FOR EYE DOCTORS

 

The most up-to-date data on the first 150 eyes with central retinal vein occlusion (CRVO) and 17 eyes with hemispheric retinal vein occlusion (HRVO) treated with Retinal Endovascular Surgery (REVS) was presented at the American Society of Retina Specialists (ASRS) Annual Meeting on August 20, 2003. The pre-operative characteristics and postoperative results and complications for both groups are listed below.

CRVO

Pre-Op

• 150 eyes of 150 patients (ages 25 – 90 years, mean 66 years), 60 men, 78 left eyes
• CVO average duration = 4.3 months (0.25 – 60; median 2.5 months)
• 131 (87%) with < 20/200 visual acuity
• 98 (65%) Central Vein Occlusion Study (CVOS) type “indeterminate” or “nonperfused”
• 86 (57%) with posterior vitreous detachment (PVD)
• 65 (43%) with afferent pupillary defect (APD)
• 23 (15%) with pre-existing anterior segment neovascularization (ASN)
• 23 (15%) pseudophakic/aphakic
• 20 (13%) with history of fellow eye retinal vein occlusion

 

Post-Op

• 78 (52%) recovered > 3 lines of acuity within 4 months of REVS
• 21 (14%) recovered > 8 lines of acuity within 4 months
• 51 of 102 (48%) had recovered > 3 lines of acuity at the 1 year followup examination
  

Acuity (lines)	CVOS-4 mo. (n = 150)	CVOS-12 mo. (n = 140)	t-PA- 4 mo. (n = 150)	t-PA-12 mo. (n = 102)
> 8	0% (0)	0% (0)	14% (21)	17% (17)
> 4, < 8	2% (3)	1% (2)	27% (41)	25% (26)
> 3, < 4	1% (2)	4% (6)	11% (16)	8%  (8)
> 3	3% (5)	6% (8)	52% (78)	50% (51)

¹Evaluation of grid pattern photocoagulation for macular edema in central vein occlusion: The Central Vein Occlusion Study Group M report. The Central Vein Occlusion Study Group. Ophthalmology 1995; 102:1425-33. Note: ~ 50% of the CVOS eyes had grid laser.

HRVO

Pre-Op

• 17 eyes of 17 patients (ages 47-86 years, mean 73 years), 8 men, 11 right eyes)
• HVO average duration = 3 months (0.25 – 10 months; median 2 months)
• 12 eyes < 20/200 visual acuity
• 10 eyes with PVD
• 6 eyes with APD
• 6 eyes pseudophakic/aphakic

Post-Op

• 13 eyes recovered > 1 line of visual acuity
• 11 eyes had recovered > 3 lines of acuity by 4 months and at last follow-up (2-15 months, average 7.3 months)
• 6 eyes recovered > 5 lines at last follow-up
• 2 eyes recovered > 8 lines at last follow-up

 

Postoperative Complications following REVS (167 Cases)

• 32 (19%) developed recurrent/persistent cystoid macular edema
• 23 (14%) eyes developed vitreous hemorrhage (17 of 150 (11%) CRVO cases, 1 of 15 HRVO cases)

Average time to onset – 4 months (range 1 day to 24 months)

18 were CVOS type I or N pre-op

5 had pre-op ASN

6 had subsequent vitreous washout procedures

4 spontaneously cleared

• 14 (8%) had new/progressive ASN (all CRVO cases)

Average time to onset – 1.8 months (range 0.5 to 3 months)

All were CVOS type I or N pre-op

4 had subsequent glaucoma tube procedures, 7 panretinal laser procedures

3 spontaneously regressed with topical steroids and cycloplegia.

• 8 (4.8%) retinal detachments
• 6 (3.6%) re-occluded
• 4 (2.4%) macular puckers
• 2 (1.2%) macular holes