Central Retinal Vein Occlusion Follow-up

  • Author: Lakshmana M Kooragayala, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Jan 5, 2011
 

Further Outpatient Care

Since neovascular complications and development of second venous occlusions can develop after central retinal vein occlusion (CRVO), all of these patients need follow-up care for long periods of time.

CVOS recommended careful observation with frequent follow-up examinations in the early months for detection of iris neovascularization and prompt treatment.

Patients with poor initial visual acuity should be monitored every month during the first few months and spaced thereafter, depending on the course of the disease. These criteria apply more for patients with ischemic CRVO than with patients with nonischemic CRVO.

With any associated complications, follow-up care should be individualized.

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Deterrence/Prevention

Optimal control of associated systemic diseases may reduce the incidence of similar occlusions in the fellow eye.

Even though controversial, good control of intraocular pressure in patients known to have glaucoma may prevent CRVO.

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Complications

Ocular neovascularization is a potential complication.[24] Anterior segment neovascularization can lead to neovascular glaucoma. Posterior segment neovascularization can lead to vitreous hemorrhage.

Macular edema is another potential complication.[19, 33, 46] Macular edema is the common cause of decreased vision in CRVO, more so in the nonischemic type. It may resolve with good visual return. The patient may develop permanent degenerative changes with poor visual prognosis and may develop cystoid macular edema leading to lamellar or full-thickness macular hole.

Other potential complications include cellophane maculopathy and macular pucker, as well as optic atrophy.

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Prognosis

For nonischemic CRVO, complete recovery with good visual recovery occurs only in about 10% of cases. Fifty percent of patients will have 20/200 or worse vision. About one third of patients convert to ischemic CRVO. CVOS noted that, of 547 eyes initially diagnosed to have nonischemic central retinal vein obstructions, 185 (34%) progressed to become ischemic central retinal vein obstructions within 3 years; 15% converted within the first 4 months.

For ischemic CRVO, more than 90% of patients will have 20/200 or worse vision. About 60% of patients develop ocular neovascularization with associated complications. About 10% of patients can develop CRVO or other type of vein occlusions within either the same eye or the contralateral eye within 2 years.

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Patient Education

Good control of systemic medical problems is important, as are regular medical and ophthalmologic checkups.

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Contributor Information and Disclosures
Author

Lakshmana M Kooragayala, MD  Vitreo-retinal Surgeon, Marietta Eye Clinic

Lakshmana M Kooragayala, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, and Medical Association of Georgia

Disclosure: Nothing to disclose.

Specialty Editor Board

V Al Pakalnis, MD, PhD  Professor of Ophthalmology, University of South Carolina School of Medicine; Chief of Ophthalmology, Dorn Veterans Affairs Medical Center

V Al Pakalnis, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and South Carolina Medical Association

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Steve Charles, MD  Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine; Adjunct Professor of Ophthalmology, Columbia College of Physicians and Surgeons; Clinical Professor Ophthalmology, Chinese University of Hong Kong

Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Club Jules Gonin, Macula Society, and Retina Society

Disclosure: Alcon Laboratories Consulting fee Consulting; OptiMedica Ownership interest Other; Topcon Medical Lasers Consulting fee Consulting

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the assistance of Ryan I Huffman, MD, with the literature review and referencing for this article.

References

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Recent onset central retinal vein occlusion, showing extensive hemorrhages in the posterior pole and giving the "blood and thunder appearance."
Peripheral fundus view of the same patient as in the previous image, showing hemorrhages extending all over the fundus.
Fluorescein angiograph of same patient as in previous images, showing hypofluorescence due to blockage from hemorrhages in the retina. It is not useful to perform a fluorescein angiogram in acute stages of the disease.
Fundus picture of the same patient as in previous images, showing resolving neovascularization of the disc and panretinal photocoagulation scars.
Fluorescein angiogram of the same patient as in the previous images, taken more than 1 year later, showing persistent cystoid macular edema with good laser spots.
Patient with nonischemic central retinal vein occlusion presented with dilated, tortuous veins and superficial hemorrhages.
Fundus picture of the same patient as in previous image, showing resolved hemorrhages and pigmentary changes in the macula several months later.
Central retinal vein occlusion showing significant disc edema with dilated tortuous veins and scattered retinal hemorrhages.
Fluorescein angiogram of the same patient in as in previous image, showing leakage from disc, staining of retinal veins.
Fundus of a patient with nonischemic central retinal vein occlusion, showing few scattered peripheral fundus hemorrhages.
Scattered retinal hemorrhages in a patient with central retinal vein occlusion.
Fluorescein angiogram of a patient with nonischemic central retinal vein occlusion, showing staining of dilated tortuous veins with leakage into macula in a cystoid pattern.
Fluorescein angiogram of the same patient as in previous image, showing perifoveal capillary leakage in a cystoid pattern in late phases of angiogram.
Late phase of fluorescein angiograph of the same patient as in previous image, showing cystoid pattern of leakage from perifoveal dilated leaking capillary network.
Arteriovenous phase of fluorescein angiograph showing perifoveal capillary leakage in a patient with nonischemic central retinal vein occlusion.
Fundus picture of a well-compensated, old central retinal vein occlusion showing optociliary shunt vessels.
Red-free photo of the same patient as in the previous image, showing prominent optociliary shunt vessels.
 
 
 
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