Clinical Features of Combined Central Retinal Artery and Vein Occlusion

Abstract

Purpose To describe the clinical features of combined central retinal artery and vein occlusion (CCRAVO). Methods This retrospective study included 33 admitted patients (33 eyes) who had CCRAVO. Clinical data, such as age, gender, best-corrected visual acuity (BCVA), intraocular pressure (IOP), findings on fundus color photography and fundus fluorescein angiography (FFA), and information about follow-up, were collected and analyzed. Results The age of the patients with CCRAVO ranged from 22 to 78 years, with a mean of 48.8 ± 14.1 years. At presentation, BCVA of the involved eyes ranged from no light perception (NLP) to 20/20. In addition, 45.5% (15/33) of the eyes had BCVA of finger counting (FC) or below, whereas 12.1% (4/33) had BCVA of 20/60 or above. The IOP was lower in the involved eyes than in the fellow eyes (15.0 ± 3.0 mmHg vs. 16.4 ± 2.3 mmHg, p=0.03). Ophthalmoscopic examination showed changes in both central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO), including retinal hemorrhage, retinal ischemic whitening, optic disc hyperemia and/or edema, venous dilation and tortuosity, cotton wool spot (CWS), and Roth's spot. FFA showed prolonged arm-to-retina time (ART) and retinal arteriovenous passage time (RAP) (17.1 ± 4.9 s and 12.1 ± 8.8 s, respectively). Capillary nonperfusion (CNP) was seen in 21 eyes (63.6%), and in 14 (42.2%) of these, CNP was larger than 10 disc areas. At 2 to 3 weeks after presentation, BCVA improved in 23 eyes (71.9%) and further deteriorated in 5 eyes (15.6%). Retinal ischemic whitening improved in more than half of the eyes, whereas retinal hemorrhage increased in nearly half of the eyes. Follow-up ranged from 6 to 56 months. Seven patients were lost to follow-up. At final follow-up, six eyes had a visual acuity of 20/60 or greater, but 6 eyes had FC or worse. Four eyes developed neovascularization on follow-up. Conclusion CCRAVO is a sight-threatening entity. Manifestations of CRAO and CRVO can be seen simultaneously in the early stage of disease, and CRVO may play a more important role in the development of CCRAVO.

Population-Based Incidence of Ocular Neovascularization Following Central Retinal Artery Occlusion in Olmsted County, Minnesota

“…Prior studies on CRAO secondary to CRVO have reported that the incidence of neovascularization ranges widely, from 0 to 81%. 10 , 11 In our study, all three (100%) of the patients with CRAO caused by CRVO developed NVA and NVG.…”

Neovascular glaucoma with combined retinal vascular occlusion in carotid cavernous fistula

“…The exact mechanism of combined occlusions is not known. It is presumed that central retinal vein occlusion (CRVO) leads to increase in intraluminal pressure of the retinal capillary bed, which is then transmitted to the retinal artery to decrease its blood flow 14. In our case, a long-standing CRVO led to a subsequent central retinal artery occlusion.…”

Clinical Features of Central Retinal Vein Occlusion in Young Patients

“…In the future, electroretinography can also be used to further analyze the relationship between retinal and optic nerve function and explore the prognosis of CRVO in young patients. Although the prognosis of CRVO in young patients is generally favorable, studies have reported that patients with combined central retinal artery and vein occlusion may be younger than the patients who had only CRVO or CRAO [71,72]. In a previous study, mean age of the patients with combined central retinal artery and vein occlusion was 48.8 ± 14.1 years [72].…”

“…Although the prognosis of CRVO in young patients is generally favorable, studies have reported that patients with combined central retinal artery and vein occlusion may be younger than the patients who had only CRVO or CRAO [71,72]. In a previous study, mean age of the patients with combined central retinal artery and vein occlusion was 48.8 ± 14.1 years [72]. In these patients, artery occlusion could be secondary to CRVO, which increases the intraluminal pressure of the retinal capillary bed, and the pressure is transmitted to the retinal artery to decrease or even stop the blood flow.…”