Vein occlusion, retinal

Retinal or vitreous hemorrhage, retinal detachment, transient or permanent visual loss central retinal vein occlusion... 

Intravitreal triamcinolone injection is safe and effective for cystoid macular edema caused by uveitis, diabetic maculopathy, and central retinal vein occlusion, and for pseudophakic cystoid macular edema. Potential risks include glaucoma, cataract, retinal detachment, and endophthalmitis. Infectious endophthalmitis is extremely rare when appropriate sterile technique is practised. Seven patients developed a clinical picture simulating endophthalmitis after intravitreal injection of triamcinolone (71). The authors believed that this effect was a toxic reaction to the injected material and explained that the differential diagnosis of infectious endophthalmitis in eyes that have been injected with triamcinolone under sterile conditions includes a sterile toxic endophthalmitis that requires careful monitoring, perhaps every 8-12 hours, in order to determine whether the inflammation is worsening or improving. Resolution occurs spontaneously, and in the absence of eye pain unnecessary intervention can be avoided. 

Retinal vein occlusion (18-21), retinal artery occlusion (22), and optic neuritis (23,24) have been described in women taking estrogens. 

Murray DC, Christopoulou D, Hero M. Combined central retinal vein occlusion and cilioretinal artery occlusion in a patient on hormone replacement therapy. Br J Ophthalmol 2000 84(5) 549-50. 

Cahill M, O Toole L, Acheson RW. Hormone replacement therapy and retinal vein occlusion. Eye 1999 13(Pt 6) 798-800. 

Kirwan JF, Tsaloumas MD, Vinall H, Prior P, Kritzinger EE, Dodson PM. Sex hormone preparations and retinal vein occlusion. Eye 1997 ll(Pt l) 53-6. 

Among the less common forms of thromboembolism that have been reported is occlusion of the retinal vein, familiar with the oral contraceptives but unusual with HRT (36). 

Williamson TH. Central retinal vein occlusion what s the story BrJ Ophthalmol 1997 81 698-704. 

Proliferative retinopathy (e.g., proliferative stage of sickle cell, diabetes, retinal vein occlusion)... 

An additional clinical use of acetazolamide is unrelated to its ocular hypotensive properties.The 500-mg acetazolamide capsule administered daily for 2 weeks may produce either a partial or a complete resolution of macular edema in patients with cystoid macular edema (CME), retinitis pigmentosa, and chronic intermediate uveitis (pars planitis). Macular edema produced by primary retinal vascular diseases (branch and central retinal vein occlusion and macular telangiectasia) did not respond to acetazolamide therapy. It is believed that acetazolamide may improve visual function if the macular edema stems from retinal pigment epithelial dysfunction. Improved macular edema in these conditions may be associated with fluid movement from the retina to the choroid. However, acetazolamide does not appear to alter macular blood flow. 

The beneficial outcomes of systemic bevacizumab therapy for CNV stimulated investigators to administer the drug intravitreally, using a dose that would be therapeutically equivalent to the systemic dose used in the SANA study but approximately 400-fold less overall (about 1.25 mg total dose vs. 5 mg/kg). Although initial studies had not suggested any benefit from bevacizumab, a 1.0-mg intravitreal injection of bevacizumab was administered to a patient with wet AMD poorly responsive to pegaptanib therapy and to another patient with macular edema after central retinal vein occlusion (CRVO). Both patients demonstrated complete resolution of edema by OCT at 1 week acuity improved from 20/200... 

Rosenfeld PJ, Fung AE, PuMafito CA. Optical coherence tomography findings after an intravitreal injection of bevacizumab (Avastin) for macular edema from central retinal vein occlusion. Ophthalmic Surg Lasers Imaging 2005 36 336. 

Ip MS, GottUeb JL, KahanaA, et al. Intravitreal triamcinolone for the treatment of macular edema associated with central retinal vein occlusion.Arch Ophthalmol 2004 122 1131. 

Some patients first sign of morbidity from elevated lOP can be presentation with sudden loss of vision due to a central retinal vein occlusion (CRVO). Elevated lOP is the second most common risk factor for CRVO behind systemic hypertension. 

Papillitis (41) and retinal vein occlusion (42) have been attributed to hepatitis B vaccine. 

Devin F, Roques G, Disdier P, Rodor F, Weiller PJ. Occlusion of central retinal vein after hepatitis B vaccination. Lancet 1996 347(9015) 1626. 

Meyer CH, Schmidt JC, Rodrigues EB, et al. Risk of retinal vein occlusions in patients treated with rofecoxib (Vioxx). Ophthalmologica. 2005 219 243-247. 

HeierJS +, Ophthalmology I 13(4), 642 (2006) Rosenfeld PJ +, Ophthalmology I 13(4), 632 Maculopathy Ocular pain Ocular pruritus Ocular xerosis Retinal vein occlusion (2006) HeierJS +, Ophthalmology I 13(4), 642 Subretinal fibrosis Vision blurred Visual disturbances Vitreous floaters... 

Hasan S, Elbedawi M, Castro O, et al. Central retinal vein occlusion in sickle cell disease. South Med J 2004 97 202-204. 

Intravitreal triamcinolone acetonide use has increased recently following case series of successful treatment of edema due to various etiologies as well as choroidal neovascularization. It has been advocated for the treatment of macular edema associated with diabetes (54), uveitis (38,39), and central retinal vein occlusion (55). In addition, it has been proposed as adjunctive treatment for proliferative diabetic retinopathy (41) and exudative AMD (43,44). 

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