Clinical Course of Younger Patients With Central Retinal Vein Occlusion

Objective To describe the clinical course of patients 55 years and younger withcentral retinal vein occlusion (CRVO). Design and Methods Retrospective, noncomparative case series. Medical records of 67 patientswere reviewed for demographic, photographic, clinical, and visual acuity (VA)data. Data from 57 patients with at least 6 months of follow-up (mean, 29.2months) were analyzed statistically. Main Outcome Measures Best-corrected visual acuity and incidence of intraocular neovascularization. Results Of 67 consecutive patients (55% men; mean age, 45 years), the medianpresenting VA was 20/50. Forty-five patients (67%) were found to have at least1 systemic disease. In 57 patients with at least 6 months of follow-up, thefinal VA was 20/40 or better in 42%, 20/50 to 20/100 in 18%, and 20/200 orworse in 40%. Visual decline was most common within 3 to 6 months of CRVOonset. Visual improvement was uncommon after 12 months. Of the 22 patientswith a presenting VA of 20/40 or better, 36% declined to 20/400 or worse atthe most recent examination. Of the 10 patients with a presenting VA of 20/200to 20/400, 8 improved to 20/60 or better. None of the 6 patients with a presentingVA of counting fingers or worse improved. Intraocular neovascularization wasdiagnosed at 1 to 9 months following CRVO in 10 patients (18%). Neovascularizationof the anterior segment developed in 6 patients (11%), including neovascularglaucoma in 3 (5%). The occurrence of neovascularization appeared to be unrelatedto sex, age, presence of associated disease, duration of symptoms, or presentingVA. Conclusions Younger patients with CRVO have a variable clinical course. PresentingVA does not appear to be predictive of visual or anatomic outcome. As a significantnumber of patients with good vision at presentation develop legal blindness,therapeutic intervention during periods of visual decline may be consideredin these patients.