Subgroup Analysis Of Visual Results In Central Retinal Vein Occlusion (CRVO) Treated With Erythrocytapheresis

Abstract

Purpose: : To study the visual outcome according to the initial visual acuity (VA) in recent-onset CRVO treated by hemodilution therapy using erythrocytapheresis.

Methods: : In a collaborative retrospective study, 31 patients with CRVO (3 weeks or less duration, VA between 20/250 to 20/32, 18 to 85 years of age) treated with one session of erythrocytapheresis were evaluated after 12 months follow-up. The first treatment target was a hematocrit (Ht) level of 35%. Additional session(s) were performed if, during the following 6 weeks, the Ht level increased over 38%. The treated patients were compared to a natural history group (n=30) presenting a similar background, CRVO type and follow-up. Patients with diabetes, uncontrolled systemic hypertension, anti coagulant therapy were excluded in both groups.

Results: : At the12-month visit, a 4 ETDRS line difference was observed between the two groups (p=.007). Patients with a baseline VA between 20/200 and 20/50 had the largest difference: 64% of the treated vs 31.6% of the non treated eyes had a final VA of 20/50 or more whereas 24% vs 42% respectively had a final VA of less than 20/200. The subgroup with a baseline VA from 20/40 to 20/32 had a final VA of 20/40 or better in 60% vs 54% respectively.Age, male gender, cardiovascular history and high level of creatinine were risk factors for anterior segment neovascularization. The erythrocytapheresis group presented less conversion into an ischemic form than the control group (9.7% vs 46.7%, p=.001).

Conclusions: : This study supports that erythrocytapheresis can, at a reasonable cost, improve the final prognosis of CRVO when applied at the early phase of the disease with fair VA in non-diabetic or patients without marked cardiovascular profile.

Keywords: vascular occlusion/vascular occlusive disease • retina • immunomodulation/immunoregulation