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B. Wolff, E. Riviere, J.-F. Girmens, O. Genevois, A. Gaudric, J.-A. Sahel, M. Paques; Anatomical and Visual Outcome of Central Retinal Vein Occlusions Associated to Perivenular Whitening. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4720.
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During acute central retinal vein occlusion (CRVO), ischemic opacification of the perivenular retina may be present, which is believed to be an indication of acute, global retinal hypoperfusion in the absence of capillary closure. Little is known on the long-term outcome of these patients.
Review of the charts of 23 patients with CRVO associated to perivenular whitening (PVW) seen in two centers with at least 6 months of follow up.
There were 13 women and 10 men, with mean age of 42.8 years. All had abrupt onset of visual loss (ranging from "hand motion"-20/20), contrasting with moderate signs of CRVO. Without specific treatment, most experienced visual improvement within days. After a mean follow-up of 15 months, mean visual acuity had increased from 20/160 to 20/30, with only one patient having severe visual loss. However, despite an overall favorable outcome in term of central vision, 15 (65%) patients reported persistent pericentral microscotomas objectivated by Amsler grid testing. Optical coherence tomography demonstrated thinning of the inner layers of the perifoveal retina (mean ± Standard Deviation of macular volume 6.1 ± 0.5 vs 6.9± 0.2 mm3 in fellow eyes, p<0.05). One patient developed extensive capillary nonperfusion with new vessels and severe macular atrophy. None developed chronic macular edema. Two eyes experienced recurrence of CRVO with macular edema in the same eye, several years later.
PVW-associated CRVOs follows a peculiar course, the most frequent complication being post-ischemic atrophy of the perifoveal retina which is the likely cause of the frequent pericentral scotomas. Such presentation and outcome may be related to an inaugural, acute and transient retinal hypoperfusion which may also explain the low incidence of macular edema and capillary closure. Specific therapeutic strategies, for instance oxygen administration in order to prevent perifoveal atrophy, may be of interest for such patients.
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