Factors associated with extremely poor visual outcomes in patients with central retinal vein occlusion

Abstract

Here, we examined prognostic factors for extremely poor visual outcomes in patients with central retinal vein occlusion (CRVO) in actual practices. We included 150 consecutive eyes with treatment-naïve acute CRVO from four different facilities and observed them for over 24 months. Macular edema (ME) was treated with one or three monthly anti-vascular endothelial growth factor injections (1 or 3 + pro re nata). According to the final Snellen visual acuity (VA), we divided the patients into very poor VA (< 20/200) and control (≥ 20/200) groups and examined risk factors for poor final visual outcomes. The baseline Snellen VA was hand motion to 20/13. The mean number of anti-VEGF injections for ME was 5.3 ± 3.7 during the follow-up period. In total, 49 (32.7%) patients exhibited a very poor final VA; this group comprised significantly older patients with a significantly poorer baseline VA (P < 0.01 for both) than the control group. Comorbid internal carotid artery disease and diabetic retinopathy were significantly associated with a poor final VA. In actual clinical practice, visual outcomes may be extremely poor despite ME treatment in certain patients with CRVO, with advanced age, poor baseline VA, and comorbid internal carotid artery disease and diabetic retinopathy being significant risk factors.

Figure 1

Comparisons of the best-corrected visual acuity (logarithm of the minimum angle of resolution) (A), central retinal thickness (B), and defect length in the ellipsoid zone band (C) at corresponding time points between central retinal vein occlusion-patients exhibiting a final Snellen visual acuity (VA) of < 20/200 (very poor VA group) or ≥ 20/200 (control group).

Figure 2

Longitudinal changes in best-corrected visual acuity (logarithm of the minimum angle of resolution) from baseline in patients with central retinal vein occlusion, exhibiting a final Snellen visual acuity (VA) of < 20/200 (very poor VA group) or ≥ 20/200 (control group). In the very poor VA group, the BCVAs gradually deteriorated. The BCVAs after month 3 are significantly worse than the baseline BCVA. In the control group, the BCVAs are significantly better compared to that at baseline (P < 0.001 for all measuring points).

Figure 3

A scatter plot showing the best-corrected visual acuity (logarithm of the minimum angle of resolution) at baseline and final examination of each patient.