Incidence and Clinical Features of Neovascularization of the Iris following Acute Central Retinal Artery Occlusion
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Purpose: To investigate the incidence of neovascularization of the iris (NVI) and clinical features of patients withNVI following acute central retinal artery occlusion (CRAO). Methods: A retrospective review of 214 consecutive CRAO patients who visited one tertiary hospital betweenJanuary 2009 and January 2015 was conducted. In total, 110 patients were eligible for this study after excludingpatients with arteritic CRAO, a lack of follow-up, iatrogenic CRAO secondary to cosmetic filler injection, orNVI detected before CRAO attack. Fluorescein angiography (FA) was applied until retinal arterial reperfusionwas achieved, typically within 1 to 3 months. Results: The incidence of NVI was 10.9% (12 out of 110 patients). Neovascular glaucoma was found in sevenpatients (6.4%). The mean time to NVI diagnosis after CRAO events was 3.0 months (range, 1 week to 15months). The cumulative incidence was 5.5% at 3 months, 7.3% at 6 months, and 10.9% at 15 months. Severelynarrowed ipsilateral carotid arteries were observed in only three patients (27.3%). The other nine patients(75.0%) showed no predisposing conditions for NVI, such as proliferative diabetic retinopathy or centralretinal vein occlusion. Reperfusion rate and prevalence of diabetes were significantly different between patientswith NVI and patients without NVI (reperfusion: 0% [NVI] vs. 94.7% [no NVI], p < 0.001; diabetes: 50.0%[NVI] vs. 17.3% [no NVI], p = 0.017). Conclusions: CRAO may lead to NVI and neovascular glaucoma caused by chronic retinal ischemia fromreperfusion failure. Our results indicate that follow-up fluorescein angiography is important to evaluate retinalartery reperfusion after acute CRAO events, and that prophylactic treatment such as panretinal photocoagulationshould be considered if retinal arterial perfusion is not recovered.
Abstract
Purpose: To investigate the incidence of neovascularization of the iris (NVI) and clinical features of patients withNVI following acute central retinal artery occlusion (CRAO). Methods: A retrospective review of 214 consecutive CRAO patients who visited one tertiary hospital betweenJanuary 2009 and January 2015 was conducted. In total, 110 patients were eligible for this study after excludingpatients with arteritic CRAO, a lack of follow-up, iatrogenic CRAO secondary to cosmetic filler injection, orNVI detected before CRAO attack. Fluorescein angiography (FA) was applied until retinal arterial reperfusionwas achieved, typically within 1 to 3 months. Results: The incidence of NVI was 10.9% (12 out of 110 patients). Neovascular glaucoma was found in sevenpatients (6.4%). The mean time to NVI diagnosis after CRAO events was 3.0 months (range, 1 week to 15months). The cumulative incidence was 5.5% at 3 months, 7.3% at 6 months, and 10.9% at 15 months. Severelynarrowed ipsilateral carotid arteries were observed in only three patients (27.3%). The other nine patients(75.0%) showed no predisposing conditions for NVI, such as proliferative diabetic retinopathy or centralretinal vein occlusion. Reperfusion rate and prevalence of diabetes were significantly different between patientswith NVI and patients without NVI (reperfusion: 0% [NVI] vs. 94.7% [no NVI], p < 0.001; diabetes: 50.0%[NVI] vs. 17.3% [no NVI], p = 0.017). Conclusions: CRAO may lead to NVI and neovascular glaucoma caused by chronic retinal ischemia fromreperfusion failure. Our results indicate that follow-up fluorescein angiography is important to evaluate retinalartery reperfusion after acute CRAO events, and that prophylactic treatment such as panretinal photocoagulationshould be considered if retinal arterial perfusion is not recovered.
참고문헌 (12)
- Park SJ, "Nationwide incidence of clinically diagnosed central retinal artery occlusion in Korea, 2008 to 2011", Ophthalmology, 121, pp.1933~1938 (2014)
- 사공민, "Intravitreal Bevacizumab for the Treatment of Neovascular Glaucoma Associated With Central Retinal Artery Occlusion", Korean Journal of Ophthalmology, 23(3), pp.215~218 (2009), 대한안과학회
- Hayreh SS, "Ocular neovascularization with retinal vascular occlusion. II: Occurrence in central and branch retinal ar tery occlusion", Arch Ophthalmol, 100, pp.1585~1596 (1982)
- Rudkin AK, "Ocular neovascularization following central retinal artery occlusion: prevalence and timing of onset", Eur J Ophthalmol, 20, pp.1042~1046 (2010)
- Duker JS, "A prospective study of acute central retinal artery obstruction: the incidence of secondary ocular neovascularization", Arch Ophthalmol, 109, pp.339~342 (1991)
- Ahn SJ, "Efficacy and safety of intra-arterial thrombolysis in central retinal artery occlusion", Invest Ophthalmol Vis Sci, 54, pp.7746~7755 (2013)
- Sivak-Callcott JA, "Evidence-based recommendations for the diagnosis and treatment of neovascular glaucoma", Ophthalmology, 108, pp.1767~1776 (2001)
- Hayreh SS, "Retinal artery occlusion: associated systemic and ophthalmic abnormalities", Ophthalmology, 116, pp.1928~1936 (2009)
- Mendrinos E, "Ocular ischemic syndrome", Surv Ophthalmol, 55, pp.2~34 (2010)
- Aiello LP, "Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders", N Engl J Med, 331, pp.1480~1487 (1994)
- Duker JS, "The efficacy of panretinal photocoagulation for neovascularization of the iris after central retinal artery obstruction", Ophthalmology, 96, pp.92~95 (1989)
- "Natural history and clinical management of central retinal vein occlusion: the Central Vein Occlusion Study Group", Arch Ophthalmol, 115, pp.486~491 (1997)