eMedicine Specialties > Ophthalmology > Retina

Central Retinal Vein Occlusion: Follow-up

Author: Lakshmana M Kooragayala, MD, Vitreo-retinal Surgeon, Marietta Eye Clinic
Contributor Information and Disclosures

Updated: May 26, 2009

Follow-up

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.

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.

Complications

  • Ocular neovascularization22
    • Anterior segment neovascularization leading to neovascular glaucoma
    • Posterior segment neovascularization leading to vitreous hemorrhage
  • Macular edema41,18,28
    • Macular edema is the common cause of decreased vision in CRVO, more so in the nonischemic type.
    • May resolve with good visual return
    • May develop permanent degenerative changes with poor visual prognosis
    • May develop cystoid macular edema leading to lamellar or full-thickness macular hole
  • Cellophane maculopathy and macular pucker
  • Optic atrophy

Prognosis

  • 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.
  • 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.

Patient Education

  • Good control of systemic medical problems
  • Regular medical and ophthalmologic checkups

Miscellaneous

Medicolegal Pitfalls

  • In view of multiple systemic problems these patients can have, it is important to refer patients to an appropriate specialist to avoid any legal ramifications.
    • Initially, these patients should be referred to an internist.
    • Patients may be referred to a retinal specialist and a glaucoma specialist, as required, to treat advanced problems.
 
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.



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References
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Further Reading

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Keywords

central retinal vein occlusion, CRVO, nonischemic central vein occlusion, venous stasis retinopathy, ischemic central vein occlusion, retinal vascular disorder

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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.

Medical Editor

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.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
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.

Managing Editor

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 & 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 Consulting

CME Editor

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.

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