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Andrew J Rong, Swarup Sai Swaminathan, Elizabeth Vanner, Richard K Parrish; Predictors of Neovascular Glaucoma in Central Retinal Vein Occlusion. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5424.
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© ARVO (1962-2015); The Authors (2016-present)
Central retinal vein occlusions (CRVO) are associated with significant visual morbidity. Neovascularization is a major sequela of CRVO and can manifest as neovascular glaucoma (NVG), a visually devastating complication. We performed a retrospective study to determine the risk factors in an acute CRVO that could predict the development of NVG.
361 charts of patients presenting to the Bascom Palmer Eye Institute with CRVO were reviewed from 2015 to 2017. 89 patients met the inclusion criteria of CRVO symptom onset to presentation <90 days, absence of anterior segment neovascularization on presentation, no intravitreal anti-VEGF injection prior to presentation. Those who met inclusion criteria were further screened for potential risk factors for the development of NVG. Risk of NVG was assessed with Fisher’s exact test, Wilcoxon rank-sum test, and Cox proportional hazards models.
There were 11 cases of NVG out of 89 patients (12.3%) who presented with CRVO and met inclusion criteria. The average adjusted time to NVG diagnosis was 195 days. Patients with an afferent papillary defect on initial presentation had a statistically significant increased risk of NVG compared to those who did not (hazard ratio [HR], 4.2; 95% confidence interval [CI], 1.15-15.27; P=0.02). Prior history of glaucoma was associated with development of NVG (HR 5.82; 95% CI, 1.24-27.24; P=0.01) and correspondingly, increased intraocular pressure on presentation between the CRVO (16.9±3.8mmHg) and NVG (19.8±4.9 mmHg) subgroup was associated with development of NVG (HR 1.96; 95% CI, 1.03-3.71; P=0.04). Age, BMI, history of diabetes or hypertension, presenting visual acuity, and presenting macular edema thickness were not found to be associated with development of NVG. Subgroup analysis showed that none of the 15 patients presenting with a CRVO under the age of 50 years developed NVG(Figure), and the 6 month post-CRVO visual acuities for this cohort were significantly better than their counterparts aged 50 years or older.
In patients presenting with acute CRVO, a prior history of glaucoma, presence of a relative afferent pupillary defect, and elevated intraocular pressures on presentation are associated with an increased risk of developing NVG. Patients with multiple risk factors should be followed closely during the first 200 days following CRVO symptom onset. Younger age may be a protective factor against the development of NVG.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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