The value of serial doppler imaging in central retinal vein occlusion: Correlation with visual recovery

doi:10.1016/S0009-9260(96)80159-0

Clinical Radiology

Volume 51, Issue 6, June 1996, Pages 411-414

https://doi.org/10.1016/S0009-9260(96)80159-0 Get rights and content

A prospective study of 80 patients with central retinal vein occlusion (CRVO) was performed to determine whether Doppler flow measurements can predict visual outcome. All patients at presentation, had full ophthalmological examination, fluorescein angiography, relative afferent pupillary defect test and electroretinography to distinguish between ischaemic and non-ischaemic occlusions. In addition, all patients were examined at presentation with colour Doppler ultrasound using a 7.5 MHz linear array probe. Both the clinical examinations and colour Doppler ultrasound were repeated at one year following initial presentation in a smaller group of 20 patients.

A significant reduction in velocity within the central retinal vein was noted in the ischaemic compared with non-ischaemic CRVO affected eye at the time of the baseline scan. The minimum venous velocity within the central retinal vein was most severely affected. No velocity difference was present within the ophthalmic artery.

Follow-up at one year with colour Doppler ultrasound showed an increase in blood velocity values within the central retinal vein in the CRVO affected eye but this was of no prognostic value and did not correlate with clinical outcome. Serial colour Doppler ultrasound examinations, therefore, have no clinical application in patients with CRVO and are of no prognostic value.

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Furthermore, these tools will likely allow us to record responses of critical blood flow parameters in response to putative therapies for disease. In the past, serial color Doppler monitoring in CRVO has had limited clinical utility7; however, more recent developments in this technology reveal drastic reductions in retinal blood flow velocity in patients with retinal vein occlusion. Moreover, measurements made with this Doppler technology were predictive of visual prognosis.4,75
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A summary is presented in Table 2. The majority of case-control and cohort studies reported impairment of the blood flow parameters related to the ocular arterial circulation in patients with CRVO (8 reports5,7,8,64,65,89,123,124 of 12). Reduced blood velocity in the vein was found in all studies that measured velocity parameters in the central retinal vein in patients with CRVO.
Color Doppler imaging (CDI) is a widely used method for evaluating ocular circulation that has been used in a number of studies on retinal diseases. CDI assesses blood velocity parameters by using ultrasound waves. In ophthalmology, these assessments are mainly performed on the retrobulbar blood vessels: the ophthalmic, the central retinal, and the short posterior ciliary arteries. In this review, we discuss CDI use for the assessment of retinal diseases classified into the following: vascular diseases, degenerations, dystrophies, and detachment. The retinal vascular diseases that have been investigated by CDI include diabetic retinopathy, retinal vein occlusions, retinal artery occlusions, ocular ischemic conditions, and retinopathy of prematurity. Degenerations and dystrophies included in this review are age-related macular degeneration, myopia, and retinitis pigmentosa. CDI has been used for the differential diagnosis of retinal detachment, as well as the evaluation of retrobulbar circulation in this condition. CDI is valuable for research and is a potentially useful diagnostic tool in the clinical setting.
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It has been suggested that measures of blood flow are helpful in evaluating the severity of RVO and differentiating between iCRVO and non-iCRVO,17,18 although at present time, the usefulness of this technology to establish this differentiation remains controversial.20,26,296,309 Venous flow velocities were found to be significantly lower in iCRVO than in non-iCRVO.17,26,296 Tranquart et al reported that means of minimum and maximum venous flow velocities using color Doppler imaging were statistically significantly lower in iCRVO (n = 18) (mean 1.83 ± SD 0.94 and mean 2.94 ± SD 1.34 cm/s, respectively) than those in non-iCRVO (n = 50) (mean 2.28 ± SD 0.73 and mean 3.66 ± SD 1.19 cm/s, respectively).296
Retinal vein occlusion (RVO)-including central RVO, branch RVO, and hemicentral and hemispheric RVO—is the second most common vascular cause of visual loss, surpassed only by diabetic retinopathy. The presence and extent of retinal ischemia in RVO is associated with a worse prognosis. On this basis, most previously conducted studies considered ischemic retinal vein occlusion (iRVO) and non-iRVO as separate entities based on set thresholds of existing retinal ischemia as determined by fundus fluorescein angiography. Other diagnostic technologies have been used specifically in the differentiation of ischemic central retinal vein occlusion and nonischemic central retinal vein occlusion. To date, there is no fully accepted definition for iRVO. Some clinicians and researchers may favor establishing a clear differentiation between these forms of RVO; others may prefer not to consider iRVO as a separate entity. Whatever the case, retinal ischemia in RVO confers a higher risk of visual loss and neovascular complications; thus, it should be determined as accurately as possible in patients with this disease and be considered in clinical and experimental studies. Most recently conducted clinical trials evaluating new treatments for macular edema secondary to RVO included none or only few patients with iRVO based on previous definitions (i.e., few patients with sizeable areas of retinal ischemia were recruited in these trials), and thus it is unclear whether the results observed in recruited patients could be extrapolated to those with retinal ischemia. There has been scant research aiming at developing and/or testing treatments for retinal ischemia, as well as to prevent new vessel formation as a result of RVO. We provide a detailed review of the knowledge gathered over the years on iRVO, from controversies on its definition and diagnosis to the understanding of its epidemiology, risk factors and pathogenesis, the structural and functional effects of this disease in the eye and its complications, natural history, and outcomes after treatment. In each section, the definition of iRVO used is given so, independently of whether iRVO is considered a separate clinical entity or a more severe end of the spectrum of RVO, the information will be useful to clinicians to determine patient's risk, guide therapeutic decisions, and counsel patients and for researchers to design future studies.
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Original PaperThe value of serial doppler imaging in central retinal vein occlusion: Correlation with visual recovery

Ophthalmology

American Journal of Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Central retinal vein occlusion: a prospective histopathological study of 29 eyes in 28 cases

Transactions of the American Ophthalmological Society

Risk factor associated with branch versus central retinal vein occlusion

Annals of Ophthalmology

Systemic factors contributory to retinal vein occlusion

Archives of Internal Medicine

Medical conditions underlying retinal vein occlusion in patients with glaucoma or ocular hypertension

British Journal of Ophtalmology

Prognosis for rubeosis iridis following central retinal vein occlusion

British Journal of Ophthalmology

Streptokinase in central retinal vein occlusion: a controlled clinical trial

British Medical Journal

Original Paper
The value of serial doppler imaging in central retinal vein occlusion: Correlation with visual recovery