −0.55). There was no dependence of the abnormalities observed on the time elapsed from vein occlusion. The findings of activated FVII and high FI.2, D-dimer, and Lp(a) are not uncommon in patients with CRVO. Increased thrombin formation with fibrin deposition and impaired fibrinolysis may play a role in the pathophysiology of CRVO and require specific treatment

Retinal Vascular Occlusive Disorders - Risk Factors

2018 ◽  
Vol 3 (02) ◽  
Author(s):  
Shivcharan Lal Chandravanshi, Sunil Kumar Shrivastava, Priyanka Agnihotri, Smriti Gupta
Keyword(s):  
Risk Factors ◽  
Retinal Vein Occlusion ◽  
Central Retinal Vein Occlusion ◽  
Branch Retinal Vein Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Vein Occlusion ◽  
Department Of Ophthalmology ◽  
Retinal Artery ◽  
Central Retinal Vein

Aims and Objective - The aim of the present study is to identify risk factors associated with different retinal vascular occlusive diseases (RVOD), such as central retinal artery occlusion (CRAO), hemi-retinal artery occlusion (HRAO), branch retinal artery occlusion (BRAO), cilioretinal artery occlusion (Cilio-RAO), central retinal vein occlusion (CRVO), branch retinal vein occlusion (BRVO), and hemi-retinal vein occlusion (HRVO). Patients and Method - A cross-sectional study on 114 consecutive subjects, aged 24-96 years who have attended at the outpatient department of ophthalmology at Shyam Shah Medical College, Rewa, MP, were included in the study. The Duration of study was January 2016 to December 2017. Only patients with CRAO, BRAO, HRAO, Cilio-RAO, CRVO, BRVO, and HRVO were included in the study. Other retinal vascular disorders such as diabetic vaso-occlusive disease, anterior and posterior ischemic and non-ischemic neuropathy, hypertensive retinopathy, sickle cell retinopathy, retinal telangiectasia, retinopathy of prematurity, were excluded from study. Results - We have included 114 patients, 64 cases (56.14%) males, 50 (43.85%) females, aged 56+/-8 years (range 24-96 years).  Bilateral retinal vascular occlusive disorders were seen in only 4 cases (3.5%). Two patients have bilateral CRVO followed by one case of bilateral BRVO and one case of bilateral CRAO.  Out of 114 patients, branch retinal vein occlusion was seen in 62 cases (54.38%), followed by central retinal vein occlusion in 36 cases (31.57%), CRAO in 8 cases (7.01%), and hemi- retinal vein occlusion in 4 cases (3.50%). Hypertension was the most common, (40 cases, 35.08%) risk factor identified for retinal vascular occlusive disorders followed by diabetes 24 cases (21.05%), combined diabetes and hypertension in 22 cases (19.29%), and atherosclerosis in 18 cases (15.78%). Conclusions - Retinal vascular occlusive diseases have systemic as well as ocular risk factors. Understanding of these risk factors is essential for proper treatment of RVOD. Timely identification of risk factors for RVOD may helpful in decreasing ocular and systemic morbidity in these patients.

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