Department of Ophthalmology and Visual Sciences, College of Medicine, University of Iowa, Iowa City, Iowa.
Ophthalmology. 2011 Aug;118(8):1603-11. doi: 10.1016/j.ophtha.2011.04.036. Epub 2011 Jun 24.
To investigate systematically the role of anti-platelet-aggregating drugs or anticoagulants in central retinal vein occlusion (CRVO) and hemi-CRVO.
Cohort study.
Six hundred eighty-six consecutive patients with CRVO (567 patients, 585 eyes) and nonischemic hemi-CRVO (119 patients, 122 eyes).
At first visit, all patients had a detailed ophthalmic and medical history (including the use of anti-platelet aggregating drugs or anticoagulants), and comprehensive ophthalmic and retinal evaluation. Visual evaluation was carried out by recording visual acuity, using the Snellen visual acuity chart, and visual fields with a Goldmann perimeter. The same ophthalmic evaluation was performed at each follow-up visit. At the initial visit, CRVO and hemi-CRVO were classified as nonischemic and ischemic.
Visual acuity, visual fields, and severity of retinal hemorrhages.
All 3 types of CRVO, showed a significantly greater severity of retinal hemorrhages among aspirin users than nonusers (P<0.001). Initial visual acuity and visual fields were significantly worse in aspirin users than nonusers in nonischemic CRVO and hemi-CRVO, but did not differ for ischemic CRVO. Among patients with nonischemic CRVO who initially had 20/60 or better visual acuity, there was a significant association of aspirin use with visual acuity deterioration. The odds ratio of visual acuity deterioration, adjusting for age, diabetes, ischemic heart disease, and hypertension, for aspirin users relative to nonusers was 2.24 (95% confidence interval [CI], 1.14-4.41; P = 0.020). Of those whose macular edema resolved, overall cumulative visual acuity outcome also suggested a higher percentage with deterioration among aspirin users, odds ratio for deterioration of 3.62 (95% CI, 0.97-13.54; P = 0.05) for aspirin users relative to nonusers. For the nonischemic CRVO patients with 20/70 or worse visual acuity at the initial visit, after resolution of macular edema, improvement in visual acuity was less likely in the aspirin users than in nonusers (odds ratio, 0.18; 95% CI, 0.04-0.72; P = 0.016).
Findings of this study indicate that, for patients with CRVO and hemi-CRVO, the use of aspirin, other anti-platelet aggregating agents, or anticoagulants was associated with a worse visual outcome and no apparent benefit.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
系统研究抗血小板聚集药物或抗凝剂在视网膜中央静脉阻塞（CRVO）和半侧 CRVO 中的作用。
队列研究。
686 例连续的 CRVO（567 例患者，585 只眼）和非缺血性半侧 CRVO（119 例患者，122 只眼）。
初次就诊时，所有患者均接受详细的眼科和病史（包括抗血小板聚集药物或抗凝剂的使用情况）以及全面的眼科和视网膜评估。视力评估通过记录视力、使用 Snellen 视力表和 Goldmann 周边视野进行。每次随访时都进行相同的眼科评估。初次就诊时，CRVO 和半侧 CRVO 分为非缺血性和缺血性。
视力、视野和视网膜出血程度。
所有 3 种类型的 CRVO 中，阿司匹林使用者的视网膜出血严重程度明显高于非使用者（P<0.001）。非缺血性 CRVO 和半侧 CRVO 中，阿司匹林使用者的初始视力和视野明显差于非使用者，但缺血性 CRVO 则不然。在初始视力为 20/60 或更好的非缺血性 CRVO 患者中，阿司匹林使用与视力恶化存在显著相关性。调整年龄、糖尿病、缺血性心脏病和高血压后，阿司匹林使用者相对于非使用者，视力恶化的优势比为 2.24（95%置信区间[CI]，1.14-4.41；P=0.020）。对于黄斑水肿消退的患者，总体累积视力结果也表明阿司匹林使用者中视力恶化的比例较高，阿司匹林使用者相对于非使用者视力恶化的优势比为 3.62（95%CI，0.97-13.54；P=0.05）。对于初始视力为 20/70 或更差的非缺血性 CRVO 患者，在黄斑水肿消退后，阿司匹林使用者的视力改善可能性小于非使用者（优势比，0.18；95%CI，0.04-0.72；P=0.016）。
本研究结果表明，对于 CRVO 和半侧 CRVO 患者，使用阿司匹林、其他抗血小板聚集剂或抗凝剂与更差的视力结果相关，且无明显获益。
作者没有与本文讨论的任何材料有关的专有或商业利益。
