Retinal vein occlusions associated or complicated with glaucoma. Aspects of prediction and paths of progression.

Background and Objectives: The aim of the study is to evaluate prediction factors and progression paths when retinal vein occlusions are associated with preexisting glaucoma or complicated with neovascular glaucoma. Materials and Methods: The study included 111 patients diagnosed with retinal vein occlusions, of whom 21 with preexisting open angle glaucoma and 12 with neovascular glaucoma as complication. The study was conducted from September 2020 to September 2022 in Timisoara, Romania. We assessed intraocular pressure, cup-disc ratio and retinal nerve fiber layer from the moment of retinal vein occlusion diagnosis until at least one year of follow-up, considering these aspects as values of prediction concerning the paths of progression when glaucoma and retinal vein occlusions come together. Results: The mean initial IOP for the affected eyes was higher (15.89 ± 2.73) than for fellow eyes (15.20 ± 3.11), with an increase of the IOP after one year, but with no statistically significant differences for the affected eyes (p=0.116) or for the other eyes (p=0.684), neither for the affected eyes associated with glaucoma in comparison with affected eyes without glaucoma association. The mean cup-disc ratio was higher for the affected eyes in comparison with the fellow eyes (0.4812 ± 0.219 for the affected eyes and 0.4738 ± 0.229 for the fellow ones in cases without associated glaucoma and 0.681 ± 0.157 for the affected eyes and 0.600 ± 0.241 for the fellow eyes in cases with associated glaucoma), with statistical significant differences in the evolution for both groups in comparison with the unaffected eyes (p=0.0056 for the first group and p=0.0003 for the second group). Comparing the evolution of the affected eyes with the preexisting glaucoma and the affected eyes without preexisting glaucoma, no statistical difference has been found (p=0.1104). The mean retinal nerve fiber layer decreased significantly in affected eyes without glaucoma (from 96 ± 14.71 to 89.16 ± 13.07) and in affected eyes with associated glaucoma (from 78.50 ± 4.23 to 75.50 ± 5.83), but with no significant differences (p=0.182). The level of decreasing was significantly more consistent in association with a venous occlusion (p= 0.0001). Conclusions: The findings of the current study fortify the correlation between glaucoma as a risk factor for retinal venous occlusion development, the intraocular pressure and optic nerve cupping as prediction factors in retinal venous occlusions, the association of a well-controlled preexisting glaucoma with no effect on the progression of the retinal venous occlusions and the development of a neovascular glaucoma with a much aggressive and different path of disease progression.

Central Retinal Vein Occlusion After Discontinuation of Rivaroxaban Therapy in a Young Patient with COVID-19 Pulmonary Embolism: A Case Report.

BACKGROUND We present the report of the first case, to the best of our knowledge, of central retinal vein occlusion (CRVO) that occurred 3 days after anticoagulation discontinuation in a patient with a history of pulmonary embolism in the course of COVID-19. CASE REPORT A previously healthy 38-year-old man was hospitalized in April 2021 with severe COVID-19 pneumonia, complicated by segmental and subsegmental pulmonary embolism. The patient was treated with a concurrent combination of remdesivir, dexamethasone, therapeutic enoxaparin, ceftriaxone, passive oxygen therapy, and convalescent plasma therapy, which led to pulmonary improvement. The treatment with therapeutic enoxaparin (80 mg/0.8 mL twice a day) was continued for 1 month after discharge, followed by 15 mg of rivaroxaban twice a day for 3 weeks and 20 mg of rivaroxaban once a day for 11 weeks. Within 3 days after rivaroxaban discontinuation, the patient experienced a decrease in visual acuity in his right eye, to the level of 5/25. Nonischemic CRVO with cystoid macular edema was diagnosed and an intravitreal injection of ranibizumab was performed. Common identifiable factors contributing to CRVO were excluded, and the treatment with prophylactic enoxaparin was initiated. Two weeks later, macular edema decreased significantly and visual acuity improved to 20/20. The treatment with enoxaparin was discontinued. CONCLUSIONS Rebound hypercoagulability after discontinuation of rivaroxaban therapy can manifest as CRVO in a young patient with a history of COVID-19 pulmonary embolism. It was successfully treated with an intravitreal injection of ranibizumab.

Significant vision improvement and successful prevention of recurrence by electroacupuncture in hemiretinal vein occlusion combined with macular edema: A case report.

RATIONALE: Retinal vein occlusion (RVO) is the second commonest retinal vascular pathology, with macular edema (ME) as one of its major complications, which could finally cause vision loss. Anti-vascular endothelial growth factor (anti-VEGF therapy), as the standard therapy, has an unsustainable effect and needs repeated injections, which associates with frequent adverse events and significant economic burden. We reported a patient who had developed RVO and ME, and finally recovered after electroacupuncture treatment. PATIENT CONCERNS: A 56-year-old woman complained a decrease of visual acuity in the right eye for 1 year. She received injection of 0.5 mg Conbercept, one of the anti-VEGF therapies, in the vitreous cavity 6 times in 1 year, and finally turned to acupuncture for help out of short-term effectiveness after each injection and high expenditure (CNY 40,800). No other severe medical history was reported. DIAGNOSIS: Under comprehensive consideration of clinical manifestations and the results of fluorescein fundus angiography and optical coherence tomography, the patient was diagnosed with hemi-RVO and ME. INTERVENTIONS: The patient received electroacupuncture 3 sessions per week throughout 8 months (93 sessions in total). OUTCOMES: The visual acuity of the patient was improved from 0.6 to 0.9 after the 8-month electroacupuncture treatment and remained stable during the 24-month follow-up; the central retinal thickness remained stable between 350 and 414 throughout the treatment and follow-up periods. Patients regarded the vision-related quality of life as satisfactory. The total expenditure of electroacupuncture treatment was CNY 6045. The patient did not receive any Conbercept injection over the whole period of 32 months. No relevant adverse events occurred. LESSONS: Electroacupuncture might be effective in alleviating the symptoms of hemi-RVO-associated ME, with a potential of long-lasting effect. The frequency of anti-VEGF therapy could be reduced to the most extent, and the possibility of recurrence could be reduced as well, resulting good economic benefits.

Hyperbaric oxygen treatment of central retinal vein occlusion with cilioretinal artery occlusion secondary to hormonal treatment: Case report and review.

INTRODUCTION: This report describes a case of central retinal vein occlusion (CRVO) and cilioretinal artery occlusion (CLRAO) after hormonal treatment for induction of ovulation that was successfully treated with hyperbaric oxygen. CASE REPORT: A 48 year-old woman was admitted to our department for sudden blurred vision in her left eye. The patient had a history of 3-months hormonal treatment for induction of ovulation. The best corrected visual acuity was 7/10 (20/32) in the left eye and 10/10 (20/20) in the right eye. Fundus examination of the left eye revealed flame-shaped haemorrhages, whitening of the retina along the distribution of cilioretinal artery and tortuous retinal veins. Fluorescein angiography confirmed the combination of a non-ischaemic CRVO with CLRAO. The patient was treated with a 2 h session of hyperbaric oxygen at 253 kPa (2.5 atmospheres absolute) once daily for a total of 30 sessions. Best corrected visual acuity improved to 10/10 (20/20) in the left eye. CONCLUSIONS: CRVO and CLRAO are both occlusive disorders. HBOT is a safe low-cost treatment modality that can be beneficial in some ocular pathologies. It can maintain oxygenation of the retina through the choroidal blood supply, decrease oedema and preserve compromised tissue adjacent to the ischaemic area.

Intervention of artemisinin in macular edema associated with retinal vein occlusion: A protocol for a systematic review and meta-analysis.

BACKGROUND: Artemisinin was discovered to be highly effective antimalarial drugs shortly after the isolation of the parent artemisinin in 1971 in China. It is derived from extracts of sweet wormwood (Artemisia annua) and are well established for the treatment of malaria. Recently, artemisinin has been shown that it might have therapeutic value for several other diseases. The purpose of this review is to assess the efficacy of artemisinin as a treatment for macular edema associated with retinal vein occlusion. METHODS AND ANALYSIS: A systematic literature search will be performed in all available databases to quantitatively review eligible studies and identify all relevant data. We will include randomized controlled trials assessing efficacy of artemisinin as a treatment for macular edema associated with retinal vein occlusion. The methodological qualities, including the risk of bias, will be evaluated using the Cochrane risk of bias assessment tool, while confidence in the cumulative evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. ETHICS AND DISSEMINATION: Ethical approval is not required, as this study is based on the review of published research. This review will be published in a peer-reviewed journal and disseminated both electronically and in print. PROSPERO REGISTRATION NUMBER: The protocol for this systematic review has been registered on PROSPERO under the number CRD42019131408.

[Retinal vein occlusion in a young patient: Where does intraocular hypertension come from?] / Occlusion de la veine centrale de la rétine chez un sujet jeune : chercher d'où vient l'augmentation de pression intraoculaire.

INTRODUCTION: Retinal vein occlusion presents as an acute, painless and unilateral sight loss. We report two cases of retinal vein occlusion (CRVO) in which the etiology was unusual. CASE REPORTS: Case 1. A 54-year-old woman without any significant past medical history presented with an acute loss of vision. Medical history taking revealed the practice of yoga with headstand posture like "Sirsana". Case 2. A 35-year-old woman presented with an acute loss of vision related to a retinal vein occlusion. The investigation found prolonged and repeated vomiting the days before the retinal vein occlusion. CONCLUSION: Cardiovascular assessment is recommended in the investigation of CRVO. Furthermore, especially in young patients, a situation causing an increase of intraocular pressure as the practice of yoga with taking reverse "head down" body positions or even repeated vomiting efforts may be the cause of slower circulation of blood flow in the retinal veins.

Hyperbaric oxygen for the treatment of the rare combination of central retinal vein occlusion and cilioretinal artery occlusion.

A 43-year-old male presented with sudden onset of painless, blurred vision in his left eye. Dilated fundoscopic examination showed signs consistent with the diagnosis of a combination of central retinal vein occlusion (CRVO) and cilioretinal artery occlusion (CLRAO). He received daily 2-h sessions of hyperbaric oxygen treatment (HBOT), 253 kPa for 14 days. At the end of the HBOT course, the patient's left visual acuity had improved from 20/200 to 20/20. Dilated fundoscopic examination showed that the intra-retinal haemorrhages in the entire retina and the retinal whitening along the course of the CLRA seen at presentation had completely resolved. The combination of CLRAO and CRVO comprises a discrete clinical entity. Even though there are many hypotheses concerning this condition, it is most likely the result of elevated intraluminal pressure in the retinal capillaries due to CRVO that exceeds the pressure in the CLRA. HBOT may be an effective treatment for CRVO-associated CLRAO.

Ocular morbidity from sickle cell disease in a Nigerian cohort.

UNLABELLED: Sickle cell Retinopathy is increasingly being recognised as a cause of significant ocular morbidity and blindness in Africa south of the Sahara. This study looked for retinopathy in a cohort of 90 Nigerians with Sickle Cell Disease (SCD). METHOD: The cohort consisted of black Nigerians from the Hausa-Fulani, Ibo and Yoruba, as well as other minority ethnic groups resident in the Federal Capital Territory aged between 5-36 yr. 88 patients were SS and only 2 SC. RESULTS: SCD related posterior lesions were seen in 22 patients (24%). Of these, 19 cases (21%) had Non Proliferative Sickle Retinopathy (NPSR) while 5 (5.6%) had Proliferative Sickle Retinopathy (PSR) in various stages of development, and 2 had both PSR and NPSR. Patients with PSR are at risk of blindness from vitreous haemorrhage and tractional retinal detachment. A 14-year-old male with arterio-venous anastomosis was the youngest with PSR while the most advanced PSR lesion was a sea fan in a 25-year-old female. CONCLUSIONS: standard treatment consisting of photocoagulation and/or vitrectomy is not available in many eye centres in sub-Saharan Africa and steps need to be taken to improve this situation. The role of anti-sickling remedies, if any, is the subject of ongoing investigations. Our findings with NIPRISAN, a phytomedicinal preparation currently undergoing trials, will be reported subsequently.

Cup-to-disc ratio, intraocular pressure, and primary open-angle glaucoma in retinal venous occlusion.

PURPOSE: To investigate the association of cup-to-disc ratio (CDR), intraocular pressure (IOP), and primary open-angle glaucoma (POAG) with the site of retinal venous occlusion (RVO) and optic nerve head swelling (ONHS). DESIGN: Prospective observational case series. PARTICIPANTS: Four hundred fifty consecutive cases from a single tertiary referral center. METHODS: Fundus photography of the retinopathy, 30 degrees stereo photography of the optic disc, and Goldmann applanation tonometry were the main parameters studied. The diagnosis of POAG was obtained from the referring ophthalmologist. MAIN OUTCOME MEASURES: The main outcome measures were the CDR, measured vertically through the center of the optic disc, and the site of RVO, identified as an arteriovenous (AV) crossing, optic cup, or optic nerve. Retinal venous occlusions occurring within the optic nerve were subdivided on the basis of the presence or absence of ONHS. RESULTS: There were poor correlations between CDR and IOP (r = 0.18; P = 0.000209) and CDR and age (r = 0.21; P = 0.000012). There were 197 AV crossing-sited RVOs (AV-RVOs) (43.8%) and 46 optic cup (OC)-sited RVOs (10.2%). The remainder occurred within the optic nerve; the ONHS group had 80 cases (17.8%) and the nonoptic nerve head swelling group (NONHS) had 127 cases (28.2%). The OC-RVO group tended to be the oldest of the four groups, whereas the ONHS group was the youngest (P < 0.000001). The mean CDR was significantly higher in the OC-RVO (0.65) compared with the rest of the groups (0.45-0.48). The proportion of cases with CDR > or = 0.7 was significantly higher in the OC-RVO group (39.1%) compared with the rest of the groups (0-6.3%). There was a trend (P = 0.000012) for IOP in the OC-RVO group (19.0 mmHg) and NONHS group (17.6 mmHg); the proportion of cases with IOP more than 21 mmHg was also higher in these cases (P = 0.00033). The prevalence of POAG was highest (P < 0.000001) in the OC-RVO group (39.1%) followed by the NONHS group (18.1%), ONHS group (8.8%), and AV-RVO (4.1%) group, respectively. CONCLUSIONS: Optic cup and optic nerve-sited RVO without ONHS are associated with raised IOP and may share a common management strategy aimed at controlling ocular pressure. Glaucomatous optic disc cupping, in contrast, seems to be important in the OC-sited RVO group only. Intraocular pressure, POAG, and glaucomatous optic disc cupping do not significantly seem to contribute to the development of RVO at an AV crossing or when the occlusion occurs within the optic nerve in association with ONHS.

Adjunctive hyperbaric oxygenation in macular edema of vascular origin.

Macular edema (ME) is a primary reason for permanent decreases of visual acuity (VA) in diabetic retinopathy and retinal vein occlusions. The standard treatment (photocoagulation, rheological treatment) provide only a limited success. We have therefore studied the additional use of hyperbaric oxygenation (HBO2) in patients with persistent ME. Five patients (1 female, 4 male; 7 eyes) were treated by adjunctive HBO2. The average age of the patients was 60.6 (38.9-76.8) yr. The VA was measured with Early Treatment Diabetic Retinopathy Study charts before and after HBO2 with a monthly follow up. Fluorescein angiography was performed before and after HBO2 with a follow up every 3 mo. Each patient received 10-30 HBO2 treatments (median 15). The follow-up period was 15 mo. for every patient. The mean increase in VA was 3.5 (2-4) lines after HBO2. Retinal photocoagulation was performed in six eyes. Diabetic macular edemas showed no morphologic change, while ME originating from retinal vein occlusions (CME) regressed. The VA in our patients with ME of vascular origin seemed to improve with HBO2. Photocoagulation was necessary in most cases. Visual function correlated with the angiographic presentation only for CME.

Hyperbaric oxygen treatment for macular edema in retinal vein occlusion: relation to severity of retinal leakage.

Twelve subjects with macular edema in retinal vein occlusion received hyperbaric oxygen treatment. Median visual acuity improved from 20/100 to 20/25 (p = 0.002). Clinically significant improvement (2 lines or more) was achieved in 10 cases (83%). Evaluation of the inward permeability coefficient of the blood-retinal barrier using vitreous fluorophotometry showed no significant alteration in the permeability. Studies of larger groups of vein occlusion patients are required to better understand and characterize the visual changes after the oxygen treatment. Moreover, further follow-up is required before conclusions can be reached about the long-term effect of this treatment.

[Hyperbaric oxygen treatment for macular edema after retinal vein occlusion--fluorescein angiographic findings and visual prognosis].

It has been reported that hyperbaric oxygen treatment improves visual function in patients with chronic macular edema associated with retinal vein occlusion. This study was designed to investigate relationship between visual prognosis and characteristics of macular edema. From fluorescein angiography performed prior to the therapy, areas of capillary closure and fluorescein leakages were quantitatively evaluated within 1 disc diameter from the fovea. In 27 eyes for which good angiograms were available, 19 eyes were classified as having mild ischemia 1 (area of capillary closure < 25%) and 8 eyes were classified as having severe ischemia (closure area < or = 25%). Of the 27 eyes, 14 showed visual improvement after the therapy. While only one eyes (13%) had visual improvement in the severe ischemic group, 11 eyes (58%) showed visual improvement in the mild ischemic group. The degree of fluorescein leakage before the therapy had no effect on visual outcome. The degree of macular ischemia was found to be a more significant factor influencing visual prognosis after the treatment than the degree of macular edema.

[The long term results of hyperbaric oxygen treatment for macular edema with retinal vein occlusion].

We retrospectively evaluated the effect of hyperbaric oxygen treatment on seventy-nine eyes of seventy cases with cystoid macular edema secondary to retinal vein occlusion. Twenty-three eyes had central retinal vein occlusion (CRVO), and fifty-six eyes had branch retinal vein occlusion (BRVO). Visual acuity improved by two lines or more in 40 eyes (17%) with BRVO, and in 10 eyes (44%) with CRVO immediately after the therapy. Six months or more after treatment, visual improvement persisted in 14 of 30 BRVO eyes (47%), and in only one of 11 CRVO eyes (9%). CRVO showed poor prognosis in the long term compared with BRVO. We speculated that activation of aerobic metabolism might be more important than reduction of vascular hyperpermeability as the therapeutic effect of hyperbaric oxygen, and that hyperbaric oxygen might mainly affect the retinal cells in the marginal zone of the ischemic retina in the macular region.

[Hyperbaric oxygen treatment for cystoid macular edema secondary to retinal vein occlusion].

A prospective study was made to estimate the effect of hyperbaric oxygen (HBO) on 14 eyes of cystoid macular edema (CME) secondary to retinal vein occlusion. The visual acuity was improved 2-6 lines (average 3.6 lines) after the treatment, while the control group of 12 cases showed little improvement. The therapeutic effect was stable, however, fluorescein angiography showed no leakage reduction from the perifoveal capillaries, or visual function was enhanced prior to eventual improvement in the fundus. Since HBO therapy has few contraindications nor side effects, it is an effective modality in the treatment of CME.

Cases from the aerospace medicine residents' teaching file. Case #38. A navigator with nonischemic central retinal vein occlusion progressing to ischemic central retinal vein occlusion.

A case report of a young USAF navigator with nonischemic central retinal vein occlusion progressing to ischemic central retinal vein occlusion is presented. This young man was treated with hyperbaric oxygen therapy early in the course of his disease with complete resolution of his condition. Two years later his vision remained 20/17. This is the first known case of central retinal vein occlusion being treated with hyperbaric oxygen.

TCM treatment of retinal vein occlusion in 216 cases.

Traditional Chinese Medicine was adopted in the treatment of 216 cases (219 eyes) of retinal vein occlusion. The period of treatment averaged 3 months; the total rate of efficacy was 80.4%. During an average follow-up of 3 years, 84.1% of the patients maintained a stable or slightly improved vision. The authors believed that treatment of the disease with TCM promoted the absorption of blood and formation of collateral circulation, and suppressed neovascularization, thus preventing repeated bleeding that would lead to serious complications.

Asymptomatic miniocclusions of the optic disc veins in glaucoma.

This study was done to document photographically the evolution of asymptomatic venous stasis changes of the optic disc in glaucoma, estimate their prevalence, and report the clinical findings. Asymptomatic venous miniocclusions were found to develop and occasionally disappear in the optic disc stereophotographs of nine patients with early to moderate glaucoma or ocular hypertension during a mean follow-up of 9 years. In the 1664 photographs examined, a prevalence of 3% was found. None of the patients had a history of retinal vein occlusion or venous stasis retinopathy. Progression of glaucomatous optic disc changes occurred in eight of nine patients. It is possible that asymptomatic miniocclusions are secondary to the changes at the bottom of the optic cup. The miniocclusions, which are easily missed if not looked for, may be an early indicator of glaucomatous progression of the optic disc cupping.