69 results on '"Central retinal vein occlusion (CRVO)"'
Search Results
2. Central retinal vein occlusion post ChAdOx1 nCoV-19 vaccination – can it be explained by the two-hit hypothesis?
- Author
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Shweta Parakh, Shrey Maheshwari, Shrutanjoy Das, Hans Vaish, Gaurav Luthra, Rupesh Agrawal, Vishali Gupta, and Saurabh Luthra
- Subjects
ChAdOx1 nCoV-19 vaccine ,Central retinal vein occlusion (CRVO) ,Vaccine-induced immune thrombotic thrombocytopenia (VITT) ,Anti-PF4 antibodies ,SARS-CoV-2 ,Two-hit hypothesis ,Ophthalmology ,RE1-994 - Abstract
Abstract Purpose To report a case of central retinal vein occlusion (CRVO) seven days following the first dose of ChAdOx1 nCoV-19 vaccine and propose a hypothesis for the possible underlying pathogenesis. Observation A 31-year-old male presented with CRVO with cystoid macular edema, one week after receiving his first ChAdOx1 nCoV-19 vaccine dose. Apart from mild hyperhomocysteinemia, no major thrombophilic or systemic risk factors were found. Anti-platelet factor 4 antibodies, specific for vaccine-induced immune thrombotic thrombocytopenia, were also negative. However, he tested strongly positive (> 250 U/mL) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) IgG spike antibodies, 2 weeks post the first dose – suggestive of a prior subclinical infection. Conclusion COVID-19 is known to be associated with an altered host one-carbon metabolism resulting in hyperhomocysteinemia. We hypothesize that a prior subclinical infection with COVID-19, the first hit, may have led to hyperhomocysteinemia in our patient and vaccination must have been the second hit that triggered the thrombotic event. Further studies, including correlation of thrombotic complications with IgG antibody titres post-vaccination, are essential in order to better understand the pathogenesis of such events.
- Published
- 2022
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- View/download PDF
3. Clinical utility of ultra-widefield fluorescein angiography and optical coherence tomography angiography for retinal vein occlusions
- Author
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Tien-En Tan, Farah Ibrahim, Priya R. Chandrasekaran, and Kelvin Yi Chong Teo
- Subjects
branch retinal vein occlusion (BRVO) ,central retinal vein occlusion (CRVO) ,ultra-widefield (UWF) ,optical coherence tomography angiography (OCTA) ,fluorescein angiography (FA) ,retinal imaging ,Medicine (General) ,R5-920 - Abstract
Retinal vein occlusions (RVOs) are the second most common retinal vascular disease after diabetic retinopathy, and are a significant cause of visual impairment, especially in the elderly population. RVOs result in visual loss due to macular ischemia, cystoid macular edema (CME), and complications related to neovascularization. Vascular assessment in RVOs traditionally relies on standard fluorescein angiography (FA) for assessment of macular and retinal ischemia, which aids in prognostication and guides intervention. Standard FA has significant limitations—it is time-consuming, requires invasive dye administration, allows for limited assessment of the peripheral retina, and is usually evaluated semi-qualitatively, by ophthalmologists with tertiary expertise. More recently, the introduction of ultra-widefield FA (UWF FA) and optical coherence tomography angiography (OCTA) into clinical practice has changed the tools available for vascular evaluation in RVOs. UWF FA allows for evaluation of peripheral retinal perfusion, and OCTA is non-invasive, rapidly-acquired, and provides more information on capillary perfusion. Both modalities can be used to provide more quantitative parameters related to retinal perfusion. In this article, we review the clinical utility and impact of UWF FA and OCTA in the evaluation and management of patients with RVOs.
- Published
- 2023
- Full Text
- View/download PDF
4. Central retinal vein occlusion post ChAdOx1 nCoV-19 vaccination – can it be explained by the two-hit hypothesis?
- Author
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Parakh, Shweta, Maheshwari, Shrey, Das, Shrutanjoy, Vaish, Hans, Luthra, Gaurav, Agrawal, Rupesh, Gupta, Vishali, and Luthra, Saurabh
- Subjects
- *
SARS-CoV-2 , *RETINAL vein occlusion , *VACCINATION , *IDIOPATHIC thrombocytopenic purpura - Abstract
Purpose: To report a case of central retinal vein occlusion (CRVO) seven days following the first dose of ChAdOx1 nCoV-19 vaccine and propose a hypothesis for the possible underlying pathogenesis. Observation: A 31-year-old male presented with CRVO with cystoid macular edema, one week after receiving his first ChAdOx1 nCoV-19 vaccine dose. Apart from mild hyperhomocysteinemia, no major thrombophilic or systemic risk factors were found. Anti-platelet factor 4 antibodies, specific for vaccine-induced immune thrombotic thrombocytopenia, were also negative. However, he tested strongly positive (> 250 U/mL) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) IgG spike antibodies, 2 weeks post the first dose – suggestive of a prior subclinical infection. Conclusion: COVID-19 is known to be associated with an altered host one-carbon metabolism resulting in hyperhomocysteinemia. We hypothesize that a prior subclinical infection with COVID-19, the first hit, may have led to hyperhomocysteinemia in our patient and vaccination must have been the second hit that triggered the thrombotic event. Further studies, including correlation of thrombotic complications with IgG antibody titres post-vaccination, are essential in order to better understand the pathogenesis of such events. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
5. Factors Affecting Compliance and Visual Outcomes in Patients Receiving Intravitreal Bevacizumab Injections.
- Author
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Radhakrishnan O, Agrawal T, Giri N, Gandhi S, and Goyal K
- Abstract
Background Vascular endothelial growth factor (VEGF) is a powerful mitogen for endothelial cells that promotes migration, proliferation, and tube formation necessary for the angiogenic development of new blood vessels. When VEGF increases significantly, it causes pathological angiogenesis and increased vascular permeability in eye conditions such as diabetic retinopathy (DR), age-related macular degeneration (AMD), and retinal vein occlusion (RVO). These disorders have become important global sources of morbidity and have a substantial financial impact not only on the medical community but also on the patients. Therefore, this study aims to determine the success rates of intravitreal bevacizumab therapy and the visual outcomes which may be increased by determining the factors affecting patient compliance and raising awareness about DR, neovascular AMD, and RVO among patients and studying the factors responsible for non-compliance to treatment. Methodology This experimental pre-post study was conducted in the ophthalmology department at a tertiary care hospital and research center in western Maharashtra from September 2022 to June 2024. A total of 150 eyes of 150 patients who were diagnosed cases of DR, neovascular AMD, and non-ischemic RVO were included in the study. Written informed consent was obtained from each patient. Data were entered in Microsoft Excel (Microsoft Corp., Redmond, WA, USA) and statistical analysis was done using SPSS 27.0 software (IBM Corp., Armonk, NY, USA). The chi-square test was employed to check the association between categorical variables. Pearson's correlation test was used, and p-values <0.05 were considered significant. Results The compliance rate in our study was 79.3% (113 individuals). In our study, 58% (87 individuals) were male while 42% (63 individuals) were females. Most patients were from urban areas 74.7% (112 individuals). Among the study participants, DR patients constituted 48.6% (73 individuals), while neovascular AMD and RVO were seen in 32% (48 individuals) and 19.4% (29 individuals), with 62% (93 individuals) being diabetic and 64.7% (97 individuals) being hypertensive. In our study, 92% (138 individuals) were willing to take treatment, with 88.7% (133 individuals) worried about their visual outcomes and 66% (99 individuals) afraid of getting injected. Appointments posed a financial burden to 30.7% (46 individuals) of patients, with 55.3% (83 individuals) having transportation issues. Overall, 18.7% (28 individuals) of patients had missed appointments between 14 and 90 days while 30.7% (46 individuals) had missed their appointments by 90 and 365 days. Younger patients with a shorter duration of diabetes had higher compliance rates. Post-injection, there was an overall significant improvement in vision as well as a reduction in the central subfield macular thickness, volume cube, and thickness average cube. Conclusions In the present study, four-fifths of the patients were compliant with treatment, and visual improvement was significant. In addition, there was a significant reduction in the macular thickness after the treatment. One of the factors for non-compliance included in our study was the need for follow-up. Younger patients and those with a shorter duration of diabetes had significantly higher compliance. We recommend further studies should be conducted to compare the effectiveness with the control group in randomized control trials., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethics Sub-Committee, Dr. D. Y. Patil Medical College, Hospital and Research Centre issued approval IESC/PGS/2022/109. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Radhakrishnan et al.)
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- 2024
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6. Case Report: A Case of Cystoid Macular Edema in Retinitis Pigmentosa With Central Retinal Vein Occlusion
- Author
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Da-Hu Wang, Cao Gu, and Yuan-Zhi Yuan
- Subjects
cystoid macular edema ,retinitis pigmentosa (RP) ,central retinal vein occlusion (CRVO) ,anti-VEGF (vascular endothelial growth factor) ,case report ,Medicine (General) ,R5-920 - Abstract
SignificanceCystoid macular edema (CME) is a common complication of retinitis pigmentosa (RP). However, CME in RP with central retinal vein occlusion (CRVO) is rare. Prompt administration of anti-vascular endothelial growth factor (anti-VEGF) medication can achieve a satisfactory prognosis.PurposeThis report describes a case of using anti-VEGF medication to treat CME secondary to RP with impending or mild CRVO.Case ReportA 26-year-old female presented for blurred vision in both eyes. Best-corrected visual acuity (BCVA) was 20/50 in the right eye and finger-counting in the left eye. According to ophthalmic examinations, CME secondary to RP in the right eye and CME secondary to RP with impending or mild CRVO in her left eye can be diagnosed. Central macular thickness (CMT) was 554 μ m in the right eye and 831 μm in the left eye. Only the left eye was treated with a single intravitreal injection of anti-VEGF medication. One month later, BCVA increased to 20/200 and CMT decreased to 162 μm in the left eye. Interestingly, BCVA in the right eye also had an improvement (20/40) and intraretinal fluid decreased significantly. However, 3 months after injection, these improvements of both eyes were not maintained.ConclusionThis is the second case of RP with CRVO. Intravitreal injection of anti-VEGF medication for addressing CME secondary to RP with CRVO is an effective treatment, but it needs to be reinjected.
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- 2022
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7. A classic case of ischemic central retinal vein occlusion with macular edema
- Author
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Mani Kruthika Mantha, Tarun Kumar Suvvari, Lakshmoji Naidu Kotipalli, and Tejaswi Kota
- Subjects
bevacizumab ,central retinal vein occlusion (crvo) ,diabetes ,fluorescein angiogram ,macular edema ,unilateral ischemic crvo ,Medicine - Abstract
Central retinal vein occlusion (CRVO) is a significant cause of marked or total loss of vision in the middle-aged and elderly population. The patient was a 54-year-old man with a history of uncontrolled diabetes and was given seven intravitreal bevacizumab (Avastin) injections as treatment. The patient was advised to follow-up during the next 6 months, including gonioscopy and undilated examination of the iris to look for the iris/disc neovascularization. We presented a classic case of unilateral ischemic CRVO with macular edema, in whom diabetes is the leading risk factor. Close follow-up and diabetes control are advisable to prevent a similar scenario.
- Published
- 2021
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8. Post-Coronavirus Disease 2019 (COVID-19) Syndrome Associated with Central Retinal Vein Occlusion: A Case Report.
- Author
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Quigley, Clare, Butler, Triona, Byrne, Luke, Moore, David, and Doyle, Aoife
- Subjects
- *
CHEST pain , *RETINAL vein occlusion , *SARS-CoV-2 , *COVID-19 , *POST-acute COVID-19 syndrome - Abstract
Coronavirus Disease 2019 (COVID-19) pneumonia may predispose to thromboembolic disease, including after the acute phase. We report on a unique case of central retinal vein occlusion (CRVO) occurring eight months after diagnosis of Coronavirus Disease 2019 (COVID-19) pneumonia in a likely case of post-COVID-19 syndrome. A 42-year-old man developed blurred vision in his right eye eight months after symptoms of pneumonia. He had no underlying medical conditions, but experienced exertional chest pain since diagnosis of COVID-19 was confirmed by detection of SARS-CoV-2 on nasopharyngeal swab and was also seeing cardiology for management of myocarditis. His best-corrected visual acuity on snellen chart testing was reduced to 6/18 in the affected right eye, and dilated fundal examination revealed a non-ischaemic CRVO. The thromboembolic complications of COVID-19 may extend to CRVO, which in this case presented months after onset of symptoms of pneumonia, in association with myocarditis. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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9. An Unusual Ocular Manifestation of Disseminated Tuberculosis: Combined Retinal Vascular Occlusion Inducing Acute Loss of Vision.
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Kumar Behera P, Padarabinda Tripathy K, Pathi D, Tarun Venkat Mahesh S, and Das MK
- Abstract
Disseminated tuberculosis (TB) is a life-threatening disease caused by the hematogenous spread of Mycobacterium tuberculosis. Acute loss of vision as a symptom of disseminated TB is uncommon, as per the literature. Uveitis is the most common ocular manifestation of TB, and tubercular retinal arterial or venous occlusion, with or without ocular signs, has been rarely described before. We discuss the case of a 34-year-old truck driver who presented with fever, cough, and sudden painless loss of vision in the right eye. Examination revealed optic neuropathy, as well as central retinal artery and venous occlusion. Investigations showed bilateral miliary shadows on chest X-ray and multiple ring-enhancing brain lesions on MRI brain, consistent with disseminated TB. Anti-tubercular therapy led to clinical improvement. We report this case to highlight the rarity of this condition., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kumar Behera et al.)
- Published
- 2024
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10. Acute Visual Field Impairment
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Huang, Bo, Li, Suxia, and Yan, Hua, Series editor
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- 2018
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11. Retinal venous pressure is decreased after anti-VEGF therapy in patients with retinal vein occlusion–related macular edema.
- Author
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Kida, Teruyo, Flammer, Josef, Konieczka, Katarzyna, and Ikeda, Tsunehiko
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- *
MACULAR edema , *VENOUS pressure , *RETINAL vein , *RETINAL vein occlusion , *INTRAVITREAL injections - Abstract
Purpose: The pathomechanism leading to retinal vein occlusion (RVO) is unclear. Mechanical compression, thrombosis, and functional contractions of veins are discussed as the reasons for the increased resistance of venous outflow. We evaluated changes in the retinal venous pressure (RVP) following intravitreal injection of anti-vascular endothelial growth factor (VEGF) agent to determine the effect on RVO-related macular edema. Methods: Twenty-six patients with RVO-related macular edema (16 branch RVOs [BRVOs] and 10 central RVOs [CRVOs], age 72.5 ± 8.8 years) who visited our hospital were included in this prospective study. Visual acuity (VA), intraocular pressure (IOP), central retinal thickness (CRT) determined by macular optical coherence tomography, and RVP measured using an ophthalmodynamometer were obtained before intravitreal injection of ranibizumab (IVR) and 1 month later. Results: Comparison of the BRVOs and CRVOs showed that VA was significantly improved by a single injection in BRVOs (P < 0.0001; P = 0.1087 for CRVOs), but CRT and RVP were significantly decreased without significant difference in IOP after the treatment in both groups (P < 0.0001). Conclusion: The anti-VEGF treatment resulted in a significant decrease in the RVP, but the RVP remained significantly higher than the IOP. An increased RVP plays a decisive role in the formation of macula edema, and reducing it is desirable. [ABSTRACT FROM AUTHOR]
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- 2021
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12. One-year outcomes of ziv-aflibercept for macular edema in central retinal vein occlusion
- Author
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Mohab Eldeeb, Errol W. Chan, Chintan J. Dedhia, Ahmad Mansour, and Jay Chhablani
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Ziv-aflibercept ,Anti-vascular endothelial factor (anti-VEGF) ,Macular edema ,Central retinal vein occlusion (CRVO) ,Optical coherence tomography (OCT) ,Ophthalmology ,RE1-994 - Abstract
Purpose: To report the 12-month efficacy and safety outcomes of intravitreal ziv-aflibercept in macular edema secondary to central retinal vein occlusion (CRVO). Methods: Interventional case series documenting 12-month outcomes of intravitreal ziv-aflibercept (1.25 mg in 0.05 mL) in 6 patients with treatment-naive macular edema secondary to CRVO. All patients had comprehensive ophthalmic examination, spectral domain optical coherence tomography at baseline and all follow-up visits, and fluorescein. Retreatment decisions were based on recurrence or persistence of intraretinal or subretinal fluid, deterioration in visual acuity (VA), increase in central subfield thickness (CST) by ≥ 50 μm from the previous visit, or lowest recorded CST. Results: Participants had (2 males, 4 females) an average age of 53.5 years. From baseline to 12 months, the mean logMAR VA improved from 0.86 (Snellen ≈ 20/145) to 0.33 (Snellen ≈ 20/40), central macular thickness decreased from 519 μm to 255 μm, and total macular volume decreased from 14.7 mm3 to 7.1 mm3. No eyes had uveitis, cataract progression, intraocular pressure (IOP) elevations, or systemic adverse events. Conclusions and importance: Ziv-aflibercept achieves favorable intermediate-term functional and structural outcomes in macular edema secondary to CRVO. No safety concerns were raised. Low-cost ziv-aflibercept may thus be useful for CRVO in resource-poor countries. Further prospective studies in larger cohorts are needed further establish the efficacy and safety of this agent.
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- 2017
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13. Central Retinal Vein Occlusion
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Hayreh, Sohan Singh and Hayreh, Sohan Singh
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- 2015
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14. Central Retinal Artery Occlusion
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Hayreh, Sohan Singh and Hayreh, Sohan Singh
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- 2015
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15. Combined Central Retinal Artery Occlusion (CRAO) and Central Retinal Vein Occlusion (CRVO) in a Celiac Disease Patient: A Case Report.
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Al Fardan F, Aldebasi MH, AlThekair FY, Guma M, and Aldebasi T
- Abstract
Celiac disease (CD) is a digestive disorder caused by an abnormal immune reaction to gluten, leading to severe malabsorption syndrome. Central retinal vein occlusion (CRVO) was reported in a couple of cases worldwide in patients with this disease entity. Herein, we are reporting a rare case of combined central retinal vein and artery occlusion in a young female celiac disease patient presented with a counting finger vision at six feet and improved to 20/60 vision after conservative management., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Al Fardan et al.)
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- 2024
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16. Vasculitic central retinal vein occlusion: The presenting sign of seronegative rheumatoid arthritis
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Matthew G.J. Trese, Yoshihiro Yonekawa, Benjamin J. Thomas, and Sandeep Randhawa
- Subjects
Central retinal vein occlusion (CRVO) ,Vasculitic CRVO ,Rheumatoid arthritis (RA) ,Seronegative rheumatoid arthritis ,Vectra DA biomarker assay ,Ophthalmology ,RE1-994 - Abstract
Purpose: To report the case of a patient who presented with a vasculitic central retinal vein occlusion (CRVO), which was the result of an undiagnosed systemic inflammatory condition, seronegative rheumatoid arthritis (RA). Observations: The patient presented with reduced vision in the left eye and polyarthralgia. Fundoscopic examination revealed a central retinal vein occlusion (CRVO) with concurrent evidence of vasculitis. Work-up for polyarthralgia included comprehensive serologic testing for connective tissue disease, including Vectra® disease activity (DA) testing. Results of these studies confirmed the diagnosis of seronegative rheumatoid arthritis (RA). Systemic steroid therapy was initiated with subsequent anatomic and visual improvement. Conclusions and importance: We hypothesize that the systemic inflammation—a hallmark of RA—led to the development of a vasculitic CRVO and, thus, the retinal manifestations served as the disease marker that prompted thorough work-up of the patient's disease, even in the face of initial seronegativity. This case serves as a reminder that, in the setting of CRVO and polyarthralgia, systemic inflammatory conditions must be considered as the underlying etiology. Further, this case report highlights our evolving understanding of the role that serologic markers play in the diagnosis and monitoring of RA.
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- 2016
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17. Central retinal vein occlusion associated with the use of tranexamic acid.
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Al Shaharani, Ali and Al Ghamdi, Turki
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Here we report a case of central retinal vein occlusion that developed after using tranexamic acid. A 46-year-old female not known to have any previous illness came to the ophthalmology clinic complaining of sudden blurring of the vision in her left eye for almost 1 month, for which it is advised that tranexamic acid should be discontinued. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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18. Hyperaldosteronism Presenting With Unilateral Blindness: A Case Report.
- Author
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Manuel SL and Kender M
- Abstract
Hyperaldosteronism is a common cause of secondary hypertension. It has been classically associated with the clinical triad of hypertension, unexplained hypokalemia, and metabolic alkalosis. We present a case of a 66-year-old man who experienced blindness, hypokalemia, and hypertension that was resistant to anti-hypertension medications. He was found to have a retinal detachment and central retinal vein occlusion (CRVO). Laboratory evaluation revealed a marked elevation of plasma aldosterone activity and suppressed renin. A computerized tomography (CT) abdomen was subsequently ordered, which revealed bilateral adrenal nodules. Adrenal vein sampling was performed, which confirmed bilateral hyperfunctioning adrenal nodules. He was successfully treated with spironolactone. CRVO in the setting of hyperaldosteronism is an uncommon presentation., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Manuel et al.)
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- 2023
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19. A classic case of ischemic central retinal vein occlusion with macular edema
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Lakshmoji Naidu Kotipalli, Mani Kruthika Mantha, Tarun Kumar Suvvari, and Tejaswi Kota
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medicine.medical_specialty ,Bevacizumab ,genetic structures ,fluorescein angiogram ,bevacizumab ,central retinal vein occlusion (crvo) ,Central retinal vein occlusion ,Diabetes mellitus ,Ophthalmology ,Gonioscopy ,medicine ,Iris (anatomy) ,Intravitreal bevacizumab ,Risk factor ,Macular edema ,macular edema ,medicine.diagnostic_test ,diabetes ,business.industry ,General Medicine ,medicine.disease ,eye diseases ,medicine.anatomical_structure ,unilateral ischemic crvo ,Medicine ,business ,medicine.drug - Abstract
Central retinal vein occlusion (CRVO) is a significant cause of marked or total loss of vision in the middle-aged and elderly population. The patient was a 54-year-old man with a history of uncontrolled diabetes and was given seven intravitreal bevacizumab (Avastin) injections as treatment. The patient was advised to follow-up during the next 6 months, including gonioscopy and undilated examination of the iris to look for the iris/disc neovascularization. We presented a classic case of unilateral ischemic CRVO with macular edema, in whom diabetes is the leading risk factor. Close follow-up and diabetes control are advisable to prevent a similar scenario.
- Published
- 2021
20. Different Patterns of Retinal Vein Occlusion on Fundus Fluorescein Angiography.
- Author
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Riaz, Sidrah, Khan, Muhammad Tariq, Aqil, Zaheer-ud-Din, Qadeer, Riaz, and Shaukat, Shahroze
- Subjects
- *
RETINAL vein occlusion , *FLUORESCENCE angiography , *INTRAVENOUS injections , *NEOVASCULARIZATION , *HOSPITAL care , *DIAGNOSIS - Abstract
Purpose: To study the different patterns of retinal veins occlusion (RVO) on fundus fluorescein angiography (FFA). Materials & Methods: It is a hospital based descriptive study of 33 patients, conducted in Akhtar Saeed Trust Hospital, Ophthalmology Department from February 2014 to October 2016. These patients were selected from outpatient department (OPD) and diagnosed as cases of vein occlusions clinically. Presenting features were sudden painless visual loss, visual field defects, floaters if neovascularization has occurred, flame shaped retinal hemorrhages, dilated tortuous veins in all four quadrants or segmental depending upon it is central or branch vein occlusion. Patients with cataract, vitreous hemorrhage, proliferative diabetic retinopathy and media opacities which impair fundus view were excluded. After informed consent all selected patients were sent for fundus fluorescein angiography (FFA) with intravenous injections of 3ml of 25% and multiple photographs were taken for 20-25 minutes with Topcon digital fundus camera. The pattern of vein occlusions were observed and noted. Results: In this hospital based study 33 patients of vein occlusions, 21 males and 11 females, all with unilateral involvement were included. The age range was 50-75 years with mean age 62.50 years. The duration of visual disturbances on presentation was 2 to 4 weeks from onset of visual symptoms. After clearance of hemorrhages fundus fluorescein angiography (FFA) was performed. Most common site for venous occlusion was superotemporal quadrant seen in 39.40 % cases and non ischemic variety of vein occlusion was more common than ischemic variety. Conclusion: Based on FFA findings non ischemic CRVO was more common as compare to ischemic CRVO. Temporal BRVO's were seen more commonly as compared to nasal BRVO. Macular edema and leakage was seen in all cases of retinal vein occlusion (RVO). [ABSTRACT FROM AUTHOR]
- Published
- 2017
21. Clinical utility of ultra-widefield fluorescein angiography and optical coherence tomography angiography for retinal vein occlusions.
- Author
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Tan TE, Ibrahim F, Chandrasekaran PR, and Teo KYC
- Abstract
Retinal vein occlusions (RVOs) are the second most common retinal vascular disease after diabetic retinopathy, and are a significant cause of visual impairment, especially in the elderly population. RVOs result in visual loss due to macular ischemia, cystoid macular edema (CME), and complications related to neovascularization. Vascular assessment in RVOs traditionally relies on standard fluorescein angiography (FA) for assessment of macular and retinal ischemia, which aids in prognostication and guides intervention. Standard FA has significant limitations-it is time-consuming, requires invasive dye administration, allows for limited assessment of the peripheral retina, and is usually evaluated semi-qualitatively, by ophthalmologists with tertiary expertise. More recently, the introduction of ultra-widefield FA (UWF FA) and optical coherence tomography angiography (OCTA) into clinical practice has changed the tools available for vascular evaluation in RVOs. UWF FA allows for evaluation of peripheral retinal perfusion, and OCTA is non-invasive, rapidly-acquired, and provides more information on capillary perfusion. Both modalities can be used to provide more quantitative parameters related to retinal perfusion. In this article, we review the clinical utility and impact of UWF FA and OCTA in the evaluation and management of patients with RVOs., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Tan, Ibrahim, Chandrasekaran and Teo.)
- Published
- 2023
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22. Collateral Vessel Development in Central and Branch Retinal Vein Occlusions Are Associated With Worse Visual and Anatomic Outcomes
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Maurizio Battaglia Parodi, Francesco Bandello, Rosangela Lattanzio, Emanuela Aragona, Alessandro Arrigo, Giovanni Scalia, Arrigo, A., Aragona, E., Lattanzio, R., Scalia, G., Bandello, F., and Battaglia Parodi, M.
- Subjects
Male ,Vascular Endothelial Growth Factor A ,medicine.medical_specialty ,genetic structures ,Optic Disk ,Visual Acuity ,Collateral Circulation ,Angiogenesis Inhibitors ,Slit Lamp Microscopy ,Retina ,Macular Edema ,Tonometry, Ocular ,Oct angiography ,Central retinal vein occlusion ,Ophthalmology ,Ranibizumab ,optical coherence tomography angiography (OCTA). collateral vessels ,Retinal Vein Occlusion ,medicine ,optical coherence tomography (OCT) ,Humans ,In patient ,Fluorescein Angiography ,Collateral vessels ,central retinal vein occlusion (CRVO) ,Intraocular Pressure ,Aged ,Optical coherence tomography (OCT) ,business.industry ,Optical coherence tomography angiography (OCTA). collateral vessels ,Retinal Vessels ,Foveal avascular zone ,Middle Aged ,medicine.disease ,eye diseases ,Peripheral ,Cross-Sectional Studies ,Branch retinal vein occlusion (BRVO) ,Retinal vein occlusions ,Intravitreal Injections ,Branch retinal vein occlusion ,Female ,Central retinal vein occlusion (CRVO) ,sense organs ,business ,branch retinal vein occlusion (BRVO) ,Tomography, Optical Coherence ,Follow-Up Studies - Abstract
PURPOSE. The purpose of this study was to investigate the effects of the extension of collateral vessels on the outcomes of eyes affected by central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO). METHODS. The study was designed as a cross-sectional case series. Patients affected by CRVO and BRVO were progressively recruited, along with an age- and sex-matched control group of healthy subjects. Structural optical coherence tomography (OCT) and OCT angiography (OCTA; 4.5 × 4.5 mm and 9.0 × 9.0 mm acquisitions) were performed on all participants in order to assess the relationship between the presence of collateral vessels and final anatomical outcomes - central macular thickness (CMT), foveal avascular zone - and functional outcomes - best corrected visual acuity (BCVA). RESULTS. Fifty-six eyes affected by CRVO and 47 eyes affected by BRVO were included. Baseline LogMAR BCVA was 0.41 ± 0.33 LogMAR in CRVO, and 0.39 ± 0.25 LogMAR in BRVO (P < 0.01), improving to 0.20 ± 0.26 LogMAR in CRVO (P < 0.01), and 0.19 ± 0.22 LogMAR in BRVO (P < 0.01). Baseline CMT was 511 ± 214 μm in CRVO and 482 ± 178 μm in BRVO (P > 0.05), decreasing to 328 ± 105 μm (P < 0.01) and 321 ± 78 μm in CRVO and BRVO, respectively (P < 0.01). Collateral vessels were detected in 16 of 56 eyes (29%) in CRVO and in 47 of 47 eyes (100%) in BRVO. Their extension was correlated with worse anatomic and visual outcomes. Remarkably, no correlation was found with peripheral capillary nonperfusion and vessel density impairment. CONCLUSIONS. The present study demonstrates that collateral vessel extension is associated with worse anatomic and functional outcomes in patients affected by CRVO and BRVO.
- Published
- 2021
23. Management of Accidental Intravitreal Dexamethasone Injection Into the Lens: A Case Report.
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Siotto Pintor E, Demarinis G, Tatti F, and Peiretti E
- Abstract
An accidental injection of a dexamethasone implant inside the crystalline lens was observed in the right eye of a 63-year-old woman suffering from a macular edema secondary to a central retinal vein occlusion. A 23-gauge pars plana vitrectomy and lensectomy followed by an intraocular lens implantation were performed to carefully remove the lens and save the whole implant in order to preserve its therapeutics effects. A strict follow-up over the following 3 months revealed an improving of macular edema and no postoperative complications. The injection of a dexamethasone implant into the lens could be effectively and successfully managed with a pars plana vitrectomy and lensectomy., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Siotto Pintor et al.)
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- 2023
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24. Central retinal vein occlusion with moyamoya disease: a case report.
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Song SS, Jia XG, Zhao LJ, and Wang QQ
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Moyamoya disease is mainly caused by stenosis or occlusion of the terminal internal carotid artery, anterior cerebral artery, and proximal middle cerebral artery, and an abnormal vascular network is formed near the stenosis or occlusion of vascular lesions. Moyamoya disease can lead to a series of complications such as transient cerebral ischemia, cerebral infarction, and cerebral hemorrhage, which have been reported in the literature. Eye involvement with moyamoya disease is relatively rare in the literature. This article introduces a case of central retinal vein occlusion in a teenager related to moyamoya disease. The patient was only 16 years old and suddenly suffered from vision loss in the left eye. After detailed ophthalmological examination, she was diagnosed with central retinal vein occlusion in the left eye. In order to find the exact cause, we conducted head and neck CTA and brain DSA examinations on the patient, and finally found that the main cause of central retinal vein occlusion in this patient was moyamoya disease, which indicated that central retinal vein occlusion in young people may be caused by moyamoya disease in the early stage. This discovery has great clinical significance, for characteristic manifestations of the eye, suggesting that examination of moyamoya disease is a routine item for such patients, so as to achieve early detection, early diagnosis and early treatment, in order to avoid cerebral infarction, cerebral palsy, and serious or even life-threatening complications such as bleeding., Competing Interests: None., (AJTR Copyright © 2023.)
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- 2023
25. Malignant optic glioma masked by suspected optic neuritis and central retinal vein occlusion
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Nancy J. Fischbein, Michael, Mrudula Penta, Y. Joyce Liao, Aleksandrs Kalnins, and Tarek El-Sawy
- Subjects
lcsh:Medical physics. Medical radiology. Nuclear medicine ,medicine.medical_specialty ,genetic structures ,Optic nerve ,Optic glioma ,lcsh:R895-920 ,030218 nuclear medicine & medical imaging ,Neuro-ophthalmology ,03 medical and health sciences ,0302 clinical medicine ,Central retinal vein occlusion ,Biopsy ,medicine ,Radiology, Nuclear Medicine and imaging ,Optic neuritis ,Glioblastoma multiforme (GBM) ,Head and neck radiology ,medicine.diagnostic_test ,business.industry ,Malignant optic glioma ,medicine.disease ,eye diseases ,Serial imaging ,Central retinal vein occlusion (CRVO) ,Radiology ,sense organs ,business ,030217 neurology & neurosurgery ,Head and Neck - Abstract
Malignant optic glioma presents a clinical and diagnostic challenge, as early imaging findings overlap with other more common causes of optic nerve enhancement and enlargement, potentially leading to delay in diagnosis. This rare diagnosis carries an extremely poor prognosis, with death usually occurring within 1 year. We present a case of malignant optic glioma that was initially diagnosed as optic neuritis and central retinal vein occlusion, and we emphasize the importance of serial imaging and definitive biopsy to promote early diagnosis and treatment of this entity. Keywords: Head and neck radiology, Neuro-ophthalmology, Optic glioma, Glioblastoma multiforme (GBM), Optic nerve, Central retinal vein occlusion (CRVO)
- Published
- 2019
26. The influence of anti-VEGF therapy on present day management of macular edema due to BRVO and CRVO: a longitudinal analysis on visual function, injection time interval and complications.
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Papadia, Marina, Misteli, Marie, Jeannin, Bruno, and Herbort, Carl
- Abstract
The purpose of this study was to evaluate the impact of intravitreal bevacizumab injections on the management and outcome of patients affected by retinal vein occlusions, their effectiveness on morphological and functional parameters, the modalities of long-term management and the need for additional laser treatment due to ischemic retinal evolution. Patients diagnosed with branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO) had a comprehensive work-up including complete ophthalmic examination, fluorangiography (FA), optical coherence tomography (OCT), visual field testing (VFT), microperimetry (MP), and laser flare photometry (LFP). In case of BRVO, intraocular bevacizumab injection was performed if significant macular edema/visual deficit was still present 3 months after onset of occlusion and injections were started at presentation in case of CRVO. Post-injection follow-up examination including best corrected visual acuity (BCVA), intraocular pressure (IOP), LFP, OCT, MP, and VFT were performed monthly and recorded at the end of follow-up. Follow-up FA was performed between 12 and 18 months after diagnosis. Injections were repeated in case of recurrence of a significant central macular edema. Patients were subdivided into 2 groups according to number of injections: 1-4 injections or more than 4 injections. The proportion of resolved cases (no recurrence after a minimum follow-up of 12 months) was calculated and correlated with number of injections. In patients needing sustained injections, management modalities were recorded. The proportion of patients having needed laser photocoagulation treatment because of significant ischemic signs was recorded. Fifty-one patients were diagnosed with retinal vein occlusion between 2006 and 2012 at the Centre for Specialized Ophthalmic Care (COS) in Lausanne, Switzerland. Forty-four had enough data and were included in the study. Nine eyes were affected by CRVO and 35 were affected by BRVO. Mean BCVA at presentation was 0.24 ± 0.2 and improved to 0.81 ± 0.38 ( p < 0.01) at 48 months. MP improved from 184.9 ± 92 to 362.5 ± 56.2 ( p < 0.01) at 42 months follow-up. The number of injections varied from 1 to 25 (mean 5.5 ± 5.43). 31/44 eyes received 1-4 injections (group 1) of which all were recurrence free, with a follow-up of at least 1 years in all. 13/44 eyes received more than 5 injections (group 2) with functional and morphological parameters maintained in 9/13 but only 1/13 patients showed resolution. Rhythm of injection varied from one patient to another but 8/13 patients needing continuous injections had a constant time interval between injections. In 8/44 patients, laser photocoagulation had to be performed due to ischemic complications. The visual outcome using bevacizumab intravitreal injection was exceptionally good and functional parameters such as BCVA, MP, and VFT improved significantly. In about two-thirds of patients, resolution was obtained after 1-4 injections. In one-third of patients, continuous injections were necessary but a constant rhythm for re-injection for each patient could be established allowing to reduce to a minimum follow-up visits. The absence of significant side effects allowed to re-treat apparently without limitation achieving maintained visual function. FA monitoring for the detection of ischemic complications should not be neglected especially in cases where bevacizumab could be discontinued. [ABSTRACT FROM AUTHOR]
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- 2014
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27. Retinal venous pressure is decreased after anti-VEGF therapy in patients with retinal vein occlusion–related macular edema
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Katarzyna Konieczka, Tsunehiko Ikeda, Teruyo Kida, and Josef Flammer
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Vascular Endothelial Growth Factor A ,Intraocular pressure ,medicine.medical_specialty ,Visual acuity ,Retinal Vein ,genetic structures ,Angiogenesis Inhibitors ,Cellular and Molecular Neuroscience ,chemistry.chemical_compound ,Ophthalmology ,Edema ,Retinal Vein Occlusion ,medicine ,Humans ,Prospective Studies ,Macular edema ,Aged ,Ophthalmodynamometer ,business.industry ,Anti-VEGF ,Retinal ,medicine.disease ,Thrombosis ,eye diseases ,Sensory Systems ,Treatment Outcome ,chemistry ,Branch retinal vein occlusion (BRVO) ,Intravitreal Injections ,Retinal Disorders ,sense organs ,Central retinal vein occlusion (CRVO) ,Retinal venous pressure (RVP) ,medicine.symptom ,Ranibizumab ,business ,Venous Pressure ,Tomography, Optical Coherence ,medicine.drug - Abstract
Purpose The pathomechanism leading to retinal vein occlusion (RVO) is unclear. Mechanical compression, thrombosis, and functional contractions of veins are discussed as the reasons for the increased resistance of venous outflow. We evaluated changes in the retinal venous pressure (RVP) following intravitreal injection of anti-vascular endothelial growth factor (VEGF) agent to determine the effect on RVO-related macular edema. Methods Twenty-six patients with RVO-related macular edema (16 branch RVOs [BRVOs] and 10 central RVOs [CRVOs], age 72.5 ± 8.8 years) who visited our hospital were included in this prospective study. Visual acuity (VA), intraocular pressure (IOP), central retinal thickness (CRT) determined by macular optical coherence tomography, and RVP measured using an ophthalmodynamometer were obtained before intravitreal injection of ranibizumab (IVR) and 1 month later. Results Comparison of the BRVOs and CRVOs showed that VA was significantly improved by a single injection in BRVOs (P < 0.0001; P = 0.1087 for CRVOs), but CRT and RVP were significantly decreased without significant difference in IOP after the treatment in both groups (P < 0.0001). Conclusion The anti-VEGF treatment resulted in a significant decrease in the RVP, but the RVP remained significantly higher than the IOP. An increased RVP plays a decisive role in the formation of macula edema, and reducing it is desirable.
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- 2021
28. A Comparative Study of Ganglion Cell Complex Thickness Changes in Diabetic Macular Edema and Central Retinal Vein Occlusion Macular Edema: An Optical Coherence Tomography Study.
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Mathurkar S, Daigavane S, and Saldanha C
- Abstract
Aim This study aims to compare the ganglion cell complex changes in diabetic macular edema (DME) and central retinal vein occlusion (CRVO) macular edema using optical coherence tomography (OCT). Methods This was a hospital-based cross-sectional study conducted for six months. All patients having DME and CRVO macular edema presenting to the Ophthalmology Department at Acharya Vinobha Bhave Rural Hospital were included in the study. A detailed and comprehensive ophthalmic examination was performed, and OCT was done for each patient. Results The incidence of both DME and CRVO macular edema were both found to be maximum in the age group of 61-69 years. DME is more common in males (62.86%) than females (37.14%); the same was observed in CRVO group: 54.29% were males and 45.71% were females. Macular edema showed a mean value of 370.11 in DME and 428.71 in CRVO. Thus, the CRVO group showed more macular edema than the DME group. The ganglion cell complex thickness showed a mean value of 58.47 in DME and 66.77 in the CRVO group, implying that the thickness reduced significantly in the DME group. Conclusion OCT provides quantitative measurement of the ganglion cell complex thickness, which helps monitor the course of macular edema secondary to CRVO and diabetes Mellitus and thereby provides an assessment of the prognosis of the disease as these two diseases in particular are major causes of blindness worldwide, and timely care and management can help in altering its course., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Mathurkar et al.)
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- 2022
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29. Vaping-Related Clotting Phenomena Presenting As Central Retinal Vein Occlusion.
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Balinski AM, Harvey RN, Ko RB, Smalley MM, Cutler NE, and Siddiqi MT
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Central retinal vein occlusion (CRVO) typically manifests as unilateral vision loss from thrombosis and occlusion of the central retinal vein in patients with thrombophilic risk factors. Here we report a case of a 23-year-old male with three weeks of intermittent left-sided eye pressure and vision loss, who was found to have decreased visual acuity, retinal hemorrhages, and an impending CRVO in his left eye. Upon further evaluation, infectious disease and autoimmune labs were normal, but he had mildly increased right heart pressures and hypercoagulable changes in the right middle cerebral artery. He denied any personal or family history of clotting disorders but noted a four-year history of vaping. He was started on anticoagulation and discharged. Outpatient genetic testing for Factor V Leiden, protein C, protein S, and prothrombin G20210 was normal. His visual acuity returned to normal in the left eye and the retinal hemorrhages resolved. After the exclusion of organic causes, significant vaping history was considered the likely etiology of his hypercoagulable state and resultant CRVO. Vaping-related clotting phenomena may explain the etiology of an otherwise unexplained CRVO, but further investigation of the long-term health consequences of electronic cigarette use is still needed., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Balinski et al.)
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- 2022
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30. One-year outcomes of ziv-aflibercept for macular edema in central retinal vein occlusion
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Jay Chhablani, Chintan J Dedhia, Errol W. Chan, Ahmad M. Mansour, and Mohab Eldeeb
- Subjects
medicine.medical_specialty ,Intraocular pressure ,Visual acuity ,genetic structures ,030226 pharmacology & pharmacy ,03 medical and health sciences ,0302 clinical medicine ,Optical coherence tomography ,Central retinal vein occlusion ,lcsh:Ophthalmology ,Case report ,medicine ,Adverse effect ,Prospective cohort study ,Macular edema ,Optical coherence tomography (OCT) ,medicine.diagnostic_test ,business.industry ,Ziv-aflibercept ,medicine.disease ,eye diseases ,Surgery ,Ophthalmology ,lcsh:RE1-994 ,Anti-vascular endothelial factor (anti-VEGF) ,030221 ophthalmology & optometry ,sense organs ,Central retinal vein occlusion (CRVO) ,medicine.symptom ,business ,Uveitis - Abstract
Purpose To report the 12-month efficacy and safety outcomes of intravitreal ziv-aflibercept in macular edema secondary to central retinal vein occlusion (CRVO). Methods Interventional case series documenting 12-month outcomes of intravitreal ziv-aflibercept (1.25 mg in 0.05 mL) in 6 patients with treatment-naive macular edema secondary to CRVO. All patients had comprehensive ophthalmic examination, spectral domain optical coherence tomography at baseline and all follow-up visits, and fluorescein. Retreatment decisions were based on recurrence or persistence of intraretinal or subretinal fluid, deterioration in visual acuity (VA), increase in central subfield thickness (CST) by ≥ 50 μm from the previous visit, or lowest recorded CST. Results Participants had (2 males, 4 females) an average age of 53.5 years. From baseline to 12 months, the mean logMAR VA improved from 0.86 (Snellen ≈ 20/145) to 0.33 (Snellen ≈ 20/40), central macular thickness decreased from 519 μm to 255 μm, and total macular volume decreased from 14.7 mm 3 to 7.1 mm 3 . No eyes had uveitis, cataract progression, intraocular pressure (IOP) elevations, or systemic adverse events. Conclusions and importance Ziv-aflibercept achieves favorable intermediate-term functional and structural outcomes in macular edema secondary to CRVO. No safety concerns were raised. Low-cost ziv-aflibercept may thus be useful for CRVO in resource-poor countries. Further prospective studies in larger cohorts are needed further establish the efficacy and safety of this agent.
- Published
- 2017
31. Alterations to vascular endothelium in the optic nerve head in patients with vascular comorbidities.
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Kang, Min H., Balaratnasingam, Chandrakumar, Yu, Paula K., Morgan, William H., McAllister, Ian L., Cringle, Stephen J., and Yu, Dao-Yi
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- *
VASCULAR endothelium , *OPTIC nerve , *ANALYSIS of covariance , *RETINAL vein , *ARTERIAL occlusions , *BLOOD coagulation - Abstract
Abstract: Vascular comorbidities are inherently linked to the pathogenesis of central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO). However, the endothelial-mediated pathogenic mechanisms that precede, and therefore modulate, luminal occlusion have not been clarified. The aim of this study was to delineate the pattern of endothelial morphometric alteration in the central retinal artery and vein in patients with vascular comorbidities. Eyes with a previous history of vascular occlusion were not included in this study in order to avoid the confounding effects of post-occlusion endothelial changes. This study also sought to determine if vascular comorbidities had a disparate effect on arterial and venous endothelium in the optic nerve head. Comparisons were made between 13 human eyes from patients with vascular comorbidities and 22 control eyes from patients with no known systemic disease. Novel micro-cannulation techniques developed in our laboratory were used to label the cytoskeleton and nuclei of endothelial cells in the central retinal artery and vein following which images were captured using confocal microscopy. Endothelial and nuclear morphometric parameters were quantified in different laminar regions of the optic nerve head. F-actin stress fibre expression was also quantified. Analysis of covariance was used to determine statistical differences between the two groups. Interestingly, age did not influence endothelial morphometry, nuclear morphometry or f-actin expression in central retinal vessels. There were also no arterial endothelial differences between control and disease groups in any laminar region. Endothelial f-actin stress fibre expression increased significantly in the central retinal vein in patients with vascular comorbidities. The greatest change in these eyes was found to occur at the posterior lamina cribrosa. Increased venous endothelial f-actin stress fibre expression may reflect vascular comorbid disease-induced alterations to hemodynamic properties and coagulation cascades in the central retinal vein. The posterior lamina may be an important site for thrombus formation in CRVO as venous endothelia in this region are most influenced by the presence of vascular comorbidities. The findings of this study suggest that the role of endothelial dysfunction in CRVO and CRAO pathogenesis could be different. [Copyright &y& Elsevier]
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- 2013
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32. Hyperhomocysteinemia, as an Independent Risk Factor for Retinal Venous Occlusion in an Indian Population.
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Lahiri, Kapil, Dutta, Jayanta, Datta, Himadri, and Das, Harendra
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Total plasma homocysteine was analysed in 64 cases of retinal vein occlusion (RVO) of which 24 cases of central retinal vein occlusion (CRVO) and 40 cases of branch retinal vein occlusion (BRVO) and compared with 45 age and sex matched control. Homocysteine was significantly increased in RVO cases in respect to control ( P < 0.001). Analysis also revealed that prevalence of rise of plasma homocysteine was more in cases of CRVO (OR = 13) than that of BRVO (OR = 5.03). [ABSTRACT FROM AUTHOR]
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- 2013
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33. Case Report: A Case of Cystoid Macular Edema in Retinitis Pigmentosa With Central Retinal Vein Occlusion.
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Wang DH, Gu C, and Yuan YZ
- Abstract
Significance: Cystoid macular edema (CME) is a common complication of retinitis pigmentosa (RP). However, CME in RP with central retinal vein occlusion (CRVO) is rare. Prompt administration of anti-vascular endothelial growth factor (anti-VEGF) medication can achieve a satisfactory prognosis., Purpose: This report describes a case of using anti-VEGF medication to treat CME secondary to RP with impending or mild CRVO., Case Report: A 26-year-old female presented for blurred vision in both eyes. Best-corrected visual acuity (BCVA) was 20/50 in the right eye and finger-counting in the left eye. According to ophthalmic examinations, CME secondary to RP in the right eye and CME secondary to RP with impending or mild CRVO in her left eye can be diagnosed. Central macular thickness (CMT) was 554 μ m in the right eye and 831 μm in the left eye. Only the left eye was treated with a single intravitreal injection of anti-VEGF medication. One month later, BCVA increased to 20/200 and CMT decreased to 162 μm in the left eye. Interestingly, BCVA in the right eye also had an improvement (20/40) and intraretinal fluid decreased significantly. However, 3 months after injection, these improvements of both eyes were not maintained., Conclusion: This is the second case of RP with CRVO. Intravitreal injection of anti-VEGF medication for addressing CME secondary to RP with CRVO is an effective treatment, but it needs to be reinjected., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Wang, Gu and Yuan.)
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- 2022
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34. Intravitreal Bevacizumab for Macular Edema Due to Central Retinal Vein Occlusion: Perfused vs. Ischemic and Early vs. Late Treatment.
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DeCroos, Francis Char, Ehlers, Justis P., Stinnett, Sandra, and Fekrat, Sharon
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- *
BEVACIZUMAB , *RETINAL degeneration , *RETINAL vein , *INTESTINAL ischemia , *VISUAL acuity , *TOMOGRAPHY , *FLUORESCENCE angiography , *DISEASES - Abstract
Purpose/aims: This study investigates the efficacy of intravitreal bevacizumab (IVB) for cystoid macular edema (CME) secondary to central retinal vein occlusion (CRVO). Subgroup analysis was performed comparing early (within 90 days of CRVO onset) and late treatment (after 90 days) as well as perfused and ischemic subgroups. Materials and Methods: Retrospective review of 48 consecutive eyes with CRVO treated with IVB was performed. Data collected at various time points included best corrected visual acuity (BCVA), central foveal thickness (FT) on optical coherence tomography (OCT), perfusion status on fluorescein angiography (FA), and complications. Results Mean initial BCVA was 20/288 compared to 20/214 at 12 months ( p == 0.07) and 20/204 ( p == 0.03) at final follow-up. Initial mean central FT was 591 micrometers compared to 339 micrometers at 12 months ( p == 0.003). Mean follow-up was 10.5 months, and mean number of injections was 3.7. After IVB, no significant difference in BCVA gain or edema resolution on OCT was noted between the early and late treatment groups or between the perfused and ischemic subgroups. Conclusions: IVB improves foveal thickness in eyes with CRVO, but this does not always correlate with visual recovery. No difference in efficacy was observed for IVB treatment of perfused versus ischemic CRVO or when used for early versus late treatment. [ABSTRACT FROM AUTHOR]
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- 2011
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35. Retinal Vein Occlusion: Beyond the Acute Event
- Author
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Ehlers, Justis P. and Fekrat, Sharon
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- *
RETINAL vein , *RETINAL blood vessel diseases , *VEIN diseases , *CLINICAL trials , *DISEASE management , *DRUG delivery devices , *DRUG therapy , *EDEMA , *BEVACIZUMAB , *TRIAMCINOLONE , *THERAPEUTICS - Abstract
Abstract: Retinal vein occlusion is a major cause of vision loss. We provide an overview of the clinical features, pathogenesis, natural history, and management of both branch retinal vein occlusion and central retinal vein occlusion. Several recent multicenter randomized clinical trials have been completed which have changed the approach to this disorder. Management of retinal vein occlusions can be directed at the underlying etiology or the resulting sequelae. Options include surgical intervention, laser photocoagulation, intravitreal pharmacotherapy, and sustained drug delivery devices. [Copyright &y& Elsevier]
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- 2011
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36. Netzhauterkrankungen bei primärer pulmonaler Hypertension.
- Author
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Beck, R., Eckard, A., Ewert, R., and Guthoff, R.
- Abstract
Copyright of Der Ophthalmologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2003
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37. Genetic determinants of fasting and post-methionine hyperhomocysteinemia in patients with retinal vein occlusion
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Marcucci, Rossella, Giusti, Betti, Betti, Irene, Evangelisti, Lucia, Fedi, Sandra, Sodi, Andrea, Cappelli, Stefania, Menchini, Ugo, Abbate, Rosanna, and Prisco, Domenico
- Subjects
- *
VENOUS thrombosis , *HOMOCYSTEINE - Abstract
Introduction: Moderate hyperhomocysteinemia is considered a risk factor for both venous and arterial thrombosis. A prevalence of up to 30% of fasting hyperhomocysteinemia has been recently reported in patients with retinal vein occlusion (RVO) whereas conflicting data exist on the role of C677T polymorphism of the methylenetetrahydrofolate reductase (MTHFR) gene as a risk factor for RVO. No report has been published on cystathionine beta-synthase (CBS) 844ins68 polymorphism (another genetic determinant of blood Hcy levels) in RVO patients. Moreover, scarce information is available on the usefulness of measuring homocysteine also after methionine loading to increase the diagnostic efficacy of hyperhomocysteinemia in RVO patients. Materials and methods: In 55 consecutive patients with diagnosis of RVO and 65 matched controls, plasma fasting total homocysteine (Hcy) levels and CBS and MTHFR polymorphisms were evaluated. In patients with normal fasting Hcy levels, post-methionine Hcy levels were determined. Results: Moderate fasting hyperhomocysteinemia was detected in 18/55 patients (32.7%). In the remaining 37 patients, Hcy was measured again post-methionine loading (PML). Only 3/37 (8.1%) patients had PML hyperhomocysteinemia. Thus, the total prevalence of moderate hyperhomocysteinemia in this cohort of RVO patients was 21/55 (38.2%). The prevalence of homozygosity for C677T MTHFR genotype, but not that of heterozygosity for CBS844ins68, was significantly higher in RVO patients than in controls. Conclusions: Differently from what has been reported for arterial and/or venous thrombosis, a single fasting Hcy measurement is able to detect most of RVO patients (85.7%) with moderate hyperhomocysteinemia. C677T MTHFR, but not CBS 844ins68, genotype may play a role as risk factor for RVO. [Copyright &y& Elsevier]
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- 2003
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38. Central retinal vein occlusion associated with the use of tranexamic acid
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Turki Abdullah Al Ghamdi and Ali Mohammed Al Shaharani
- Subjects
medicine.medical_specialty ,genetic structures ,business.industry ,Case Report ,medicine.disease ,eye diseases ,03 medical and health sciences ,Ophthalmology clinic ,Left eye ,Ophthalmology ,0302 clinical medicine ,tranexamic acid (TA) ,Central retinal vein occlusion ,030221 ophthalmology & optometry ,Medicine ,030212 general & internal medicine ,business ,central retinal vein occlusion (CRVO) ,Tranexamic acid ,medicine.drug ,Anti-fibrinolytic - Abstract
Here we report a case of central retinal vein occlusion that developed after using tranexamic acid. A 46-year-old female not known to have any previous illness came to the ophthalmology clinic complaining of sudden blurring of the vision in her left eye for almost 1 month, for which it is advised that tranexamic acid should be discontinued.
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- 2019
39. Comparison of the efficacy and safety of drug therapies for macular edema secondary to central retinal vein occlusion
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Tian-Wei Qian, Meng-Ya Zhao, Xun Xu, Meng-Xiao Li, and Yong-Jing Wan
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Vascular Endothelial Growth Factor A ,medicine.medical_specialty ,Intraocular pressure ,corticosteroid ,Visual acuity ,Bevacizumab ,genetic structures ,Recombinant Fusion Proteins ,Placebo ,Triamcinolone ,Risk Assessment ,Dexamethasone ,03 medical and health sciences ,0302 clinical medicine ,Central retinal vein occlusion ,Adrenal Cortex Hormones ,Ophthalmology ,Ranibizumab ,Retinal Vein Occlusion ,Medicine ,Humans ,030212 general & internal medicine ,central retinal vein occlusion (CRVO) ,Macular edema ,Intraocular Pressure ,Aflibercept ,Randomized Controlled Trials as Topic ,macular edema ,business.industry ,Research ,General Medicine ,Aptamers, Nucleotide ,medicine.disease ,eye diseases ,Receptors, Vascular Endothelial Growth Factor ,Treatment Outcome ,Evidence Based Practice ,anti-VEGF ,Intravitreal Injections ,030221 ophthalmology & optometry ,medicine.symptom ,business ,medicine.drug - Abstract
ObjectivesTo evaluate the efficacy and safety of anti-vascular endothelial growth factor (VEGF) agents and corticosteroids for the treatment of macular oedema (ME) secondary to central retinal vein occlusion (CRVO).DesignSystematic review and network meta-analysis.ParticipantsPatients from previously reported randomised controlled trials (RCTs) comparing anti-VEGF and corticosteroids for the treatment of ME secondary to CRVO.MethodsLiterature searches were conducted using PubMed, Medline, Embase, Cochrane Library and clinicaltrials.gov until March 2017. Therapeutic effects were estimated using the proportions of patients gaining/losing ≥15 letters, best-corrected visual acuity (BCVA) and central retinal thickness (CRT). Treatment safety was estimated using the proportions of adverse events, namely increased intraocular pressure (IOP), cataracts, vitreous haemorrhage (VH) and retinal tear. The software ADDIS (V.1.16.8) was used for analysis. Treatment effect and safety of different drugs could be ranked based on simulation.ResultsEleven RCTs comprising 2060 patients were identified. Regarding patients gaining ≥15 letters, aflibercept and ranibizumab were significantly more effective than sham/placebo at 6 months. Regarding patients losing ≥15 letters at 6 months, ranibizumab showed significant improvement compared with dexamethasone. Aflibercept, bevacizumab or ranibizumab showed greater improvements in BCVA than sham/placebo at 6 months. Intravitreal ranibizumab injection demonstrated greater CRT reduction than both sham and dexamethasone did. Dexamethasone had a higher risk of increased IOP than aflibercept and ranibizumab. Ranibizumab demonstrated a greater risk of cataracts than dexamethasone. Aflibercept and ranibizumab demonstrated low incidence of VH and retinal tear, respectively. Aflibercept had a slight advantage over ranibizumab as assessed by benefit–risk analysis.ConclusionsAnti-VEGF agents have advantages in the treatment of ME secondary to CRVO. Aflibercept and ranibizumab showed marked BCVA improvement and CRT reduction. Aflibercept may have a slight advantage over ranibizumab. The results of this study can serve as a reference for clinicians to provide patient-tailored treatment.PROSPERO registration numberCRD42017064076.
- Published
- 2018
40. NEOVASCULAR GLAUCOMA, A LATE COMPLICATION OF CENTRAL RETINAL VEIN OCCLUSION.
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OPREA, MONICA CLAUDIA, ANGHELACHE, MARINA DANIELA, DUMITRACHE, MARIETA, and POTOP, VASILE
- Subjects
- *
OCULAR hypertension , *GLAUCOMA , *EYE diseases , *RETINAL vein , *RETINAL blood vessels - Abstract
The purpose of this paper is to present the evolution of central retinal vein occlusion (CRVO) in a young patient with risk factors (thrombophilia and hypercholesterolemia) and the therapeutic management of the condition. The complications of the CRVO are macular edema and neovascular glaucoma. Treatment of the complications is medical, intravitreal injection with vascular endothelial growth factors (VEGF) inhibitors (Avastin) and steroidal anti inflammatory drugs (triamcinolone acenoide), and surgical, trabeculectomy with iridectomy and postoperative subconjunctival 5- fluorouracil (5-FU) injections. The management of CRVO summarises two major objectives, identifying risk factors with their management and recognising and treating sight threatening complications that can be encountered. The particularity of this case is the patients' early age, NVG being a late secondary complication of CRVO in the elderly. [ABSTRACT FROM AUTHOR]
- Published
- 2015
41. Vasculitic central retinal vein occlusion: The presenting sign of seronegative rheumatoid arthritis
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Sandeep Randhawa, Matthew G.J. Trese, Yoshihiro Yonekawa, and Benjamin J. Thomas
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medicine.medical_specialty ,Pathology ,Systemic steroid ,Disease ,Article ,03 medical and health sciences ,chemistry.chemical_compound ,Seronegative rheumatoid arthritis ,0302 clinical medicine ,Vasculitic CRVO ,Central retinal vein occlusion ,lcsh:Ophthalmology ,medicine ,030212 general & internal medicine ,030203 arthritis & rheumatology ,business.industry ,Retinal ,medicine.disease ,Connective tissue disease ,Dermatology ,eye diseases ,Ophthalmology ,chemistry ,lcsh:RE1-994 ,Rheumatoid arthritis (RA) ,Etiology ,Central retinal vein occlusion (CRVO) ,business ,Vasculitis ,Vectra DA biomarker assay - Abstract
Purpose To report the case of a patient who presented with a vasculitic central retinal vein occlusion (CRVO), which was the result of an undiagnosed systemic inflammatory condition, seronegative rheumatoid arthritis (RA). Observations The patient presented with reduced vision in the left eye and polyarthralgia. Fundoscopic examination revealed a central retinal vein occlusion (CRVO) with concurrent evidence of vasculitis. Work-up for polyarthralgia included comprehensive serologic testing for connective tissue disease, including Vectra ® disease activity (DA) testing. Results of these studies confirmed the diagnosis of seronegative rheumatoid arthritis (RA). Systemic steroid therapy was initiated with subsequent anatomic and visual improvement. Conclusions and importance We hypothesize that the systemic inflammation—a hallmark of RA—led to the development of a vasculitic CRVO and, thus, the retinal manifestations served as the disease marker that prompted thorough work-up of the patient's disease, even in the face of initial seronegativity. This case serves as a reminder that, in the setting of CRVO and polyarthralgia, systemic inflammatory conditions must be considered as the underlying etiology. Further, this case report highlights our evolving understanding of the role that serologic markers play in the diagnosis and monitoring of RA.
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- 2016
42. Quantitative analysis of metabolites in glucose metabolism in the aqueous humor of patients with central retinal vein occlusion.
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Wei, Pinghui, He, Meiqin, Teng, He, and Han, Guoge
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- *
RETINAL vein occlusion , *AQUEOUS humor , *PROTON magnetic resonance spectroscopy , *GLUCOSE metabolism , *GLUCOSE analysis , *METABOLITE analysis - Abstract
Quantitative analysis of aqueous humor (AH) was performed to investigate glucose metabolism in patients with central retinal vein occlusion (CRVO), and to explore metabolic changes after anti-vascular endothelial growth factor (VEGF) treatment. AH samples were collected from 35 patients. Participants diagnosed with CRVO (n = 15) were compared to participants who underwent cataract surgery (n = 20). Thirteen of the participants with CRVO received second-round anti-VEGF treatments. Ultra-high performance liquid chromatography tandem-mass spectrometry (UHPLC-MS/MS) was used to quantify metabolites of the AH. Central macular thickness (CMT) and retinal ganglion cell layer (RGC) thickness were measured using spectral-domain optical coherence tomography. Thirteen metabolites involved in glucose metabolism were identified. Among these metabolites, succinate, glutamate, and glutamine were significantly decreased for the CRVO group (p = 0.028, 0.009, and 0.017, respectively). The α -ketoglutarate/citrate (K/C) ratio had a significant positive correlation with glutamine levels for both control (r = 0.922, p < 0.001) and CRVO groups (r = 0.674, p = 0.006). A significant increase in lactate was observed after intravitreal anti-VEGF administration (t = 2.273, p = 0.045); the change in CMT was negatively correlated with this increase (r = −0.745, p = 0.003). The alteration of RGC thickness was negatively correlated with increases in both glutamine (r = −0.619, p = 0.024) and glucose (r = −0.754, p = 0.003). These results indicate that, compared to glucose metabolism, glutamine was significantly decreased in the AH of patients with CRVO, and may therefore serve as a potential target for CRVO therapy. The glycolytic pathway might be enhanced after intravitreal anti-VEGF injection, which is an important insight into CRVO pathophysiology. • Succinate, glutamate, and glutamine were significantly low in patients with CRVO. • The α-ketoglutarate/citrate ratio was positively correlation with glutamine levels. • Lactate levels increased significantly after intravitreal anti-VEGF administration. • The change in CMT was negatively correlated with lactate increase. • RGC thickness was negatively correlated with increased glucose and glutamine levels. [ABSTRACT FROM AUTHOR]
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- 2020
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43. Increased retinal toxicity of intravitreal tissue plasminogen activator in a central retinal vein occlusion model
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Yamamoto, Takuhiro, Kamei, Motohiro, Kunavisarut, Paradee, Suzuki, Mihoko, and Tano, Yasuo
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- 2008
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44. Intraocular bevacizumab for macular edema due to CRVO. A multifocal-ERG and OCT study
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Moschos, Marilita M. and Moschos, Michael
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- 2008
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45. Intraocular triamcinolone acetonide for macular edema due to CRVO. A multifocal-ERG and OCT study
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Moschos, Marilita M., Brouzas, Dimitrios, Loukianou, Eleni, Apostolopoulos, Michael, and Moschos, Michael
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- 2007
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46. Radiäre Optiko-Neurotomie (RON) bei Zentralvenenthrombosen
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Meyer, C. H., Mennel, S., Kunze, S., and Schmidt, J. C.
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- 2004
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47. Treatment Patterns and Clinical Outcomes for Central Retinal Vein Occlusion in the Antivascular Endothelial Growth Factor Era.
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Stallworth JY, Thomas AS, Constantine R, Stinnett SS, and Fekrat S
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Purpose: This article describes treatment patterns and visual outcomes for central retinal vein occlusion (CRVO) in the antivascular endothelial growth factor (anti-VEGF) era., Methods: A retrospective cohort study of eyes diagnosed with CRVO between 2009 and 2016 was conducted. Treatment history and visual acuity (VA) measurements were abstracted from medical records and analyzed., Results: A total of 476 eyes of 476 patients (median age 67 years, median follow-up 25.4 months) were included. Optical coherence tomography was obtained in 93.9% and fluorescein angiography in 80% of cases on presentation. Mean VA at presentation and final visit was 20/60 and 20/94, respectively, for eyes with nonischemic CRVO, whereas that of ischemic cases remained worse than 20/800 at final follow-up. Intravitreal bevacizumab was the most common first treatment (42.2%). Intravitreal steroid was the first treatment in 3.6% and ultimately administered in 11.3% of eyes. In the first year, an average of 5.2 ± 3.6 and 2.2 ± 3.4 anti-VEGF injections were given in treatment-naive and nontreatment-naive eyes, respectively., Conclusions: In our real-world cohort, anti-VEGF injection burden and frequency are lower than in published clinical trials. Visual outcomes in both ischemic and nonischemic eyes with CRVO are poorer than expected and worse than those recorded in controlled trial settings., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2019.)
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- 2019
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48. Comparison of the efficacy and safety of drug therapies for macular edema secondary to central retinal vein occlusion.
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Qian T, Zhao M, Wan Y, Li M, and Xu X
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- Humans, Aptamers, Nucleotide adverse effects, Aptamers, Nucleotide therapeutic use, Dexamethasone adverse effects, Dexamethasone therapeutic use, Intraocular Pressure drug effects, Intravitreal Injections, Randomized Controlled Trials as Topic, Ranibizumab adverse effects, Ranibizumab therapeutic use, Receptors, Vascular Endothelial Growth Factor therapeutic use, Recombinant Fusion Proteins adverse effects, Recombinant Fusion Proteins therapeutic use, Risk Assessment, Treatment Outcome, Triamcinolone adverse effects, Triamcinolone therapeutic use, Network Meta-Analysis, Adrenal Cortex Hormones adverse effects, Adrenal Cortex Hormones therapeutic use, Macular Edema drug therapy, Retinal Vein Occlusion complications, Retinal Vein Occlusion drug therapy, Vascular Endothelial Growth Factor A antagonists & inhibitors
- Abstract
Objectives: To evaluate the efficacy and safety of anti-vascular endothelial growth factor (VEGF) agents and corticosteroids for the treatment of macular oedema (ME) secondary to central retinal vein occlusion (CRVO)., Design: Systematic review and network meta-analysis., Participants: Patients from previously reported randomised controlled trials (RCTs) comparing anti-VEGF and corticosteroids for the treatment of ME secondary to CRVO., Methods: Literature searches were conducted using PubMed, Medline, Embase, Cochrane Library and clinicaltrials.gov until March 2017. Therapeutic effects were estimated using the proportions of patients gaining/losing ≥15 letters, best-corrected visual acuity (BCVA) and central retinal thickness (CRT). Treatment safety was estimated using the proportions of adverse events, namely increased intraocular pressure (IOP), cataracts, vitreous haemorrhage (VH) and retinal tear. The software ADDIS (V.1.16.8) was used for analysis. Treatment effect and safety of different drugs could be ranked based on simulation., Results: Eleven RCTs comprising 2060 patients were identified. Regarding patients gaining ≥15 letters, aflibercept and ranibizumab were significantly more effective than sham/placebo at 6 months. Regarding patients losing ≥15 letters at 6 months, ranibizumab showed significant improvement compared with dexamethasone. Aflibercept, bevacizumab or ranibizumab showed greater improvements in BCVA than sham/placebo at 6 months. Intravitreal ranibizumab injection demonstrated greater CRT reduction than both sham and dexamethasone did. Dexamethasone had a higher risk of increased IOP than aflibercept and ranibizumab. Ranibizumab demonstrated a greater risk of cataracts than dexamethasone. Aflibercept and ranibizumab demonstrated low incidence of VH and retinal tear, respectively. Aflibercept had a slight advantage over ranibizumab as assessed by benefit-risk analysis., Conclusions: Anti-VEGF agents have advantages in the treatment of ME secondary to CRVO. Aflibercept and ranibizumab showed marked BCVA improvement and CRT reduction. Aflibercept may have a slight advantage over ranibizumab. The results of this study can serve as a reference for clinicians to provide patient-tailored treatment., Prospero Registration Number: CRD42017064076., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2018
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49. Malignant optic glioma masked by suspected optic neuritis and central retinal vein occlusion.
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Kalnins A, Penta M, El-Sawy T, Liao YJ, Fischbein N, and Iv M
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Malignant optic glioma presents a clinical and diagnostic challenge, as early imaging findings overlap with other more common causes of optic nerve enhancement and enlargement, potentially leading to delay in diagnosis. This rare diagnosis carries an extremely poor prognosis, with death usually occurring within 1 year. We present a case of malignant optic glioma that was initially diagnosed as optic neuritis and central retinal vein occlusion, and we emphasize the importance of serial imaging and definitive biopsy to promote early diagnosis and treatment of this entity.
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- 2018
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50. One-year outcomes of ziv-aflibercept for macular edema in central retinal vein occlusion.
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Eldeeb M, Chan EW, Dedhia CJ, Mansour A, and Chhablani J
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Purpose: To report the 12-month efficacy and safety outcomes of intravitreal ziv-aflibercept in macular edema secondary to central retinal vein occlusion (CRVO)., Methods: Interventional case series documenting 12-month outcomes of intravitreal ziv-aflibercept (1.25 mg in 0.05 mL) in 6 patients with treatment-naive macular edema secondary to CRVO. All patients had comprehensive ophthalmic examination, spectral domain optical coherence tomography at baseline and all follow-up visits, and fluorescein. Retreatment decisions were based on recurrence or persistence of intraretinal or subretinal fluid, deterioration in visual acuity (VA), increase in central subfield thickness (CST) by ≥ 50 μm from the previous visit, or lowest recorded CST., Results: Participants had (2 males, 4 females) an average age of 53.5 years. From baseline to 12 months, the mean logMAR VA improved from 0.86 (Snellen ≈ 20/145) to 0.33 (Snellen ≈ 20/40), central macular thickness decreased from 519 μm to 255 μm, and total macular volume decreased from 14.7 mm
3 to 7.1 mm3 . No eyes had uveitis, cataract progression, intraocular pressure (IOP) elevations, or systemic adverse events., Conclusions and Importance: Ziv-aflibercept achieves favorable intermediate-term functional and structural outcomes in macular edema secondary to CRVO. No safety concerns were raised. Low-cost ziv-aflibercept may thus be useful for CRVO in resource-poor countries. Further prospective studies in larger cohorts are needed further establish the efficacy and safety of this agent.- Published
- 2017
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