Retinal Vein Occlusion

To describe the prevalence of retinal vein occlusion (RVO) and its risk factors in a multi-ethnic Asian population. This population-based study of 10,033 participants (75.7% response rate) included Chinese, Indian and Malay persons aged 40 years and older. A comprehensive ophthalmic examination, standardized interviews and laboratory blood tests were performed. Digital fundus photographs were assessed for presence of RVO following the definitions used in the Blue Mountains Eye Study. Regression analysis models were constructed to study the relationship between ocular and systemic factors and RVO. Age-specific prevalence rates of RVO were applied to project the number of people affected in Asia from 2013 to 2040. The overall crude prevalence of RVO was 0.72% (n = 71; 95% confidence interval, CI, 0.54-0.87%). The crude prevalence of RVO was similar in Chinese, Indian and Malay participants (p = 0.865). In multivariable regression models, significant risk factors of RVO included increa...

We investigated prospectively in 128 patients (140 eyes) the role of six routine clinical tests in the differentiation of ischemic central retinal vein occlusion (CRVO) from non-ischemic CRVO during its early acute phase. There were fourfunctional tests [visual acuity, visual fields, relative afferent pupillary defect (RAPID), electroretinography (ERG)] and twomorphologic tests (ophthalmoscopy and fluorescein fundus angiography). We found that none of the six tests had 100% sensitivity and specificity in such a differentiation during the early, acute phase, so that no one test can be considered a “gold standard”; however, combined information from all six is almost always reliable. Overall, the four functional tests proved far superior to the two morphologic tests in differentiating ischemic from non-ischemic CRVO: RAPID was most reliable in uniocular CRVO (with a normal fellow eye), followed closely by ERG in all cases; combined information from RAPID and ERG differentiated 97% of cases; perimetry was the next most reliable, followed by visual acuity. The two morphologic tests performed worst; fluorescein angiography provided either no information at all on retinal capillary nonperfusion (in at least one-third of the eyes during the early, acute phase) because of multiple limitations, or sometimes provided misleading information. Ophthalmoscopic appearance is the least reliable, most misleading parameter.

This article provides a review of various conditions causing sudden, painless vision loss. The conditions of amaurosis fugax, central retinal artery occlusion (CRAO), central retinal vein occlusion (CRVO), vitreous hemorrhage, ischemic optic neuropathies (ION), posterior cerebrovascular accidents, and retinal detachment (RD) are discussed. The history, physical, pathophysiology, and treatment of each disease state are discussed along with possible preventative measures for each. An emphasis is made on early ophthalmologic involvement for potential vision restoration and the importance of a thorough history and physical for all patients with ocular complaints.

Purpose To assess ocular hemodynamic response to intravitreal triamcinolone in patients with macular edema due to diabetes or retinal vein occlusion. Methods Forty-three patients that were injected by intravitreal triamcinolone acetonide (0.1 cc 4 mg) for unilateral macular edema due to diabetes mellitus (n = 17) and occlusion of retinal vein (n = 26) underwent ocular hemodynamic evaluation by color Doppler imaging (CDI) before and one, two and three months after injection. Non-injected fellow eyes as well as 16 healthy volunteers were also evaluated. Results In patients with diabetic macular edema, there was no hemodynamic difference between eyes to be injected and non-injected at baseline (P > 0.23). Compared to controls, a significant difference existed in the ophthalmic artery resistant index (P = 0.001) and end-diastolic velocity (P < 0.001) in diabetics. At one month, compared to fellow eyes, change in end diastolic velocity from baseline in treated eyes was significantly decreased in posterior ciliary arteries (0.68 ± 0.34 cm/s [mean ± SEM] vs. −1.04 ± 0.81 cm/s, P = 0.012). Throughout the study period, no significant alteration from baseline in the resistant index of any artery was noted in treated diabetic eyes (P > 0.05). In eyes with retinal vein occlusion, baseline CDI evaluation demonstrated reduced posterior ciliary arteries systolic flow velocity compared to fellow and control eyes (13.24 ± 1.04 cm/s, 16.37 ± 0.76 cm/s and 14.33 ± 1.41 cm/s, respectively, P = 0.007). Increased peak systolic velocity in the posterior ciliary arteries at one week (P = 0.02), one month (P = 0.005) and two months (P  = 0.04), and increase in central retinal artery resistant index at one month was noted (P = 0.05). Conclusion Intravitreal triamcinolone temporarily changed central retinal artery blood flow and posterior ciliary arteries' peak systolic blood velocity in eyes with retinal vein occlusion whilst no response of blood flow to triamcinolone injection but only transiently altered end diastolic blood velocity in posterior ciliary arteries was observed in diabetic eyes.

Purpose: To evaluate the effectiveness of Razumab® (world’s first biosimilar ranibizumab; Intas Pharmaceuticals Ltd., India) in Indian patients with wet age-related macular degeneration (wet AMD), diabetic macular edema (DME) and retinal vein occlusion (RVO).
Methods: RE-ENACT, a retrospective, multicenter study, analyzed pooled data of patients with wet AMD, DME, and RVO. Patients who had  received ≥3 injections of Razumab® between January and August 2016, were included. Endpoints were: improvement in best corrected visual acuity (BCVA, measured by logMAR/Snellen’s chart), decrease in central macular thickness (CMT, measured by Spectral Domain Optical oherence Tomography), and proportion of patients with intraretinal fluid (IRF) and subretinal fluid (SRF) at Weeks 4, 8 and 12.
Results: Of 561 patients included, 348 (62.04%) were men. Mean ± SE BCVA improved from baseline (0.75 ± 0.01) to Week 4 (0.72 ± 0.01, p = 0.0318), attained significance at Week 8 (0.59 ± 0.01, p < 0.0001), which was maintained at Week 12 (0.49 ± 0.01, p < 0.0001). Mean ± SE CMT significantly (p < 0.0001) decreased from baseline (418.47 ± 4.78μm) to
Weeks 4 (407.35 ± 4.65μm), 8 (342.10 ± 3.66μm), and 12 (301.17 ±  2.82μm). Proportion of patients with IRF and SRF significantly (p < 0.0001) decreased from baseline to Weeks 4, 8 and 12 (67.02% vs. 48.48%, 42.60%, and 34.22%, respectively for IRF; and 72.37% vs. 48.48%, 37.97%, 31.37%, respectively for SRF). No new safety concerns with biosimilar ranibizumab were observed.
Conclusions: Razumab® is effective in reducing macular thickness and improving visual acuity in patients with wet agerelated macular degeneration, diabetic macular edema, and retinal vein occlusion in routine clinical practice. Razumab® demonstrated considerable effectiveness with no new safety concerns.

The use of intravitreal corticosteroids in the management of macular oedema has recently gained widespread acceptance. New long-acting steroid preparations and methods of delivery have facilitated the use of these new modalities. This review describes the various types of macular oedema for which this therapeutic option is used and the results.

Purpose: Impaired fibrinolytic function is a common finding in patients with thrombotic disease. The present study was initiated to evaluate the fibrinolytic response to a venous occlusion test (VOT) in patients with retinal vein occlusion. Methods: Euglobulin clot lysis time (ECLT), tissue plasminogen activator (t-PA) activity, and plasminogen activator inhibitor (PAI) activity were measured before and after VOT in a group of 26 consecutive patients presenting with retinal vein occlusion and in 15 healthy age- and sex-matched controls. Results: Before VOT (baseline), a higher proportion of patients (54%) had an ECLT of more than 5 h compared with controls (6.7%)(p = 0.0027) indicating decreased overall fibrinolytic activity. Patients had non-significantly lower t-PA and higher PAI activities compared with controls. After VOT, a higher proportion of patients (34.6%) had an ECLT of more than 5 h compared with controls (6.7%) (p = 0.05). Patients had significantly lower t-PA activity (p = 0.0232) and significantly higher PAI activity (p = 0.0292).Subgroup analysis revealed that patients with an ECLT of more than 5 h had significantly higher levels of PAI activity at baseline (p =0.0326) and after VOT (p = 0.0184) compared with patients with an ECLT of less than 5 hours. However, t-PA activity was significantly higher(p = 0.0153) at baseline, and non-significantly higher after VOT in patients with an ECLT of more than 5 h when compared with patients with an ECLT of less than 5 hours. Conclusions: These findings suggest that impaired fibrinolysis due to increased PAI activity may play a role in the pathogenesis of retinal vein occlusion.

Background and objectiveThe aim of the present study is to define the risk factors associated with different retinal occlusive diseases, such as retinal venous thrombosis, arterial emboli and ischaemic anterior optic neuritis. Patients with any of these entities entered the study.

To better characterize a novel spectral-domain optical coherence tomography (OCT) presentation, termed paracentral acute middle maculopathy, to describe this finding in patients with nonischemic central retinal vein occlusion (CRVO), and to support a proposed pathogenesis of intermediate and deep retinal capillary ischemia. Retrospective observational case series. Clinical histories, high-resolution digital color imaging, red-free photography, fluorescein angiography, near-infrared reflectance, and spectral-domain OCT images of 484 patients with acute CRVO from 2 centers were evaluated for the presence of coexisting paracentral acute middle maculopathy. Of 484 patients diagnosed with CRVO, 25 (5.2%) demonstrated evidence of concurrent paracentral acute middle maculopathy. Patients averaged 51 years of age and presented with complaints of paracentral scotomas. All patients demonstrated hyper-reflective plaquelike lesions at the level of the inner nuclear layer by spectral-domain OCT and showed corresponding dark-gray lesions on near-infrared reflectance and perivenular deep retinal whitening on color fundus photography. There was no fluorescein angiographic correlate to these lesions. On follow-up spectral-domain OCT imaging, the lesions had resolved into areas of inner nuclear layer atrophy with persistence of scotomas. Paracentral acute middle maculopathy refers to characteristic hyper-reflective spectral-domain OCT lesions involving the middle layers of the retina at the level of the inner nuclear layer that may develop in response to ischemia of the intermediate and deep capillary plexuses. This series is the largest to describe this spectral-domain OCT finding to date, and it is the first to associate it with nonischemic CRVO.