Hayreh Sohan Singh, Zimmerman M Bridget, Beri Meena, Podhajsky Patricia
Department of Ophthalmology and Visual Sciences, College of Medicine, University of Iowa, Iowa City, Iowa 52242, USA.
Ophthalmology. 2004 Jan;111(1):133-41. doi: 10.1016/j.ophtha.2003.03.002.
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.
Nonrandomized comparative case series.
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 (>/==" BORDER="0">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.
评估视网膜中央静脉阻塞（CRVO）和半侧视网膜中央静脉阻塞（HCRVO）患者中高眼压症（OHT）和青光眼的患病率，以及CRVO/HCRVO继发的眼压（IOP）下降情况。
非随机对照病例系列研究。
我们调查了674例初诊时为单侧CRVO（n = 548）和HCRVO（n = 126）且对侧眼正常的连续患者。每位患者的对侧未受累眼作为对照。CRVO和HCRVO分为非缺血性和缺血性。在所有就诊时，患者均有详细的眼部病史，并接受全面的双眼眼部评估，包括使用Goldmann压平眼压计记录眼压；当OHT或青光眼的诊断最初不确定时，记录24小时昼夜眼压。将CRVO和HCRVO患者中OHT和青光眼的观察患病率与一般人群中的患病率进行比较。
OHT和青光眼的患病率，以及CRVO/HCRVO继发的低眼压患病率。
青光眼的总体患病率为9.9%，OHT为16.2%。发现CRVO和HCRVO患者中青光眼/OHT的患病率显著高于一般人群（P<0.0001）。不同类型的CRVO/HCRVO中青光眼/OHT患者的比例无显著差异（P = 0.156）。在初次评估时，所有患者中有48%的CRVO/HCRVO眼眼压低于对侧（未受累）眼（>/==" BORDER="0">2 mmHg）。未接受降眼压治疗的青光眼/OHT患者中低眼压的患病率显著高于无青光眼患者（P<0.0001）。在无青光眼的患者中，不同类型的CRVO/HCRVO中低眼压的患病率有显著差异（P = 0.007）。
视网膜中央静脉阻塞和HCRVO与青光眼和OHT以及受累眼随后的眼压下降有显著关联。很少有CRVO/HCRVO患者受累眼眼压高，尽管他们中许多人对侧未受累眼眼压高。对于任何CRVO/HCRVO患者，排除对侧眼的青光眼/OHT很重要；如果存在眼压升高，应进行治疗以降低该眼发生（1）CRVO/HCRVO和（2）青光眼性损害的风险。对于眼压已正常的受累眼，开具降眼压滴眼液可能没有益处。
