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Differentiation of ischemic from non-ischemic central retinal vein occlusion during the early acute phase

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Abstract

We investigated prospectively in 128 patients (140 eyes) the role of six routine clinical tests in the differentiation of ischemic central retinal vein occlusion (CRVO) from non-ischemic CRVO during its early acute phase. There were fourfunctional tests [visual acuity, visual fields, relative afferent pupillary defect (RAPID), electroretinography (ERG)] and twomorphologic tests (ophthalmoscopy and fluorescein fundus angiography). We found that none of the six tests had 100% sensitivity and specificity in such a differentiation during the early, acute phase, so that no one test can be considered a “gold standard”; however, combined information from all six is almost always reliable. Overall, the four functional tests proved far superior to the two morphologic tests in differentiating ischemic from non-ischemic CRVO: RAPID was most reliable in uniocular CRVO (with a normal fellow eye), followed closely by ERG in all cases; combined information from RAPID and ERG differentiated 97% of cases; perimetry was the next most reliable, followed by visual acuity. The two morphologic tests performed worst; fluorescein angiography provided either no information at all on retinal capillary nonperfusion (in at least one-third of the eyes during the early, acute phase) because of multiple limitations, or sometimes provided misleading information. Ophthalmoscopic appearance is the least reliable, most misleading parameter.

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Authors and Affiliations

  1. Department of Ophthalmology, University of Iowa, 52242, Iowa City, IA, USA

    Sohan Singh Hayreh, Meena Beri, Alan E. Kimura & Patricia Podhajsky

  2. Department of Preventive Medicine (Biostatistics), University of Iowa, 52242, Iowa City, IA, USA

    Marie R. Klugman

Authors
  1. Sohan Singh Hayreh
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  2. Marie R. Klugman
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  3. Meena Beri
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  4. Alan E. Kimura
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  5. Patricia Podhajsky
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Hayreh, S.S., Klugman, M.R., Beri, M. et al. Differentiation of ischemic from non-ischemic central retinal vein occlusion during the early acute phase. Graefe's Arch Clin Exp Ophthalmol 228, 201–217 (1990). https://doi.org/10.1007/BF00920022

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  • DOI: https://doi.org/10.1007/BF00920022

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