Central Retinal Vein Occlusion in Younger Swedish Adults: Case Reports and Review of the Literature

Branch retinal vein occlusion following ChAdOx1 nCoV-19 (Oxford-AstraZeneca) vaccine

PURPOSE

To present a case of branch retinal vein occlusion (BRVO) following ChAdOx1 nCoV-19 (Oxford-AstraZeneca) Vaccine.

METHODS

Case report.

RESULTS

A 60-year old otherwise healthy Caucasian male, presented to the ophthalmology emergency clinic complaining of sudden, painless vision loss in his right eye of 24 h" duration. The patient had received Vaxveria seven days prior. The clinical and fundus examination of the right eye established the diagnosis of BRVO.

CONCLUSION

The present case descibes the occurrence of BRVO soon after the vaccination with the Oxford-AstraZeneca vaccine. The close temporal relationship between the BRVO incidence and the vaccination is reinforced by the lack of othe subjective cause to justify the episode.

Comparison of Intravitreal Dexamethasone Implant and Intravitreal Ranibizumab Efficacy in Younger Patients with Branch Retinal Vein Occlusion

Objectives

This study aimed to compare the effects of dexamethasone (DEX) implants and ranibizumab (RAN) injections in younger patients with macular edema due to branch retinal vein occlusion (RVO) in a 6-month follow-up.

Methods

The treatment-naive patients with macular edema secondary to branch RVO were included retrospectively. Medical records of patients who were treated with intravitreal RAN or DEX implant were evaluated before and at the 1^st, 3^rd, and 6^th months after the injection. Primary outcome measures were the change in best-corrected visual acuity (BCVA) and central retinal thickness. The level of statistical significance was set at 0.05/3=0.016, according to the Bonferroni correction.

Results

Thirty-nine eyes of 39 patients were included in the study. The mean age of the study population was 53.82±5.08 years. Median BCVA in the DEX group (n=23) at baseline, 1^st, 3^rd, and 6^th month was 1.1, 0.80 (p=0.002), 0.70 (p=0.003), and 1 (p=0.018) logarithm of the minimum angle of resolution (log-MAR), respectively (p<0.05). Median BCVA in the RAN group (n=16) at baseline, 1^st, 3^rd, and 6^th months was 0.90, 0.61, 0.52, and 0.46 logMAR, respectively (p<0.016 for all comparisons). Median central macular thickness (CMT) in the DEX group at baseline, 1^st, 3rd, and 6th months was 515, 260, 248, and 367 μm, respectively (p<0.016 for all comparisons). Median CMT in the RAN group at baseline, 1^st, 3^rd, and 6^th months was 432.5 (p<0.016), 275 (p<0.016), 246 (p<0.016), and 338 (p=0.148) μm.

Conclusion

There is no significant difference in treatment efficacies in both visual and anatomical outcomes at the end of the 6th month. However, RAN can be considered the first choice in younger patients with macular edema secondary to branch RVO because of the lower side effect profile.

Clinical Features of Central Retinal Vein Occlusion in Young Patients

Retinal vein occlusion (RVO) is the second most common retinal vascular disease. Central RVO (CRVO), in which obstruction occurs posterior to the lamina cribrosa due to various causes, manifests with extensive venous tortuosity, dilatation of blood vessels in the four quadrants, and retinal hemorrhage. The presence of macular edema decreases visual acuity in patients with CRVO, especially in elderly patients with hypertension, hyperlipidemia, and diabetes. In the last decade, treatment modalities for CRVO have improved, with anti-vascular endothelial growth factor agents being widely used as treatment. However, there are cases of refractory or recurrent macular edema. Moreover, CRVO also occurs in young patients. This article reviews previous studies and case reports and summarizes the differences in etiological factors, clinical manifestations, treatment, and prognosis between young and elderly patients. Due to the low incidence of CRVO in young patients, clinical data from these age groups are limited. Hence, further studies are warranted to explore the differences between age groups to improve individualization of treatment of young patients.

Central retinal vein occlusion in a young healthy COVID-19 patient: A case report

Purpose

We detail a unique case of a healthy 33-year-old suspected COVID-19 patient who presented with unilateral Central Retinal Vein Occlusion, possibly as a complication of COVID-19.

Observations

A 33-year-old healthy male was referred to the emergency department due to blurred vision in his left eye for the past month, accompanied by flashes of light without any accompanying neurological symptoms. The patient reported a three-week period of fatigue, dry cough, and shortness of breath ended about 2 weeks prior to the ocular symptoms. He was not tested for COVID-19 at the time of his respiratory complaints.

The clinical examination and the ancillary tests confirmed the diagnosis of a left eye Central Retinal Vein Occlusion.

During admission, a real-time reverse transcription-polymerase chain reaction (RT-PCR) for SARS-CoV-2 from a nasopharyngeal swab was performed and was found to be negative, however, an IgG/IgM Rapid Test (Inzek International Trading, the Netherlands) was performed and was found to be IgM negative and IgG Positive for SARS-CoV-2, confirming recovery from COVID-19.

Conclusions and importance

To the best of our knowledge this is the first report of CRVO in association with COVID-19.

As the literature on human ocular manifestations of COVID-19 is still sparse, our case emphasizes the need for further investigation of ocular complication associated with this novel disease.

A novel method for electroretinogram assessment in patients with central retinal vein occlusion

PURPOSE

Central retinal vein occlusion (CRVO) is the second most common retinal vascular disorder after diabetic retinopathy that affects the eyes. We propose a method for distinction of normal and central CRVO eyes based on electroretinogram (ERG).

METHODS

Seventeen patients with CRVO in one eye were analyzed. Their ERG signals were collected in six different stimuli, including four records in the darkness (dark-adapted 0.01, dark-adapted 3.0, dark-adapted oscillatory potentials, and dark-adapted 10) and two records in brightness (light-adapted 3.0 and light-adapted 30 Hz flicker). Nonlinear features such as Hurst exponent (HE) and approximate entropy (ApEn) were extracted from healthy and CRVO eyes. Finally, a parabolic mapping and two criteria (theta angle and the density of points) were proposed to distinguish the groups.

RESULTS

For ApEn, the P values of dark-adapted 3.0 oscillatory (P = 0.0433) and flicker (P = 0.0425) confirmed significant differences between the groups. For HE, the P values of dark-adapted 3.0 oscillatory (P = 0.0421) and flicker 30 Hz (P = 0.0402) confirmed differences between the healthy and CRVO groups. The P values of theta angle for dark-adapted 3.0 (P = 0.0199), dark-adapted oscillatory (P = 0.0265), dark-adapted 10.0 (P = 0.0166), light-adapted 3.0 (P = 0.0411), and flicker (P = 0.0361) showed significant differences. Using the density criterion, the statistical test demonstrated a significant difference between the groups in dark-adapted 3 (P = 0.0038), dark-adapted oscillatory (P = 0.0102), dark-adapted 10.0 (P = 0.0071), light-adapted 3.0 (P = 0.0319), and flicker 30 Hz (P = 0.0076).

CONCLUSION

The proposed features have made it possible to distinguish between healthy and CRVO eyes. This method could be helpful in some cases with no definite diagnosis or to estimate the severity of CRVO.

Clinical efficacy evaluation of treatment of different degrees of retinal vein occlusion with ranibizumab combined with an argon ion laser

The aim of this study was to evaluate the clinical efficacy of an intravitreal injection of ranibizumab combined with argon ion laser photocoagulation therapy in the treatment of different degrees of central retinal vein occlusion (CRVO). A total of 112 CRVO patients including 25 cases of trunk occlusion, 50 cases of branch occlusion and 37 cases of hemiretinal vein-occlusion were enrolled in this study. Patients were treated with an intravitreal injection of 0.5 mg ranibizumab, followed by argon ion laser photocoagulation therapy after 7 days. Patients were followed up for 6 months and the best corrected visual acuity (BCVA), central retinal thickness (CRT), macular edema, and surgical complications were compared. Compared with the control treated with 0.5 mg ranibizumab, the BCVA and macular edema improved while CRT was significantly reduced in all groups treated with 0.5 mg ranibizumab combined with the argon ion laser. Furthermore, no obvious complications were observed in these groups and the effects of ranibizumab combined with argon ion laser photocoagulation on branch occlusion group were the best. Intravitreal injection of ranibizumab combined with argon ion laser photocoagulation therapy has better safety and effectiveness in the treatment of different degrees of CRVO. The trial registration number is 2015–318 and date of registration is 12/10/2015.