Abstract
Purpose :
Older age is a known risk factor for central retinal vein occlusion (CRVO). While less common in younger patients, CRVO has been associated with intense exercise, oral contraceptive (OCP) use, inherited thrombophilias, and systemic autoimmune diseases. We present the risk factors, clinical findings, management patterns, and visual outcomes in a group of patients younger than age 50 who were diagnosed with CRVO after a period of intense exercise.
Methods :
Individuals younger than age 50 who developed CRVO immediately after intense exercise were identified at two institutions over a 10-year period. Comorbidities, clinical findings, central subfield thickness (CST), subfoveal choroidal thickness (SFCT), management, corrected ETDRS visual acuity (VA), and sequelae were recorded.
Results :
Eight eyes of 8 patients were included. The mean age was 33.8 years (range, 16-47 years). Mean duration from symptom onset to presentation was 2.9 months (range, 0.2-11 months). The majority (62.5%, 5/8) of cases were non-ischemic whereas 37.5% (3/8) were ischemic. Hypercoagulable work-up was unremarkable in all cases. The most common comorbidity was anemia (25%, 2/8). Other notable risk factors included connective tissue disease, pregnancy, recent OCP use, and a family history of systemic venous thrombosis. Anti-vascular endothelial growth factor therapy was used in 75% (6/8) of cases. One case also received intravitreal triamcinolone, oral pentoxifylline, and panretinal laser photocoagulation. The mean follow-up period was 19 months. Mean corrected VA was 20/80 at presentation and 20/59 at 6 months, an improvement of 1.3 lines (p=0.5). Non-ischemic cases had significantly better VA than ischemic cases at presentation (20/33 vs 20/355, p=0.03) and at 6 months (20/21 vs 20/337, p=0.005). Mean CST did not significantly change from presentation to 6 months (312 µm vs 328 µm, p=0.8). Mean SFCT significantly decreased (361 µm vs 293 µm, p=0.007).
Conclusions :
Relative intravascular hyperviscosity from dehydration due to intense exercise, combined with other existing risk factors in some cases, may contribute to the development of CRVO. Non-ischemic cases are associated with better visual outcomes compared to ischemic cases in this population. Additional studies are needed to further elucidate CRVO pathogenesis following intense exercise, particularly in younger individuals.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.