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Feng Liang, Jean François Girmens, Jose Sahel, Michel Paques; Acute central retinal vein occlusion followed by disc edema: a frequent cause of macular thickening without macular edema. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3616.
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© ARVO (1962-2015); The Authors (2016-present)
Central retinal vein occlusion (CRVO) may present with various features. The clinical classifications commonly used, which distinguishes ischemic versus nonischemic forms, has a limited clinical interest because many cases cannot be integrated. We described a peculiar form of CRVO associating evidence of intracellular ischemia (perivenular whitening), but no capillary closure, that seem to have a low incidence of macular edema. Here, we extended our findings by showing that these form may be complicated by disc edema, that may be falsely diagnosed as macular edema.
The files of 30 patients with evidence of perivenular whitening were analyzed. Functional data, optical coherence tomography (OCT) and fluorescein angiographic data were reviewed.
Eight out of 30 showed evidence of disc edema occurring 10 to 35 days after presentation. Disc hemorrages were seen in 6 of the 8 cases. In 5 cases, disc edema extended to the macula, but fluorescein angiography showed that dye leakage was restricted to the disc. All cases showed in the long term a very specific OCT feature consisting of thinning of the inner nuclear layer (INL). Visual loss was attributed either to the pericentral atrophy of the INL or to the loss of outer segments due to disc edema propagated to the disc. Conversely, we identified evidence of perivenular whitening in 4 cases of CRVO presenting with macular spreading of disc edema.
CRVO with perivenular withening may be complicated by macular thickening due to the lateral spreading of disc edema. In case of macular thickening predominating on the nasal side of the macula, this feature should be suspected, especially in the presence of disc hemorrages. The interest of such finding for the overall management of CRVO remains to be determined.
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