Wittström Elisabeth
Department of Ophthalmology, Lund University, Sweden.
Open Ophthalmol J. 2017 May 22;11:89-102. doi: 10.2174/1874364101711010089. eCollection 2017.
To investigate associated systemic diseases, other conditions, visual outcome, ocular complications and treatment in Swedish patients younger than 50 years with central retinal vein occlusion (CRVO) and reviewing the literature.
Twenty-two patients with CRVO, younger than 50 years, were examined with full-field electroretinography (ERG) within 3 months after a thrombotic event, or were periodically examined and were observed for at least 6 months. In 18 of these patients, the initial retinal ischemia was studied using the cone b-wave implicit time in the 30 Hz flicker ERG. Fifteen patients also underwent fluorescein angiography. Optical coherence tomography (OCT) was performed in 14 patients. The patients studied were divided into two groups, non-ischemic and ischemic, which were compared. All patients underwent ocular and systemic examination, as well as complete screening for thrombophilic risk factors.
Of the 22 patients, 15 had non-ischemic type of CRVO and 7 the ischemic type. Patients with non-ischemic CRVO showed significantly improved visual acuity (VA) at the final examination (p=0.006). Patients with ischemic CRVO showed no significant reduction in VA at the final examination (p=0.225). Systemic hypertension (27% in non-ischemic CRVO and 29% in ischemic CRVO) was the most prevalent systemic risk factor for CRVO. The mean central foveal thickness (CFT) decreased significantly from 402.3±136.2 (µm) at the initial examination to 243.8±48.1 (µm) at the final examination in the non-ischemic group (p=0.005). The mean initial CFT was 444.5±186.1 (µm) in the ischemic CRVO group, which decreased to 211.5±20.2 (µm) at the final visit (p=0.068). Pigment dispersion syndrome (PDS)/pigmentary glaucoma (PG), ocular hypertension and dehydration were equally frequent; four patients each (18%) out of 22. The clinical course of 4 younger patients with PDS/PG are described.
The patients with non-ischemic CRVO showed significantly improved VA and significantly decreased CFT at the final examination. Systemic hypertension was the most prevalent risk factor for CRVO. Younger adults with CRVO also had a high prevalence of PDS/PG, ocular hypertension and dehydration. This study highlights the importance of careful IOP monitoring, and the need to investigate possible PDS/PG and to obtain an accurate history of the patient including alcohol intake and intense exercise.
调查瑞典50岁以下中心性视网膜静脉阻塞（CRVO）患者的相关全身性疾病、其他情况、视力预后、眼部并发症及治疗情况，并复习相关文献。
22例50岁以下的CRVO患者在血栓形成事件后3个月内接受了全视野视网膜电图（ERG）检查，或定期接受检查并观察至少6个月。其中18例患者使用30Hz闪烁ERG中的视锥细胞b波隐时研究初始视网膜缺血情况。15例患者还接受了荧光素血管造影检查。14例患者进行了光学相干断层扫描（OCT）。将研究的患者分为非缺血性和缺血性两组进行比较。所有患者均接受了眼部和全身检查，以及血栓形成倾向危险因素的全面筛查。
22例患者中，15例为非缺血性CRVO，7例为缺血性CRVO。非缺血性CRVO患者在最终检查时视力（VA）有显著改善（p=0.006）。缺血性CRVO患者在最终检查时VA无显著下降（p=0.225）。系统性高血压（非缺血性CRVO患者中占27%，缺血性CRVO患者中占29%）是CRVO最常见的全身性危险因素。非缺血性组的平均中心凹厚度（CFT）从初始检查时的402.3±136.2（μm）显著降至最终检查时的243.8±48.1（μm）（p=0.005）。缺血性CRVO组的平均初始CFT为444.5±186.1（μm），在最后一次就诊时降至211.5±20.2（μm）（p=0.068）。色素播散综合征（PDS）/色素性青光眼（PG）、高眼压症和脱水的发生率相同；22例患者中各有4例（18%）。描述了4例年轻PDS/PG患者的临床病程。
非缺血性CRVO患者在最终检查时VA显著改善，CFT显著降低。系统性高血压是CRVO最常见的危险因素。年轻的CRVO成人患者中PDS/PG、高眼压症和脱水的患病率也很高。本研究强调了仔细监测眼压的重要性，以及调查可能的PDS/PG并获取患者准确病史（包括饮酒和剧烈运动情况）的必要性。
