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Sharon Fekrat - One of the best experts on this subject based on the ideXlab platform.
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retinal Vein Occlusion beyond the acute event
Survey of Ophthalmology, 2011Co-Authors: Justis P Ehlers, Sharon FekratAbstract: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.
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radial optic neurotomy as treatment for central retinal Vein Occlusion
American Journal of Ophthalmology, 2003Co-Authors: Jennifer S Weizer, Sandra S Stinnett, Sharon FekratAbstract:Abstract Purpose To review our initial experience with radial optic neurotomy as treatment for retinal Vein Occlusion. Design Interventional case series. Methods Patient population: five patients (four with central retinal Vein Occlusion and one with hemiretinal Vein Occlusion). Intervention Pars plana vitrectomy with radial optic neurotomy was performed in each case. Main outcome measures Best-corrected visual acuity, presence of macular edema, perfusion status, and time to venous phase of the angiogram were reviewed retrospectively. Results Mean preoperative visual acuity was 4/200. Preoperatively, the Vein Occlusion was perfused in one (20%), nonperfused in one (20%), and indeterminate in three (60%). Mean follow-up time was 4.5 months. Mean postoperative visual acuity was 20/400 at last follow-up. Four patients (80%) had improvement in visual acuity and one (20%) worsened. Two patients (40%) improved to 20/80 postoperatively. In four cases (80%), disk congestion improved and intraretinal hemorrhage reabsorbed more quickly than would be expected without treatment. Time to the venous phase of fluorescein angiography improved slightly in three cases (60%) postoperatively. Perfusion status as determined by fluorescein angiography was not significantly altered postoperatively. One patient (20%) had resolution of macular edema postoperatively as shown by volumetric optical coherence tomography. One patient developed choroidovitreal neovascularization and one developed iris neovascularization postoperatively, both of which responded to panretinal photocoagulation. Conclusion Radial optic neurotomy may improve visual acuity in eyes with central retinal Vein Occlusion, although choroidovitreal neovascularization from the neurotomy site can occur. Further study is needed to determine its role in the management of central Vein Occlusion.
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chorioretinal venous anastomosis for central retinal Vein Occlusion transvitreal venipuncture
Ophthalmic Surgery and Lasers, 1999Co-Authors: Sharon Fekrat, E De JuanAbstract:The authors describe an eye with a central retinal Vein Occlusion that developed chorioretinal anastomoses following transvitreal venipuncture, a vitreoretinal surgical technique.
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laser induced chorioretinal venous anastomosis for nonischemic central or branch retinal Vein Occlusion
Archives of Ophthalmology, 1998Co-Authors: Sharon Fekrat, Morton F Goldberg, Daniel FinkelsteinAbstract:Objective To establish a communication between an obstructed retinal Vein and the choroid by means of laser in eyes with nonischemic central or branch Vein Occlusion. Methods Retrospective review identified eyes with nonischemic central or branch Vein Occlusion, and with decreasing or persistently decreased visual acuity of 20/100 or worse for 4 months or more before treatment, that received 1 or more sessions of laser photocoagulation to create a chorioretinal anastomosis. Results Of 24 eyes with central Vein Occlusion, an anastomosis formed in 9 (38%) within 2 months after treatment, with visual improvement of 6 or more lines in 2 (8%) of 24 eyes, 1 to 3 lines in 5 (21%), and no improvement in 2 (8%). Of 6 eyes with branch Vein Occlusion, an anastomosis formed in 3 (50%) within 2 months after treatment, with visual improvement of 1 to 3 lines in 2 (33%) of 6 and no improvement in 1 (16%). No permanent, vision-limiting complications occurred during a mean follow-up of 13 months after the first treatment session or 8 months after the last session. Conclusions Laser photocoagulation of a retinal Vein and Bruch's membrane may create a chorioretinal anastomosis in some eyes with a nonischemic Vein Occlusion. Progression to an ischemic status may possibly be prevented with successful anastomosis formation. Marked visual improvement may occur. Treatment techniques to create reliably an anastomosis with subsequent visual improvement, while minimizing potential complications, continue to evolve.
Sohan Singh Hayreh - One of the best experts on this subject based on the ideXlab platform.
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fundus changes in central retinal Vein Occlusion
Retina-the Journal of Retinal and Vitreous Diseases, 2015Co-Authors: Sohan Singh Hayreh, Bridget M ZimmermanAbstract:The clinical entity of central retinal Vein Occlusion (CRVO) has been known since 18781 and it is a common, visually disabling disorder. Yet, a Medline literature search revealed little comprehensive information on the various retinal and optic disc changes, from any study with large cohort of eyes with CRVO. We investigated this in 581 eyes of 562 patients with CRVO, as well as their natural history.
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retinal Vein Occlusion and the optic disk
Retina-the Journal of Retinal and Vitreous Diseases, 2012Co-Authors: Sohan Singh Hayreh, Bridget M Zimmerman, Patricia PodhajskyAbstract:PURPOSE: To investigate the effect of cup to disk (C/D) ratio in various types of retinal Vein Occlusion (RVO) on the severity of retinopathy, visual outcome, and resolution of retinopathy and validity of the concept of the "compartment syndrome" in RVO. METHODS: The study comprised 1,222 consecutive eyes (768 central retinal Vein Occlusion [CRVO], 183 hemi-CRVO, and 271 branch retinal Vein Occlusion). Ophthalmic evaluation at initial and follow-up visits included recording visual acuity, visual fields, and detailed anterior segment and fundus examinations and fluorescein fundus angiography. RESULTS: Compared to sex-matched and age-matched normal eyes, C/D ratio ≥0.5 was significantly more common in all CRVOs and hemi-CRVO eyes but not in branch retinal Vein Occlusion. Retinal hemorrhages were significantly more severe in nonischemic CRVO with C/D ratio ≥0.5 compared to those with no or small cup, but no difference was found in hemi-CRVO and branch RVO. In ischemic CRVO, moderate hemorrhages were more with C/D ≥0.5 but severe hemorrhages were more with no cup. In various types of RVO, there was no significant association of C/D ratio with macular edema, retinopathy resolution, visual acuity, and visual field defect. CONCLUSION: The findings of our study contradict the concept that the "compartment syndrome" plays any role in the prevalence of various types of RVO or in their severity, the resolution of retinopathy, or the visual outcome. This indicates that the advocated procedure of radial optic neurotomy, based on the compartment syndrome, is not a logical treatment for CRVO.
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ocular neovascularization associated with central and hemicentral retinal Vein Occlusion
Retina-the Journal of Retinal and Vitreous Diseases, 2012Co-Authors: Sohan Singh Hayreh, Bridget M ZimmermanAbstract:Purpose:To investigate the incidence of ocular neovascularization (NV) in central and hemicentral retinal Vein Occlusion.Methods:The study comprised consecutive 912 (673 nonischemic and 239 ischemic) central retinal Vein Occlusion and 190 (147 nonischemic, 43 ischemic) hemicentral retinal Vein occlu
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central retinal Vein Occlusion
Encyclopedia of the Eye, 2010Co-Authors: Sohan Singh HayrehAbstract:Central retinal Vein Occlusion (CRVO) is of two types – ischemic and nonischemic. The two have very different pathogenesis, prognosis, visual outcome, and management. Ischemic CRVO is associated with ocular neo-vascularization and neovascular glaucoma, with poor visual outcome. Nonischemic CRVO has a much better visual outcome and no neovascularization. Therefore, it is crucial to differentiate the two types. The main treatments advocated for CRVO are medical, surgical, and panretinal photocoagulation. Surgical treatments have no rationale. The role of photocoagulation is still controversial. So far there is no treatment for CRVO that has stood the test of time for safety, efficacy, and long-term curative effect.
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central retinal Vein Occlusion associated with cilioretinal artery Occlusion
Retina-the Journal of Retinal and Vitreous Diseases, 2008Co-Authors: Sohan Singh Hayreh, Lynn Fraterrigo, Jost B JonasAbstract:Purpose:To describe the clinical characteristics and pathogenesis of central retinal Vein Occlusion (CRVO) associated with cilioretinal artery Occlusion (CLRAO).Methods:The study included 38 patients (38 eyes) who had CRVO associated with CLRAO and were seen in our clinic from 1974 to 1999. At their
Akitaka Tsujikawa - One of the best experts on this subject based on the ideXlab platform.
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persistent metamorphopsia associated with branch retinal Vein Occlusion
PLOS ONE, 2018Co-Authors: Rie Osaka, Koichiro Manabe, Yuki Nakano, Chieko Shiragami, Kazuyuki Hirooka, Yuki Muraoka, Saki Manabe, Yukari Takasago, Akitaka TsujikawaAbstract:Purpose To investigate longitudinal changes in metamorphopsia associated with branch retinal Vein Occlusion. Methods In this prospective observational case series, we included 32 eyes (32 patients) with branch retinal Vein Occlusion and acute macular edema. Eyes were treated as needed with intravitreal ranibizumab injections for 12 months. At baseline and 1, 6, and 12 months after initiating treatment, metamorphopsia was quantified using M-CHARTS. Retinal morphology was examined through optical coherence tomography. Results Logarithm of the minimum angle of resolution visual acuity progressively improved from 0.342 ± 0.304 (Snellen equivalent: 20/44) at baseline to 0.199 ± 0.259 (20/32) and 0.118 ± 0.195 (20/26) at 1 and 12 months, respectively (both P < 0.001). The M-CHARTS score significantly decreased from 0.63 ± 0.61 at baseline to 0.45 ± 0.50 at 1 month (P = 0.044), but no further improvement was achieved with 1 year of additional treatment (6 months: 0.47 ± 0.53 [P = 0.094] and 12 months: 0.50 ± 0.44 [P = 0.173]). Three (13.6%) of 22 eyes with baseline metamorphopsia had complete metamorphopsia resolution. At 12 months, the M-CHARTS score was correlated with baseline foveal thickness (r = 0.373, P = 0.035) and the baseline M-CHARTS score (r = 0.503, P = 0.003). A multiple regression analysis revealed that only the baseline M-CHARTS score was correlated with the 12-month M-CHARTS score (β = 0.460, P = 0.027). Conclusions Eyes with branch retinal Vein Occlusion often have persistent metamorphopsia, even when visual acuity and retinal morphology improve. Metamorphopsia at 12 months was correlated with metamorphopsia and foveal thickness at baseline.
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characteristics of optical coherence tomographic hyperreflective foci in retinal Vein Occlusion
Retina-the Journal of Retinal and Vitreous Diseases, 2012Co-Authors: Ken Ogino, Masafumi Ota, Akitaka Tsujikawa, Kazuaki Miyamoto, Atsushi Sakamoto, Tomoaki Murakami, Nagahisa YoshimuraAbstract:PURPOSE To evaluate the hyperreflective foci in branch retinal Vein Occlusion and central retinal Vein Occlusion depicted by spectral-domain optical coherence tomography (OCT). METHODS Consecutive series of 73 eyes of 73 patients with retinal Vein Occlusion (58 branch retinal Vein Occlusion and 15 central retinal Vein Occlusion) who had Spectralis OCT images obtained were retrospectively reviewed, comparing color fundus photographs and fluorescein angiography. RESULTS Hyperreflective foci were detected in 54 eyes (74.0%) by spectral-domain OCT, and hard exudates were detected in 17 eyes (23.3%) by color fundus photography. Hard exudates on the color photographs corresponded to the confluence of hyperreflective foci mainly around the outer plexiform layer in the unaffected areas on the spectral-domain OCT images, whereas fine hyperreflective foci were scattered in all retinal layers of the affected areas (P < 0.001). Most eyes with hyperreflective foci attached to the inner side of the external limiting membrane also had serous retinal detachment (P < 0.001). Compared with diabetic macular edema, we did not find subfoveal hard exudates in retinal Vein Occlusion. CONCLUSION Hyperreflective foci delineated on spectral-domain OCT suggest the pathogenesis regarding the flow of extravasated blood constituents in retinal Vein Occlusion.
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serous retinal detachment associated with retinal Vein Occlusion
American Journal of Ophthalmology, 2010Co-Authors: Akitaka Tsujikawa, Masafumi Ota, Mihori Kita, Kazuaki Miyamoto, Atsushi Sakamoto, Yuriko Kotera, Nagahisa YoshimuraAbstract:Purpose To study the pathomorphology of serous retinal detachment (RD) associated with retinal Vein Occlusion by optical coherence tomography (OCT). Design Retrospective chart review. Methods Ninety-one eyes of 91 patients with macular edema associated with retinal Vein Occlusion had undergone a comprehensive ophthalmologic examination, including measurement by spectral-domain OCT. Results Eyes with macular edema associated with retinal Vein Occlusion typically showed foveal cystoid spaces and marked retinal swelling, especially in the outer retina. In addition, 76 eyes (83.5%) showed serous RD involving the fovea, which ranged in thickness from 64 μm to 871 μm (219.2 ± 161.6 μm). Fifty-two eyes showed a small pointed RD, with a small base. The point of the RD was always located beneath the fovea, where the outer surface of the swollen neurosensory retina seemed to be contracted inward, resulting in development of the pointed RD. Two eyes with no RD at the initial visit developed such a pointed RD during follow-up. In contrast, 24 eyes showed a more dome-shaped RD, with a large base, and in 18 eyes, a pointed RD seen at the initial visit changed into a dome-shaped RD during follow-up. In some cases, small outer retinal discontinuity was seen on the external surface of the swollen neurosensory retina. Conclusions In eyes with retinal Vein Occlusion, a small pointed RD initially developed just beneath the fovea, but subsequently changed into a dome-shaped RD. Based on the findings by OCT, we hypothesize that the foveal architecture, especially that of the Muller cell cone, is involved in the formation of serous RD.
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integrity of foveal photoreceptor layer in central retinal Vein Occlusion
Retina-the Journal of Retinal and Vitreous Diseases, 2008Co-Authors: Masafumi Ota, Akitaka Tsujikawa, Mihori Kita, Kazuaki Miyamoto, Atsushi Sakamoto, Noritatsu Yamaike, Yuriko Kotera, Nagahisa YoshimuraAbstract:PURPOSE To study the correlation between final visual acuity and integrity of the foveal photoreceptor layer after resolution of macular edema (ME) associated with central retinal Vein Occlusion (CRVO). METHODS We studied retrospectively 27 eyes of 27 patients with resolved ME associated with central retinal Vein Occlusion. On optical coherence tomography, integrity of the foveal photoreceptor layer was studied using the junctions between inner and outer segments of the photoreceptor (IS/OS) line as a hallmark. RESULTS At the final visit, foveal thickness was decreased to a physiologic level in all eyes. On optical coherence tomography, 14 eyes showed the IS/OS line in the fovea, whereas 13 eyes showed no IS/OS line. In concordance with resolution of the ME, visual acuity had improved significantly by the final visit. However, final visual acuity in eyes without an IS/OS line was significantly poorer than that in eyes with an IS/OS line (P < 0.0001). In addition, integrity of the foveal photoreceptor layer after resolution of the ME had a significant correlation with the initial retinal perfusion status (P = 0.0156) and with initial visual acuity (P = 0.0050). CONCLUSIONS After resolution of the ME associated with central retinal Vein Occlusion, visual acuity is closely associated with integrity of the foveal photoreceptor layer.
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visual field defect after radial optic neurotomy for central retinal Vein Occlusion
Japanese Journal of Ophthalmology, 2006Co-Authors: Akitaka Tsujikawa, Masanori Hangai, Masashi Kikuchi, Kazuhiro Ishida, Yasuo KurimotoAbstract:Purpose To evaluate visual field defects after radial optic neurotomy (RON) in eyes with central retinal Vein Occlusion (CRVO).
David J Browning - One of the best experts on this subject based on the ideXlab platform.
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patchy ischemic retinal whitening in acute central retinal Vein Occlusion
Ophthalmology, 2002Co-Authors: David J BrowningAbstract:Abstract Objective To describe a new fundus abnormality in nonischemic central retinal Vein Occlusion and its pathophysiologic basis. Design Retrospective, observational case series. Participants Eleven consecutive patients from a community-based retina referral practice who had central retinal Vein Occlusion (CRVO) and patchy ischemic retinal whitening (PIRW) and 225 consecutive patients from the same practice with CRVO and no PIRW. Results Patchy ischemic retinal whitening occurs in younger patients with nonischemic CRVO ( P P = 0.0201). Patchy ischemic retinal whitening has a perivenular distribution in the macula, has no fluorescein angiographic correlate in milder cases, can occur before any retinal hemorrhages or macular edema, and resolves in 2 to 4 weeks. Cilioretinal arteriolar insufficiency is a common finding associated with PIRW (5/11 cases). The laboratory evaluation of patients with PIRW is generally normal. Conclusions Patchy ischemic retinal whitening is a useful fundus sign of nonischemic CRVO that can precede other signs. Familiarity with this sign and its correlates will allow accurate diagnosis and counseling of affected patients.
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vitreous hemorrhage complicating laser induced chorioretinal anastomosis for central retinal Vein Occlusion
American Journal of Ophthalmology, 1996Co-Authors: David J Browning, Michael H RotbergAbstract:Purpose To report a severe complication of laser chorioretinal anastomosis for central retinal Vein Occlusion. Method Case report. Results In the right eye of a 62-year-old woman with nonischemic central retinal Vein Occlusion, retinal neovascularization at the laser chorioretinal anastomosis site caused dense secondary vitreous hemorrhage. Vitreous hemorrhage prevented laser panretinal photocoagulation for subsequent iris neovascularization, necessitating vitrectomy surgery to clear the hemorrhage and allow the treatment. Conclusion Laser chorioretinal anastomosis can result in severe vitreous hemorrhage and complicate efforts to manage later sequelae of central retinal Vein Occlusion.
Patricia Podhajsky - One of the best experts on this subject based on the ideXlab platform.
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retinal Vein Occlusion and the optic disk
Retina-the Journal of Retinal and Vitreous Diseases, 2012Co-Authors: Sohan Singh Hayreh, Bridget M Zimmerman, Patricia PodhajskyAbstract:PURPOSE: To investigate the effect of cup to disk (C/D) ratio in various types of retinal Vein Occlusion (RVO) on the severity of retinopathy, visual outcome, and resolution of retinopathy and validity of the concept of the "compartment syndrome" in RVO. METHODS: The study comprised 1,222 consecutive eyes (768 central retinal Vein Occlusion [CRVO], 183 hemi-CRVO, and 271 branch retinal Vein Occlusion). Ophthalmic evaluation at initial and follow-up visits included recording visual acuity, visual fields, and detailed anterior segment and fundus examinations and fluorescein fundus angiography. RESULTS: Compared to sex-matched and age-matched normal eyes, C/D ratio ≥0.5 was significantly more common in all CRVOs and hemi-CRVO eyes but not in branch retinal Vein Occlusion. Retinal hemorrhages were significantly more severe in nonischemic CRVO with C/D ratio ≥0.5 compared to those with no or small cup, but no difference was found in hemi-CRVO and branch RVO. In ischemic CRVO, moderate hemorrhages were more with C/D ≥0.5 but severe hemorrhages were more with no cup. In various types of RVO, there was no significant association of C/D ratio with macular edema, retinopathy resolution, visual acuity, and visual field defect. CONCLUSION: The findings of our study contradict the concept that the "compartment syndrome" plays any role in the prevalence of various types of RVO or in their severity, the resolution of retinopathy, or the visual outcome. This indicates that the advocated procedure of radial optic neurotomy, based on the compartment syndrome, is not a logical treatment for CRVO.
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systemic diseases associated with various types of retinal Vein Occlusion
American Journal of Ophthalmology, 2001Co-Authors: Sohan Singh Hayreh, Bridget Zimmerman, Mark Mccarthy, Patricia PodhajskyAbstract:Abstract PURPOSE: To investigate systemic diseases associated with various types of retinal Vein Occlusion. METHODS: We investigated prospectively in 1090 consecutive patients with retinal Vein Occlusion, almost all Caucasian (consistent with the racial pattern here), the prevalence of associated systemic disorders before or at the onset of various types of retinal Vein Occlusion. The patients were categorized into six types of retinal Vein Occlusion based on defined criteria: nonischemic and ischemic central retinal Vein Occlusion, nonischemic and ischemic hemi-central retinal Vein Occlusion, and major and macular branch retinal Vein Occlusion. The patients had a detailed ophthalmic and systemic evaluation according to our protocol. For data analysis, patients were divided into three age groups: young (younger than 45 years), middle-aged (45 to 64 years), and elderly (65 years or older). The observed prevalence rates of major systemic diseases were compared among central retinal Vein Occlusion, hemi-central retinal Vein Occlusion, and branch retinal Vein Occlusion using a polytomous logistic regression analysis adjusting for gender and age. Logistic regression adjusting for age and gender was also used to compare the observed prevalence of systemic disease between nonischemic and ischemic in central retinal Vein Occlusion and hemi-central retinal Vein Occlusion and between major and macular branch retinal Vein Occlusion. These observed prevalence rates were also compared with those expected in a gender-matched and age-matched control population from estimates from the US National Center for Health Statistics. RESULTS: There was a significantly higher prevalence of arterial hypertension in branch retinal Vein Occlusion compared with central retinal Vein Occlusion ( P P = .028). Branch retinal Vein Occlusion also had a significantly higher prevalence of peripheral vascular disease ( P = .0002), venous disease ( P = .011), peptic ulcer ( P = .031), and other gastrointestinal disease ( P P = .049) greater than that of the combined group of patients with central retinal Vein Occlusion and patients with hemi-central retinal Vein Occlusion. There was no significant difference in prevalence of any systemic disease between central retinal Vein Occlusion and hemi-central retinal Vein Occlusion. A significantly greater prevalence of arterial hypertension ( P = .025) and diabetes mellitus ( P = .011) was present in the ischemic central retinal Vein Occlusion compared with the nonischemic central retinal Vein Occlusion. Similarly, arterial hypertension ( P = .0002) and ischemic heart disease ( P = .048) were more prevalent in major branch retinal Vein Occlusion than in macular branch retinal Vein Occlusion. Relative to the US white control population, the combined group of patients with central retinal Vein Occlusion and patients with hemi-central retinal Vein Occlusion had a higher prevalence of arterial hypertension ( P P P P P ≤ .005), cerebrovascular disease ( P = .007), chronic obstructive pulmonary disease ( P = .012), peptic ulcer ( P P = .0005), and thyroid disorder ( P = .003) compared with the US white control population. CONCLUSIONS: The findings of our study revealed that a variety of systemic disorders may be present in association with different types of retinal Vein Occlusion and in different age groups, and that their relative prevalence differs significantly, so that the common practice of generalizing about these disorders for the entire group of patients with retinal Vein Occlusion can be misleading. The presence of a particular associated systemic disease does not necessarily imply a cause-and-effect relationship with that type of retinal Vein Occlusion; the particular disease may or may not be one of the risk factors in a multifactorial scenario predisposing an eye to develop a particular type of retinal Vein Occlusion. Based on our study, we think that apart from a routine medical evaluation, an extensive and expensive workup for systemic diseases is unwarranted in the vast majority of patients with retinal Vein Occlusion.
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incidence of various types of retinal Vein Occlusion and their recurrence and demographic characteristics
American Journal of Ophthalmology, 1994Co-Authors: Sohan Singh Hayreh, Bridget M Zimmerman, Patricia PodhajskyAbstract:We analyzed data on 1,108 patients (1,229 eyes) with various types of retinal Vein Occlusion. Retinal Vein Occlusion was classified into six distinct clinical types: (I) nonischemic and (II) ischemic central retinal Vein Occlusion, (III) nonischemic and (IV) ischemic hemicentral retinal Vein Occlusion, and (V) major and (VI) macular branch retinal Vein Occlusion. Retinal Vein Occlusion occurred more often in men than women. The age range of patients was between 14 and 92 years, with 570 of 1,108 patients (51%) 65 years or older; however, 99 of 620 (16%), 15 of 154 (10%), and 17 of 375 (5%) of the patients with central, hemicentral, and branch retinal Vein Occlusion, respectively, were younger than 45 years. The cumulative probability of developing a second episode of the same or a different type of retinal Vein Occlusion in the same eye was 0.9% within two years and 2.5% within four years, and in the fellow eye was 7.7% and 11.9%, respectively. The cumulative probability of conversion of nonischemic to ischemic central retinal Vein Occlusion at six months and 18 months was 13.2% and 18.6%, respectively, in persons 65 years of age or older and 6.7% and 8.1%, respectively, in persons 45 to 64 years of age.
