Clinical analysis of the retinal vein occlusion combined with retinal artery occlusion_Chinese Journal of Ocular Fundus Diseases

Authors：

Xu Menghan , Liu Hao , Zheng Xuejing , Hou Lihua , Li Xiabo , Yan Mei , Li Tong , Lu Xin ,  Wang Min

Department of Ophthalmology, First People's Hospital of Xianyang City (Xianyang Eye Hospital), The First People's Hospital of Xianyang City Affiliated to Shaanxi University of Traditional Chinese Medicine, Clinical Medical Research Center of Eye Diseases Xianyang 712000, China;

Corresponding author：

Wang Min, Email: angin2001@126.com

Keywords：

Retinal vein occlusion; Retinal artery occlusion; Clinical features; Treatment prognosis

DOI：

10.3760/cma.j.cn511434-20240506-00184

Video：

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Objective To observe the clinical and imaging features of patients with retinal vein occlusion (RVO) complicated with retinal artery occlusion (RAO). Methods A retrospective clinical study. Fifteen patients with 15 eyes with RVO combined with RAO and macular edema diagnosed by ophthalmology examination in the Department of Ophthalmology, First People's Hospital of Xianyang City during 2 years from February 1, 2022 to January 31, 2024 were included in the study. Branch retinal vein occlusion (BRVO) combined with branch retinal artery occlusion (BRAO) occurred in 3 cases and 3 eyes. Central retinal vein occlusion (CRVO) complicated with central retinal artery occlusion (CRAO) in 12 eyes. Best corrected visual acuity (BCVA), intraocular pressure, scanning laser ophthalmoscope, optical coherence tomography (OCT), fluorescein fundus angiography (FFA) and serum homocysteine were all performed. OCT angiography (OCTA) was performed in 6 eyes. All eyes were treated with intravitreal injection of anti-vascular endothelial growth factor drugs. After the initial 1 treatment, dosage was assessed as needed. Follow-up was performed every month for 12 months after treatment. FFA inspection was performed at 3 months. During follow-up, it was found that there were no perfusion areas of capillaries, and retinal laser photocoagulation therapy was given in time. Fundus manifestations, FFA, OCT, OCTA characteristics and causes of disease were analyzed retrospectively. Results There were 15 eyes in 15 cases, 9 eyes in 9 males; 6 women with 6 eyes. Age was (61.0±9.7) years. All complained of painless vision loss in one eye. All eyes were positive for relative afferent pupillary disorder. Contralateral congenital optic disc defect was in 1 case; hypertension was in 6 cases; hyperhomocysteinemia was in 2 cases; cerebral infarction was in 3 cases; coronary heart disease was in 1 case. CRVO combined with CRAO was in 12 eyes BCVA light sensitivity-0.25. The BCVA of BRVO combined with BRAO were 0.1, 0.4 and 0.25, respectively. All the patients had retinal edema in the posterior pole of the eye, venous sinuous, dilated, thin arteries and stiff shape. The retina presents with flaky or flame-like bleeding. Posterior polar retinal lint patch was in 13 eyes. In 12 eyes with CRVO combined with CRAO, optic disc edema was observed and the boundary was not clear. In 3 eyes with BRVO combined with BRAO, no obvious abnormality was found in the optic disc, and the boundary was clear. FFA examination showed no or prolonged arterial filling, delayed retinal vein laminar flow, relatively slow or even no capillary filling, macular arteriole atretosis to varying degrees, arch ring structure destruction, optic disc telangiectasia and fluorescein leakage. OCT examination showed that the middle and inner layers of the retina were thickened to varying degrees, the diffuse reflex was enhanced, the interlayer structure was unclear, and the reflex of the lower retinal tissue was weakened. The blood flow density of superficial capillary plexus and deep capillary plexus (DCP) decreased in 6 eyes undergoing OCTA examination. Decreased or interrupted blood flow in the vascular bed of DCP. During the follow-up period, there were 13 eyes with no perfusion area of retinal capillary. The time of occurrence was (1.14±0.95) (0-2) months, and the area was 10-75 disc area. Optic nerve atrophy occurred in 5 eyes. At the last follow-up, visual acuity increased, unchanged and decreased in 12, 2 and 1 eyes, respectively. Conclusions The pathogenesis of RVO-RAO is complicated. Most RVO and RAO occurred simultaneously, and a few RVO occurred several days after RAO. Although the RAO manifestations are not typical, the radiographic features are both RVO and RAO. Compared with BVRO combined with BRAO, the prognosis of visual acuity in CRAO patients with CRVO is worse.

Citation： Xu Menghan, Liu Hao, Zheng Xuejing, Hou Lihua, Li Xiabo, Yan Mei, Li Tong, Lu Xin, Wang Min. Clinical analysis of the retinal vein occlusion combined with retinal artery occlusion. Chinese Journal of Ocular Fundus Diseases, 2024, 40(11): 848-853. doi: 10.3760/cma.j.cn511434-20240506-00184 Copy

1.	万李, 蔡丹丹, 谢学军. 视网膜中央静脉阻塞合并视网膜分支动脉阻塞一例[J]. 中华眼底病杂志, 2013, 29(6): 627-628. DOI: 10.3760/cma.j.issn.1005-1015.2013.06.022.Wan L, Cai DD, Xie XJ. A case of retinal central vein occlusion with retinal branch arterial occlusion[J]. Chin J Ocul Fundus Dis, 2013, 29(6): 627-628. DOI: 10.3760/cma.j.issn.1005-1015.2013.06.022.
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3.	王文吉. 视网膜中央动脉伴中央静脉阻塞的病因与治疗[J]. 中国眼耳鼻喉科杂志, 2018, 18(4): 223-226. DOI: 10.14166/j.issn.1671-2420.2018.04.001.Wang WJ. Etiology and treatment of central retinal artery with central vein obstruction[J]. Chin J Ophthalmol and Otorhinolaryngol, 2018, 18(4): 223-226. DOI: 10.14166/j.issn.1671-2420.2018.04.001.
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5.	Yang V, Turner LD, Imrie F. Central retinal vein occlusion secondary to severe iron-deficiency anaemia resulting from a plant-based diet and menorrhagia: a case presentation[J]. BMC Ophthalmol, 2020, 20(1): 112. DOI: 10.1186/s12886-020-01372-6.
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7.	Seknazi D, Coscas F, Sellam A, et al. Optical coherence tomography angiography in retinal vein occlucion: correlations between macular vascular density, visual acuity, and peripheral nonperfusion area on fluorescein angiography[J]. Retina, 2018, 38(8): 1562-1570. DOI: 10.1097/IAE.0000000000001737.
8.	Hwang CK, Kolomeyer AM, Brucker AJ. Optical coherence tomography angiography of a central retinal artery occlusion before and after anterior chamber paracentesis[J]. Ophthalmology, 2017, 124(5): 608. DOI: 10.1016/j.ophtha.2016.10.030.
9.	Yang S, Liu X, Li H, et al. Optical coherence tomography angiography characteristics of acute retinal arterial occlusion[J]. BMC Ophthalmol, 2019, 19(1): 147. DOI: 10.1186/s12886-019-1152-8.
10.	李林, 司马晶, 周月芷, 等. 眼压和轴长在视网膜中央静脉阻塞中的意义[J]. 临床眼科杂志, 2005, 13(2): 109-111. DOI: 10.3969/j.issn.1006-8422.2005.02.004.Li L, Sima J, Zhou YZ, et al. The significance of intraocular pressure and axial length in central retinal vein occlusion[J]. J Clin Ophthalmol, 2005, 13(2): 109-111. DOI: 10.3969/j.issn.1006-8422.2005.02.004.
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13.	Foroozan R. Combined central retinal artery and vein occlusion from orbital inflammatory pseudotumour[J]. Clin Exp Ophthalmol, 2004, 32(4): 435-437. DOI: 10.1111/j.1442-9071.2004.00850.x.
14.	孙梅, 郝晓凤, 谢立科, 等. 视网膜静脉阻塞的相关危险因素研究进展[J]. 中国中医眼科杂志, 2021, 31(6): 445-448. DOI: 10.13444/j.cnki.zgzyykzz.2021.06.016.Sun M, Hao XF, Xie LK, et al. Research progress of risk factors related to retinal vein occlusion[J]. Chinese Journal of Chinese Ophthalmology, 2021, 31(6): 445-448. DOI: 10.13444/j.cnki.zgzyykzz.2021.06.016.
15.	Nishiguchi KM, Ito Y, Terasaki H. Bilateral central retinal artery occlusion and vein occlusion complicated by severe choroidopathy in systemic lupus erythematosus[J]. Lupus, 2013, 22(7): 733-735. DOI: 10.1177/0961203313490435.
16.	李玉琢, 刘晓燕, 武海军. 视网膜中央静脉阻塞抗VEGF治疗后出现视网膜中央动脉阻塞1例[J]. 菏泽医学专科学校学报, 2022, 34(3): 74-75,97. DOI: 10.3969/j.issn.1008-4118.2022.03.023.Li YZ, Liu XY, Wu HJ. Central retinal vein occlusion: a case report of central retinal artery occlusion after anti-VEGF treatment[J]. Journal of Heze Medical College, 2022, 34(3): 74-75,97. DOI: 10.3969/j.issn.1008-4118.2022.03.023.
17.	Mendrinos E, Mavrakanas N, Kiel R, et al. Bilateral combined central retinal artery and vein occlusion in systemic lupus erythematosus resulting in complete blindness[J]. Eye (Lond), 2009, 23(5): 1231-1232. DOI: 10.1038/eye.2008.164.
18.	Kopp B, Lange F, Steinke A. The reliability of the wisconsin card sorting test in clinical practice[J]. Assessment, 2021, 28(1): 248-263. DOI: 10.1177/1073191119866257.
19.	Su CK, Au SCL. Isolated and combined unilateral central retinal artery and vein occlusions after vaccination. A review of the literature[J/OL]. J Stroke Cerebrovasc Dis, 2022, 31(8): 106552[2022-05-12]. https://pubmed.ncbi.nlm.nih.gov/35569402/. DOI: 10.1016/j.jstrokecerebrovasdis.2022.106552.
20.	Schmidt D. Comorbidities in combined retinal artery and vein occlusions[J]. Eur J Med Res, 2013, 18(1): 27. DOI: 10.1186/2047-783X-18-27.

1. 万李, 蔡丹丹, 谢学军. 视网膜中央静脉阻塞合并视网膜分支动脉阻塞一例[J]. 中华眼底病杂志, 2013, 29(6): 627-628. DOI: 10.3760/cma.j.issn.1005-1015.2013.06.022.Wan L, Cai DD, Xie XJ. A case of retinal central vein occlusion with retinal branch arterial occlusion[J]. Chin J Ocul Fundus Dis, 2013, 29(6): 627-628. DOI: 10.3760/cma.j.issn.1005-1015.2013.06.022.
2. 李娟娟, 李燕. 视网膜中央动静脉合并阻塞的临床观察[J]. 中华眼底病杂志, 2013, 29(6): 563-566. DOI: 10.3760/cma.j.issn.1005-1015.2013.06.004.Li JJ, Li Y. Clinical observation of central retinal arteriovenous occlusion[J]. Chin J Ocul Fundus Dis, 2013, 29(6): 563-566. DOI: 10.3760/cma.j.issn.1005-1015.2013.06.004.
3. 王文吉. 视网膜中央动脉伴中央静脉阻塞的病因与治疗[J]. 中国眼耳鼻喉科杂志, 2018, 18(4): 223-226. DOI: 10.14166/j.issn.1671-2420.2018.04.001.Wang WJ. Etiology and treatment of central retinal artery with central vein obstruction[J]. Chin J Ophthalmol and Otorhinolaryngol, 2018, 18(4): 223-226. DOI: 10.14166/j.issn.1671-2420.2018.04.001.
4. Schmidt-Erfurth U, Garcia-Arumi J, Gerendas BS, et al. Guidelines for the management of retinal vein occlusion by the European Society of Retina Specialists (EURETINA)[J]. Ophthalmologica, 2019, 242(3): 123-162. DOI: 10.1159/000502041.
5. Yang V, Turner LD, Imrie F. Central retinal vein occlusion secondary to severe iron-deficiency anaemia resulting from a plant-based diet and menorrhagia: a case presentation[J]. BMC Ophthalmol, 2020, 20(1): 112. DOI: 10.1186/s12886-020-01372-6.
6. Spaide RF, Klancnik JM Jr, Cooney MJ. Retinal vascular layers imaged by fluorescein angiography and optical coherence tomography angiography[J]. JAMA Ophthalmol, 2015, 133(1): 45-50. DOI: 10.1001/jamaophthalmol.2014.3616.
7. Seknazi D, Coscas F, Sellam A, et al. Optical coherence tomography angiography in retinal vein occlucion: correlations between macular vascular density, visual acuity, and peripheral nonperfusion area on fluorescein angiography[J]. Retina, 2018, 38(8): 1562-1570. DOI: 10.1097/IAE.0000000000001737.
8. Hwang CK, Kolomeyer AM, Brucker AJ. Optical coherence tomography angiography of a central retinal artery occlusion before and after anterior chamber paracentesis[J]. Ophthalmology, 2017, 124(5): 608. DOI: 10.1016/j.ophtha.2016.10.030.
9. Yang S, Liu X, Li H, et al. Optical coherence tomography angiography characteristics of acute retinal arterial occlusion[J]. BMC Ophthalmol, 2019, 19(1): 147. DOI: 10.1186/s12886-019-1152-8.
10. 李林, 司马晶, 周月芷, 等. 眼压和轴长在视网膜中央静脉阻塞中的意义[J]. 临床眼科杂志, 2005, 13(2): 109-111. DOI: 10.3969/j.issn.1006-8422.2005.02.004.Li L, Sima J, Zhou YZ, et al. The significance of intraocular pressure and axial length in central retinal vein occlusion[J]. J Clin Ophthalmol, 2005, 13(2): 109-111. DOI: 10.3969/j.issn.1006-8422.2005.02.004.
11. 魏洁. 视网膜静脉阻塞的病因和影响视力预后的相关因素分析[D]. 乌鲁木齐: 新疆医科大学, 2012.Wei J. Analysis of the etiology of retinal vein occlusion and related factors affecting visual prognosis[D]. Urumqi: Xinjiang Medical University, 2012.
12. Ørskov M, Vorum H, Larsen TB, et al. Similarities and differences in systemic risk factors for retinal artery occlusion and retinal vein occlusion: a nationwide case-control study[J]. Int Ophthalmol, 2023, 43(3): 817-824. DOI: 10.1007/s10792-022-02483-3.
13. Foroozan R. Combined central retinal artery and vein occlusion from orbital inflammatory pseudotumour[J]. Clin Exp Ophthalmol, 2004, 32(4): 435-437. DOI: 10.1111/j.1442-9071.2004.00850.x.
14. 孙梅, 郝晓凤, 谢立科, 等. 视网膜静脉阻塞的相关危险因素研究进展[J]. 中国中医眼科杂志, 2021, 31(6): 445-448. DOI: 10.13444/j.cnki.zgzyykzz.2021.06.016.Sun M, Hao XF, Xie LK, et al. Research progress of risk factors related to retinal vein occlusion[J]. Chinese Journal of Chinese Ophthalmology, 2021, 31(6): 445-448. DOI: 10.13444/j.cnki.zgzyykzz.2021.06.016.
15. Nishiguchi KM, Ito Y, Terasaki H. Bilateral central retinal artery occlusion and vein occlusion complicated by severe choroidopathy in systemic lupus erythematosus[J]. Lupus, 2013, 22(7): 733-735. DOI: 10.1177/0961203313490435.
16. 李玉琢, 刘晓燕, 武海军. 视网膜中央静脉阻塞抗VEGF治疗后出现视网膜中央动脉阻塞1例[J]. 菏泽医学专科学校学报, 2022, 34(3): 74-75,97. DOI: 10.3969/j.issn.1008-4118.2022.03.023.Li YZ, Liu XY, Wu HJ. Central retinal vein occlusion: a case report of central retinal artery occlusion after anti-VEGF treatment[J]. Journal of Heze Medical College, 2022, 34(3): 74-75,97. DOI: 10.3969/j.issn.1008-4118.2022.03.023.
17. Mendrinos E, Mavrakanas N, Kiel R, et al. Bilateral combined central retinal artery and vein occlusion in systemic lupus erythematosus resulting in complete blindness[J]. Eye (Lond), 2009, 23(5): 1231-1232. DOI: 10.1038/eye.2008.164.
18. Kopp B, Lange F, Steinke A. The reliability of the wisconsin card sorting test in clinical practice[J]. Assessment, 2021, 28(1): 248-263. DOI: 10.1177/1073191119866257.
19. Su CK, Au SCL. Isolated and combined unilateral central retinal artery and vein occlusions after vaccination. A review of the literature[J/OL]. J Stroke Cerebrovasc Dis, 2022, 31(8): 106552[2022-05-12]. https://pubmed.ncbi.nlm.nih.gov/35569402/. DOI: 10.1016/j.jstrokecerebrovasdis.2022.106552.
20. Schmidt D. Comorbidities in combined retinal artery and vein occlusions[J]. Eur J Med Res, 2013, 18(1): 27. DOI: 10.1186/2047-783X-18-27.

Chinese Journal of Ocular Fundus Diseases

Clinical analysis of the retinal vein occlusion combined with retinal artery occlusion

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