Differences in Contributory Factors among Hemicentral, Central, and Branch Retinal Vein Occlusions

doi:10.1016/S0161-6420(89)32884-3

Ophthalmology

Volume 96, Issue 3, March 1989, Pages 364-366

https://doi.org/10.1016/S0161-6420(89)32884-3 Get rights and content

Abstract

Hemicentral retinal vein occlusion (HRVO) is an anatomic variant of central retinal vein occlusion (CRVO) and thus different from branch retinal vein occlusion (BRVO). Therefore, the risk factors for HRVO should be similar to those of CRVO and different from those of BRVO. To test this, the authors compared 15 demographic and clinical variables of 28 HRVO patients with those of 117 CRVO and 214 BRVO patients. Mean age of onset and sex ratio were not significantly different among the groups. Elevated erythrocyte sedimentation rate (ESR) (P = 0.019) and elevated intraocular pressure (IOP) (P = 0.025) were significantly more prevalent in the HRVO than the BRVO group. In addition, when the authors compared CRVO with BRVO, elevated ESR (P = 0.003), elevated IOP (P = 0.015), and positive purified protein derivative (PPD) (P = 0.003) were significantly more prevalent in the CRVO than the BRVO group, whereas hypertension (P = 0.03) and hyperopia (P = 0.008) were significantly more prevalent in the BRVO group. However, of the variables tested between HRVO and CRVO patients, no significant differences were found.

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In an eye with such a branching pattern, an inferior or superior HRVO may occur if one the venous branches that drain the nasal and temporal retina is occluded.117 Given the various possible scenarios that can result in a HRVO, a consensus as to whether HRVO is a variant of BRVO or CRVO has not been reached.2,26,64 Nevertheless, the National Eye Institute SCORE investigators classified HRVO as a variant of BRVO.118
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.
The association between hypermetropia and essential hypertension
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In this study, we found that there is a strong association of hypertension with hypermetropia (61.4%). Our literature search did not reveal any studies examining the relationship between the refractive state of the eye and hypertension, although many studies demonstrating the association of refractive state with several systemic and ocular conditions existed.4–19 Numerous risk factors and associations, including genetic predisposition, obesity, sedentary lifestyle, regular consumption of alcohol, living in high altitude, hyperuricemia, open-angle glaucoma, color blindness, and asteroid hyalosis have been reported for hypertension.24–33
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To evaluate the prevalence of ocular hypertension (OHT) and glaucoma in patients with central retinal vein occlusion (CRVO) and hemi-CRVO (HCRVO) and of the fall in intraocular pressure (IOP) secondary to CRVO/HCRVO.
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We investigated 674 consecutive patients who were initially seen with unilateral CRVO (n = 548) and HCRVO (n = 126) at their onset, with a normal fellow eye. The fellow uninvolved eye in each patient acted as a control. Central retinal vein occlusion and HCRVO were categorized into nonischemic and ischemic. At all visits, patients had a detailed ocular history, as well as a thorough bilateral ocular evaluation, including IOP recording with a Goldmann applanation tonometer; when the diagnosis of OHT or glaucoma was initially uncertain, the 24-hour diurnal IOP was recorded. The observed prevalence rates of OHT and glaucoma among patients with CRVO and HCRVO were compared with those in the general population.
The prevalence of OHT and glaucoma, and of ocular hypotension secondary to CRVO/HCRVO.
The overall prevalence of glaucoma was 9.9% and of OHT 16.2%. The prevalence of glaucoma/OHT was found to be significantly (P<0.0001) higher in patients with CRVO and HCRVO than in the general population. There was no significant difference in the proportion of patients with glaucoma/OHT among the various types of CRVO/HCRVO (P = 0.156). Forty-eight percent of all patients had lower IOP (≥2 mmHg) in the CRVO/HCRVO eye than in the fellow (uninvolved) eye at their initial evaluation. The prevalence of ocular hypotension was significantly (P<0.0001) higher in patients with glaucoma/OHT not on ocular hypotensive therapy than in patients without glaucoma. Among the patients without glaucoma, the prevalence of ocular hypotension differed significantly among the various types of CRVO/HCRVO (P = 0.007).
Central retinal vein occlusion and HCRVO have a significant association with glaucoma and OHT and with a subsequent fall in IOP in the involved eye. Few patients with CRVO/HCRVO have high IOP in the involved eye, although many of them do have it in the fellow uninvolved eye. It is important to exclude glaucoma/OHT in the fellow eye of any patient with CRVO/HCRVO; if present, elevated IOP should be treated to reduce the risk of that eye developing (1) CRVO/HCRVO and (2) glaucomatous damage. There may be no benefit to prescribing IOP-lowering drops for involved eyes whose IOP is already normal.
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: Presented as a poster at the American Academy of Ophthalmology Annual Meeting, Las Vegas, October 1988.

^a: Dr. Appiah is currently at King/Drew Medical Center, and the Jules Stein Eye Institute, UCLA Center for the Health Sciences, Los Angeles.

View full text

Differences in Contributory Factors among Hemicentral, Central, and Branch Retinal Vein Occlusions

Abstract

Am J Med

Hemi-central retinal vein occlusion: pathogenesis, clinical features, and natural history

Arch Ophthalmol

The visual prognosis in retinal branch vein occlusion

Trans Ophthalmol Soc UK

Hypertensive vascular disease

Diabetes mellitus

Erythrocyte sedimentation rates in the elderly

Arch Ophthalmol