Glaucoma Profile of fellow eyes of Unilateral Central or Hemicentral Venous Occlusions

1
Glaucoma Profile of fellow eyes of Unilateral
Central or Hemicentral Venous Occlusions

• Dr. S. J. Saikumar, Dr. A. Giridhar, Dr. Mahesh
  G, Giridhar Eye Institute
• Cochin , India
• None of the authors have any financial interests
  in this study

2
Introduction

• Verhoeff in 1913 proposed a role for glaucoma in
  CRVO
• Many publications since then with prevalence
  ranging from 6-69
• IOP of affected eye drops by up to 18
• Perimetry in affected eye may be unreliable
• Hence, quite often fellow eye investigated

3
Materials and methods

• 75 patients with unilateral CRVO or Hemi CRVO
• Standard diagnostic criteria for both venous
  occlusions
• Vision, IOP, CDR and Automated Perimetry
• Visual acuity, RAPD, Indirect Ophthalmoscopy and
  FFA were used to differentiate between ischemic
  and non ischemic CRVO

4
Types of occlusions in the study
Non Ischemic
Ischemic
Hemi CRVO
5
Examination protocol

• Pre designed protocol
• Snellens visual acuity both eyes
• IOP Goldman applanation both eyes
• Retina examination I/O and S/L
• FFA when possible
• RAPD looked for
• Automated Perimetry

6
Results

• Study conducted between Jan and Dec 2004, 75
  patients satisfied inclusion criteria
• 63 CRVO, 12 Hemi CRVO
• 20 had systemic HT alone, 13 had DM alone, 18 had
  both DM and systemic HT
• VA affected eye, 6/60 or less in 29 (out of which
  25 had RAPD) and better than 6/60 in 46
• 33.3 had ischemic and the rest had non ischemic
• All ischemic cases were in the CRVO group and
  none in the Hemi CRVO

7
Glaucoma in fellow eye
8
Field defects
9
Analysis

• Risk factor analysis the opposite eye is 5 times
  more prone to develop field defect if the
  affected eye has ischemic RVO when compared to
  non ischemic RVO
• Chi square p value 0.05
• 20 new glaucoma patients picked up from this study

10
Discussion

• Overall prevalence of glaucoma in our study is
  34.6 , compares well with similar studies
• We did not perform perimetry in the affected eye
• Reports (Hayreh et al) that Goldman Kinetic
  Perimetry may be better for the affected eye
• We used HFA to pick up early glaucoma defects

11
Ischemic Non ischemic

• Hayreh et al has mentioned 4 subjective and 2
  objective criteria
• Maximum sensitivity for RAPD ERG
• Least sensitivity for Ophthalmoscopy
• We used VA, RAPD and Ophthalmoscopy
• No difference in incidence of glaucoma between
  CRVO and Hemi CRVO groups
• Subtypes in our study NTG, POAG, OHT
• Hayreh et al OHT, POAG, NTG

12
Conclusion

• 26/75 has glaucoma or OHT out of which 20 are new
  detections
• We picked up a significant number of NTG in our
  study
• Risk of glaucoma in fellow eye is 5 times more in
  ischemic CRVO
• Glaucoma screening of fellow normal eye is very
  important