Comorbidities in combined retinal artery and vein occlusions

Abstract

Background: Several general diseases cause blindness in patients with simultaneous combined retinal artery and vein occlusion.

Methods/patients: We examined 14 patients with acute unilateral visual loss due to combined retinal artery and venous occlusions. All 14 patients presented at the Polyclinic over a period of about 3 years. Fluorescein angiography was carried out in 12 patients to confirm the diagnosis. Ten patients underwent Doppler sonography and 11 echocardiography.

Results: Concerning systemic diseases, 11 of our 14 patients presented several cardiovascular risk factors, i.e., immunocytoma and arterial hypertension and hypercholesterolemia in one patient; another patient had chronic bronchitis, tachycardia and hypercholesterolemia. Six patients presented coagulation anomalies, and eight patients had arterial hypertension.Doppler sonography revealed normal carotid arteries in nine of ten patients. In 8 of 11 patients, echocardiography displayed no cardiac abnormalities.Ophthalmoscopy revealed no emboli in any of these patients.

Conclusion: Unilateral simultaneous combined incomplete retinal artery and venous occlusions should be considered as one entity. Eleven of our patients presented comorbidities reflecting several cardiovascular risk factors. Immunological diseases, malignancies and coagulopathies can cause this ocular disorder, resulting in blindness. No emboli were found in any of these patients. Patients suffering from acute visual loss must be examined for the presence of systemic diseases to enable therapy at an early stage.

Figure 1

LE: Left Eye Initial stage of infarction of the inferior temporal artery associated with a few dot-and-blot hemorrhages and enlarged, tortuous veins in the left eye of a 62-year-old man (patient no. 4).

Figure 2

A new episode with pronounced retinal changes: papilledema, cotton-wool spots and additional hemorrhages (2 weeks later with deterioration of retinal findings, patient no. 4).

Figure 3

LE: Infarction of a large cilioretinal artery associated with a CRVO in the left eye of a 39-year-old male who had arterial hypertension (patient no. 14).

Figure 4

RE: Right Eye in a 57-year-old woman. Swelling of the optic disk, macular edema, macular cherry-red spot and multiple retinal hemorrhages (patient no. 10).

Figure 5

Fluorescein-angiogram: 48 s after dye injection: delayed filling of vessels, tortuosity of vessels mainly in the area of the posterior pole, some peripheral vessels are not filled with fluorescein (temporal superior and nasal inferior areas) (patient no. 10).

Figure 6

Fluorescein-angiogram: 1 min, 56 s after dye injection. All vessels are filled with dye. Sludge phenomenon in superior temporal veins (patient no. 10).