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      A complication of ischemic branch retinal vein occlusion

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      Indian Journal of Ophthalmology
      Medknow Publications & Media Pvt Ltd

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          Abstract

          A 48-year-old male with ischemic superotemporal branch retinal vein occlusion (BRVO) in the right eye with no known systemic disease had been managed with sectoral laser photocoagulation. His 55 degree multicolor fundus image on follow-up shows a large neovascularization of the disc exerting traction over the macula. Laser marks are seen superiorly. Optical coherence tomography angiography (OCTA) shows the neovascular frond and nonperfusion area. Owing to traction, the vascular architecture is distorted [Fig. 1]. Figure 1 (a) Multicolor fundus photograph, (b) enface scan, (c) OCT angiography showing neovascularization of the disc and macular ischemia Although retinal vein occlusion is common in the elderly, it is also seen in younger population.[1] Younger patients with BRVO need a careful clinical evaluation for associated systemic diseases. They may have associated atherosclerosis, diabetes, or hypertension. Reports of hyperhomocysteinemia,[2] hyperviscosity syndrome,[3] connective tissue diseases,[4] and thrombophilia[5] with retinal vein occlusion in young patients are well known. If screening for these associations is inconclusive, a complete thrombophilic workup can be considered. OCTA in retinal vein occlusion can show nonperfusion areas, collaterals, and neovascular fronds.[6] During the follow-up of these patients, fundus photography and OCTA can help to individualize treatment and follow-up options. OCTA acts an no invasive method to predict the visual prognosis. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

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          Most cited references6

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          Optical Coherence Tomography Angiography in Eyes with Retinal Vein Occlusion

          Optical coherence angiography (OCTA) is a noninvasive technique that has been introduced in recent years to detect ophthalmological pathology. The growing usage of OCTA to detect retinal abnormalities can be attributed to its advantages over the reference-standard fluorescein angiography (FA), although both of these techniques can be used in association. OCTA's advantages include its dye independency, its ability to produce depth-resolved images of retinal and choroidal vessels that yield images of different vascular layers of the retina, and the better delineation of the foveal avascular zone. OCTA's disadvantages include the lack of normalized patient data, artefactual projection issues, and its inability to detect low-flow lesions or pathologic conditions. Different OCTA platforms use unique algorithms to detect microvasculature, which are implemented in both spectral-domain (SD) and swept-source (SS) OCT machines. Microvascular changes in retinal vein occlusions (RVOs) are visible in both the superficial and deep capillary networks of the retina in OCTA. These visualizations include a decrease in foveal and parafoveal vascular densities, non-perfusion areas, capillary engorgement and telangiectasias, vascular tortuosity, microaneurysms, disruption of the foveal perivascular plexus, and formation of collateral vessels. The restricted field of view and inability to show leakage are important limitations associated with the use of OCTA in RVO cases. In this article, we present a brief overview of OCTA and a review of the changes detectable in different slabs by OCTA in RVO cases published in PubMed and Embase.
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            Central retinal vein occlusion in young adults.

            Central retinal vein occlusion (CRVO) is usually seen in older adults and is often associated with systemic vascular disease. CRVO can be seen in young adults, and although it is occasionally associated with a systemic disease, in the majority of cases it occurs in an otherwise healthy patient with no known systemic disease or ocular problem. Inflammation of the central retinal vein has been proposed as a cause of the occlusion in young adults and for that reason it has been called papillophlebitis. The appearance of unilateral optic disc edema, dilatation, and tortuosity of the major retinal veins with a variable amount of retinal hemorrhage in young, healthy adults with complaints of blurred vision or photopsias has been called, in addition to papillophlebitis, benign retinal vasculitis, optic disc vasculitis, nonischemic CRVO, big blind spot syndrome, and presumed phlebitis of the optic disc. An approach to the diagnostic evaluation of the young adult with CRVO is presented. Although most eyes recover vision to better than 20/40, about one-fifth have significant visual loss, and many suffer ocular sequelae. Many treatment modalities have been tried for this entity, but no conclusive evidence exists that any treatment alters its natural history.
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              Thrombophilic risk factors in patients with central retinal vein occlusion.

              Few and contrasting data are available on the prevalence of hemostatic risk factors in patients with central retinal vein occlusion (CRVO). Aim of this study was to investigate the metabolic and inherited risk factors for venous thrombosis in 100 CRVO patients (age: 59 yrs; range 18-77) and in 100 controls (age: 56 yrs; range 18-84). In patients homocysteine (Hcy) levels were significantly higher than in controls and were affected by the C677T methylenetetrahydrofolate reductase (MTHFR) polymorphism (p < 0.001). The prevalences of activated protein C resistance (APCR), factor V Leiden positivity, elevated PAI-1 and Lp(a) levels were significantly higher in patients with respect to controls. At multivariate analysis, only hyperhomocysteinemia (OR 11, 95% CI 3.6-36.2; p < 0.0001) and elevated PAI-1 levels (OR 8.9, 95% CI 3.5-41.3; p < 0.01), in addition to hypertension (OR 40.5, 95% CI 8.6-188.8; p < 0.00001) and hypercholesterolemia (OR 3.1, 95% CI 1.6-20.5; p < 0.05), were independent risk factors for CRVO. These data demonstrate a potential role of hemostatic risk factors in the pathophysiology of CRVO.
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                Author and article information

                Journal
                Indian J Ophthalmol
                Indian J Ophthalmol
                IJO
                Indian Journal of Ophthalmology
                Medknow Publications & Media Pvt Ltd (India )
                0301-4738
                1998-3689
                February 2019
                : 67
                : 2
                : 276
                Affiliations
                [1]Vitreo-Retinal Services, Giridhar Eye Institute, Ponneth Temple Road, Kadavanthra, Kochi, Kerala, India
                Author notes
                Correspondence to: P C Ranjith, Vitreo-Retinal Services, Girdhar Eye Institute, Ponneth Temple Road, Kadavanthra, Kochi - 682 020, Kerala, India. E-mail: ranjith010@ 123456gmail.com
                Article
                IJO-67-276
                10.4103/ijo.IJO_882_18
                6376807
                30672491
                bc9f2966-8bb3-423c-950a-c7d2db109b26
                Copyright: © 2019 Indian Journal of Ophthalmology

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                Categories
                Ophthalmic Images

                Ophthalmology & Optometry
                Ophthalmology & Optometry

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