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N. Siddiqui, I.U. Scott, N. Unonius, V. Cruz-Villegas, S. Stinnett, S. Fekrat; The Natural History of Hemiretinal Vein Occlusion . Invest. Ophthalmol. Vis. Sci. 2003;44(13):3112.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To investigate the natural history of eyes with hemiretinal vein occlusion (HVO). Methods: Retrospective, consecutive, noncomparative case series. Medical records were reviewed of all patients with a diagnosis of hemiretinal vein occlusion (HVO) evaluated at Duke University Eye Center and Bascom Palmer Eye Institute between January 1, 1987 and December 31, 2001. All patients with at least one year of followup were included. The epidemiological features, medical histories, and clinical characteristics of all patients were extracted from the medical records. When available, fluorescein angiograms (FA) were graded by two independent observers. Results: The study initially included 140 eyes of 140 patients with a median age at presentation of 67 years (range, 33 to 99 years) and followed a median of 33 months (range, 12 to 126 months). Forty-two (52%) patients were female and fifty-six (77%) were Caucasian. Six (7.5%) patients had a history of vein occlusion . Fifty-six (70%) patients had a history of hypertension, and twenty-eight (35%) eyes had a history of glaucoma or ocular hypertension at presentation. Presenting visual acuity (VA) was better than 20/50 in twenty (25%) eyes, 20/50 to 20/200 in thirty-four (42%), and worse than 20/200 in twenty-seven (20%). Twenty-six (59%) eyes were perfused on presentation, forty-seven (60%) had foveal heme, and fifteen (39%) had macular ischemia. 82% had accumulation of foveal dye on FA. Throughout the follow-up interval, fifteen (18%) eyes developed neovascularization or vitreous hemorrhage, and seven (9%) underwent a vitrectomy for neovascularization and/or vitreous hemorrhage. Vision was stable or improved in thirteen (65%) eyes with presenting VA better than 20/50, twenty-eight (82%) with presenting VA between 20/50 and 20/200, and twelve (44%) eyes with presenting vision worse than 20/200 (p=.001). At last followup, VA was better than 20/50 in twenty-one (26%) eyes, between 20/50 and 20/200 in forty-two (53%), and worse than 20/200 in seventeen (21%) eyes. Significant predictors (p<.05) of a final VA better than 20/50 include the following features on presentation: initial visual acuity and patient age. Causes of decreased final vision include cystoid macular edema in seventy-one (88%) eyes, foveal heme in forty-seven (60%) eyes, and macular ischemia in fifteen (38%) eyes. Conclusions:In eyes with HVO, significant predictors of better final VA include initial visual acuity and younger patient age. The most common causes of decreased final vision are cystoid macular edema, foveal heme, and macular ischemia.
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