UCL Institute of Ophthalmology, London, UK.
J Glaucoma. 2010 Dec;19(9):643-9. doi: 10.1097/IJG.0b013e3181d12dea.
To describe a series of patients who have sustained a retinal vein occlusion (RVO) and also have primary angle-closure (PAC).
We retrospectively ascertained demographic characteristics (age, sex, and ethnicity), presentation (history and examination findings), investigations undertaken, features of angle-closure or occludable angles (symptoms, method of diagnosis, and treatment), and outcome (intraocular pressure (IOP) and visual acuity).
Nineteen subjects were included in the study, comprising 9 males and 10 females, with an average age of 69 years (range 44 to 86 y). The ethnicity of the group was diverse. The mode of presentation in 75% of patients was that RVO and PAC were diagnosed at the same clinical visit. In the remaining 25% of cases, the diagnosis of PAC was delayed and ranged from 4 months to 9 years after the RVO. Increased IOP on dilation was found to have raised the suspicion of PAC in some patients, either at the time of first presentation with RVO or at a later date during follow-up for the RVO, leading to gonioscopy and a diagnosis of PAC. In 1 patient, an observed asymmetrical cup-to-disc ratio led to gonioscopy and diagnosis of PAC. Fourteen patients sustained a central retinal vein occlusion (CRVO), 2 subjects sustained a hemicentral retinal vein occlusion (HRVO), and 3 patients had a branch retinal vein occlusion. In the vast majority of cases in this series (18/19), no additional systemic risk factors were identified during follow-up apart from those that were present before the RVO. The diagnosis of PAC was made in all patients on the basis of static and dynamic gonioscopy. None of these patients had experienced any symptoms of acute or intermittent IOP rises as a consequence of angle-closure. Fifteen patients were diagnosed with PAC glaucoma in 1 or both eyes. Sixteen subjects (84.0%) underwent peripheral laser iridotomies and 7 patients (37.0%) had lens extraction to improve angle configuration.
Our study supports the belief that angle-closure may be associated with retinal vein occlusions, and should be borne in mind and excluded when investigating the patient with RVO, especially CRVO/HRVO. We suggest that gonioscopy should be done in all patients presenting with RVO.
描述一组发生视网膜静脉阻塞（RVO）且同时患有原发性闭角型青光眼（PAC）的患者。
我们回顾性地确定了患者的人口统计学特征（年龄、性别和种族）、表现（病史和检查结果）、所进行的检查、闭角或可闭性房角的特征（症状、诊断方法和治疗）以及结果（眼压（IOP）和视力）。
研究纳入了 19 名受试者，包括 9 名男性和 10 名女性，平均年龄为 69 岁（范围 44 至 86 岁）。该组的种族多样。75%的患者以 RVO 和 PAC 同时在同一临床就诊中诊断出的模式就诊。在其余 25%的病例中，PAC 的诊断被延迟，范围从 RVO 后 4 个月至 9 年不等。在一些患者中，散瞳后眼压升高提示 PAC 的可能性，无论是在首次出现 RVO 时，还是在 RVO 随访期间的后期，都可能导致房角镜检查和 PAC 的诊断。在 1 名患者中，观察到的不对称杯盘比导致房角镜检查和 PAC 的诊断。14 名患者发生视网膜中央静脉阻塞（CRVO），2 名患者发生半中央视网膜静脉阻塞（HRVO），3 名患者发生分支视网膜静脉阻塞。在该系列的绝大多数病例（19 例中的 18 例）中，除了 RVO 之前存在的那些系统风险因素外，在随访期间没有发现其他额外的系统风险因素。根据静态和动态房角镜检查，所有患者均被诊断为 PAC。这些患者中没有任何人因房角关闭而出现急性或间歇性眼压升高的症状。15 名患者在 1 只或 2 只眼中被诊断为 PAC 青光眼。16 名患者（84.0%）接受了周边激光虹膜切开术，7 名患者（37.0%）接受了晶状体切除术以改善房角结构。
我们的研究支持这样一种信念，即房角关闭可能与视网膜静脉阻塞有关，在对 RVO 患者进行检查时应牢记并排除这一点，尤其是 CRVO/HRVO。我们建议在所有出现 RVO 的患者中进行房角镜检查。
