Al Ghaithi Houda, Al Hinai Ahmed, Al Abri Mohammed, Al-Futaisi Abdullah
Oman Medical Specialty Board (OMSB), Muscat, Oman.
Department of Ophthalmology, Sultan Qaboos University Hospital (SQUH), Muscat, Oman.
Oman J Ophthalmol. 2024 Oct 24;17(3):380-383. doi: 10.4103/ojo.ojo_83_24. eCollection 2024 Sep-Dec.
Central retinal vein occlusion (CRVO) is a significant cause of vision impairment in adults, often associated with various systemic and ocular risk factors. The current literature presents a limited understanding of the efficacy of antithrombotic agents in CRVO management, with sparse comparative studies evaluating the effectiveness of different antiplatelet therapies. Here, we report the case of nonischemic CRVO in a 54-year-old male with multiple systemic comorbidities, including diabetes mellitus, hypertension, and dyslipidemia. Initial treatment with aspirin 100 mg daily resulted in worsening visual acuity (VA) and retinal pathology, prompting a transition to clopidogrel 75 mg daily due to patient refusal of intravitreal injection. Remarkably, clopidogrel therapy led to rapid and sustained improvement in VA, macular edema resolution, and complete resolution of retinal vascular pathology within weeks. This case underscores the therapeutic potential of clopidogrel in nonischemic CRVO management, suggesting its superiority over aspirin in select patients. We discuss the mechanisms underlying the differential efficacy of antiplatelet agents and highlight the need for further comparative studies to guide optimal treatment strategies in CRVO.
视网膜中央静脉阻塞（CRVO）是成人视力损害的重要原因，常与多种全身和眼部危险因素相关。目前的文献对抗血栓药物在CRVO治疗中的疗效了解有限，评估不同抗血小板治疗效果的比较研究较少。在此，我们报告一例54岁男性非缺血性CRVO病例，该患者有多种全身合并症，包括糖尿病、高血压和血脂异常。最初每天服用100毫克阿司匹林治疗导致视力（VA）和视网膜病变恶化，由于患者拒绝玻璃体腔内注射，促使改为每天服用75毫克氯吡格雷。值得注意的是，氯吡格雷治疗在数周内使VA迅速且持续改善，黄斑水肿消退，视网膜血管病变完全消退。该病例强调了氯吡格雷在非缺血性CRVO治疗中的潜在治疗价值，表明其在特定患者中优于阿司匹林。我们讨论了抗血小板药物疗效差异的潜在机制，并强调需要进一步的比较研究来指导CRVO的最佳治疗策略。
