Purchase this article with an account.
JC Lai, P Mruthyunjaya, S Fekrat; Central Retinal Vein Occlusion In Patients on Chronic Coumadin® Anticoagulation . Invest. Ophthalmol. Vis. Sci. 2002;43(13):519.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Purpose: The etiology of central retinal vein occlusion (CVO) is widely believed to arise from thrombosis of the central retinal vein. The purpose of this study is to describe the clinical features of a series of patients who had a CVO while on warfarin (Coumadin®) anticoagulation and to discuss the possible mechanism for occlusion in these cases. Methods: A retrospective review was performed of 84 consecutive patients seen at the Duke University Eye Center beginning in 1997 with the diagnosis of CVO. Results: Six eyes of six patients were diagnosed with a perfused CVO while on Coumadin® anticoagulation. In two patients, the fellow eye had previously developed a CVO prior to anticoagulation therapy. Mean age was 69.8 years (58-83 years) and 3/6 (50%) patients were female. Concurrent medical conditions included diabetes mellitus, hypertension, or cardiac arrhythmia. Reasons for anticoagulation included arrhythmia (n=3), deep venous thrombosis (n=1), artificial heart valve (n=1), and previous CVO in the fellow eye (n=1). At the time of presentation, 5/6 (83%) patients were within the therapeutic range of anticoagulation parameters. Initial mean visual acuity was 20/238 (20/50-20/800). Cystoid macular edema (CME) was initially present in 6/6 eyes. Systemic work-up was initiated in 4/6 patients and revealed increased homocysteine levels (n=1) and increased anticardiolipin antibodies (n=1). Mean follow-up was 9.8 months. Patients remained on Coumadin® anticoagulation throughout follow-up. At last follow-up, 5 eyes had a perfused CVO and 1 eye had a non-perfused CVO. Surgical interventions included intravitreal tissue plasminogen activator injection (n=1), pars plana vitrectomy with endolaser (n=1), and unsuccessful attempted chorioretinal anastomoses (n=1). The one eye that progressed to a nonperfused CVO required panretinal photocoagulation. Final mean acuity was 20/291 (20/50-20/1280). No eye developed neovascular glaucoma. Conclusions: CVO can occur in patients on chronic systemic anticoagulation, suggesting that Coumadin® may not necessarily have a role in the treatment or prevention of CVO in some individuals. These findings also raise the possibility that a subset of CVO patients may have local factors besides thrombus formation that lead to the development of CVO. Pathologic correlation will be necessary to confirm this hypothesis.
This PDF is available to Subscribers Only