Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Acta Ophthalmol. 2021 Jun;99(4):e523-e530. doi: 10.1111/aos.14608. Epub 2020 Oct 28.
To compare the functional and anatomical outcomes of central retinal vein occlusion (CRVO) according to the presence of glaucoma before the onset of CRVO, and to assess whether pre-existing glaucoma affects the prognosis of CRVO in terms of development and conversion to ischaemic CRVO.
In this retrospective cohort study, patients with treatment-naïve CRVO were enrolled between December 2009 and February 2019. The patients were classified into two groups according to the presence of pre-existing primary open-angle glaucoma at CRVO diagnosis. We reviewed medical records regarding basic demographics, ocular characteristics and treatments. The effects of pre-existing glaucoma on the occurrence of ischaemic CRVO were also investigated using Cox proportional hazard models.
Of 166 eyes from 166 patients, 26 (15.7%) had pre-existing glaucoma. The pre-existing glaucoma group revealed significantly older (69.4 ± 13.3 versus 56.5 ± 15.9) and lower BCVA at baseline (1.06 ± 0.75 versus 0.64 ± 0.58, logMAR) and final visits (1.56 ± 1.35 versus 0.64 ± 0.48, logMAR) (all p < 0.05) than non-glaucomatous group. In terms of perfusion status of CRVO, the glaucoma group showed higher incidence of ischaemic CRVO (30.8% versus 5.3%, p = 0.052) at initial and last visits as well as more disorganization of retinal inner layers (DRIL) at 3 months (76.0% versus 49.6%, p = 0.015). Pre-existing glaucoma (hazard ratio (HR) = 2.141, p = 0.014), lower vision at baseline (HR = 2.071, p = 0.001) and DRIL at 3 months (HR = 2.905, p = 0.011) were significant risk factors for the occurrence of ischaemic CRVO.
In patients with CRVO, pre-existing glaucoma was associated with poorer visual and anatomical outcomes, and played as a significant risk factor for the development and conversion to ischaemic CRVO with lower vision and presence of DRIL at early phase of CRVO.
比较中央视网膜静脉阻塞（CRVO）发病前存在青光眼与不存在青光眼患者的功能和解剖学结局，并评估是否存在青光眼会影响 CRVO 的预后，包括发生缺血性 CRVO 的情况及从非缺血性 CRVO 向缺血性 CRVO 的转变。
本回顾性队列研究纳入了 2009 年 12 月至 2019 年 2 月期间接受治疗的初诊 CRVO 患者。根据 CRVO 诊断时是否存在原发性开角型青光眼（POAG），将患者分为两组。我们查阅了病历，内容包括基本人口统计学、眼部特征和治疗情况。还使用 Cox 比例风险模型探讨了青光眼对发生缺血性 CRVO 的影响。
166 例患者的 166 只眼中，26 只（15.7%）存在青光眼。青光眼组的年龄明显较大（69.4±13.3 岁比 56.5±15.9 岁），基线（1.06±0.75 比 0.64±0.58，logMAR）和末次随访时（1.56±1.35 比 0.64±0.48，logMAR）视力也较低（均 p<0.05）。在 CRVO 灌注状态方面，青光眼组在初始和末次随访时缺血性 CRVO 的发生率更高（30.8%比 5.3%，p=0.052），3 个月时视网膜内层紊乱（DRIL）的发生率也更高（76.0%比 49.6%，p=0.015）。初诊时存在青光眼（风险比（HR）=2.141，p=0.014）、基线视力较低（HR=2.071，p=0.001）和 3 个月时存在 DRIL（HR=2.905，p=0.011）是发生缺血性 CRVO 的显著危险因素。
在 CRVO 患者中，青光眼与视力和解剖学结局较差相关，并且是发生缺血性 CRVO 及从非缺血性 CRVO 向缺血性 CRVO 转变的重要危险因素，其发生与初诊时视力较低和早期存在 DRIL 有关。
