Dr. Priti Jain, Dr. Anamika Dwivedi,
Dr. Dwivedi P C, Dr. Charudatt Chalisgaonkar,
Dr.Shashi Jain (Agarwal)
INTRODUCTION
Retinal vein occlusion (RVO) is the most common retinal vascular occlusive disorder and is usually associated with variable amount of loss of vision1. RVO is second most common retinal vascular disease following diabetic retinopathy. 16.4 million Adults affected worldwide2. Timely recognition is important because complications are cause of significant ocular morbidity.
PURPOSE: To calculate Incidence & Prevalence in Tertiary health centre, identify risk-factors and clinical pattern of Retinal vein occlusion.
METHOD: The present study was a Hospital based Observational study conducted in Department of Ophthalmology, SSMC & Associated GMH, and Rewa (M.P.) from 1st March 2015 to 29th February 2016. Ophthalmic OPD patients with clinical diagnosis of RVO underwent comprehensive ophthalmic examination including FA. Biochemical investigations were done to identify associated systemic ailments.
RESULT: Following observations were made. In our study Incidence of RVO was 0.775/1000 with prevalence of 1.075/1000 of cases. CRVO is approx 1.71 times more reported than BRVO and 12 times more reported than HRVO in our hospital. Mean age of RVO patients was 53 yrs with male preponderance. Hypertension was most prevalent risk-factor, present in less than half patients. Followed by DM in one-third patients, followed by Dyslipidemia, Hyperhomocysteinemia, and OAG in decreasing frequency. . Many patients had more than one identifiable risk factor. 80% patients presented with diminution of vision. In our study left was more frequently involved than right eye.
TABLE 1:
PREVALENCE OF RVO AND SUBTYPES IN TERTIARY HEALTH CENTER
| DISEASE | NUMBER | PERCENTAGE |
| CRVO | 36 | 60 % |
| BRVO | 20 | 35% |
| HRVO | 3 | 5% |
| TOTAL | 59 | 100% |
Patients with RVO, 60 % have CRVO, 35% BRVO and 5% have HCRVO
TABLE 2
AGE-WISE DISTRIBUTION OF RVO
| YEARS | BRVO | CRVO | HRVO | TOTAL |
| No. | No. | No. | No. | |
| 31-40 | 2 | 3 | – | 5 |
| 41-50 | 3 | 7 | – | 10 |
| 51-60 | 4 | 12 | 2 | 18 |
| 61-70 | 6 | 9 | 1 | 16 |
| 71-80 | 5 | 4 | – | 9 |
| 81-90 | 0 | 1 | – | 1 |
| TOTAL | 20 | 36 | 3 | 59 |
Mean age of RVO patients was 53 yrs with maximum no. of cases reported between the age of 51- 70 years of age
TABLE 3:
SEX-WISE DISTRIBUTION OF CRVO
| SEX | BRVO | CRVO | HRVO | TOTAL | |
| No. (%) | No.(%) | No.(%) | |||
| MALE | 9(45%) | 24(67%) | 3(100%) | 36(61%) | |
| FEMALE | 11(55%) | 12(33%) | – | 23(39%) | |
| TOTAL | 20 | 36 | 3 | 59 | |
In our study males (61%) were more reported than females (39%)
TABLE 4:
RISK-FACTORS IN RVO
|
RISK- FACTOR |
RVO | |
| No. | % | |
| HYPERTENSION | 25 | 42 |
| DIABETES MELLITUS | 18 | 30 |
| DYSLIPIDEMIA | 11 | 18 |
| HYPERHOMOCYSTEINEMIA | 6 | 11 |
| GLAUCOMA | 5 | 9 |
| CAD | 2 | 3 |
| CVA | 2 | 3 |
| OCP | 2 | 3 |
| SUBSTANCE ABUSE | 2 | 3 |
| NO RISK FACTOR | 1 | 2 |
TABLE 5:
SYMPTOMS IN RVO
| SYMPTOMS | No. | % |
| DOV | 47 | 79.67 |
| VF DEFECTS | 5 | 8.47 |
| FLOATERS | 5 | 8.47 |
| ASYMPTOMATIC | 5 | 8.47 |
TABLE 6:
LATERALITY IN BRVO
| BRVO | CRVO | HRVO | ||||
| No. | % | No. | % | No. | % | |
| OD | 9 | 45. | 15 | 42 | 1 | 33 |
| OS | 11 | 55 | 21 | 58 | 2 | 67 |
P=0.9211
TABLE 7:
QUADRANT INVOLVED BRVO
| QUADRANT INVOLVED | No.
|
% |
| ST | 10 | 52 |
| IT | 8 | 40 |
| SN | 4 | 20 |
| IN | 2 | 10 |
| MULTIPLE BRVO | 4 | 20 |
TABLE 8;
DISTRIBUTION OF RVO ACCORDING TO PERFUSION STATUS
| TYPE | BRVO | CRVO | HRVO | ||
| No. | % | No. | % | ||
| ISCHEMIC | 16 | 81.48 | 20 | 56 | 3(100%) |
| NON-ISCHEMIC | 4 | 18.52 | 16 | 44 | – |
| TOTAL | 20 | 100 | 36 | 100 | 3 |
DISCUSSION: Hypertension was most prevalent risk-factor, present in less than half patients. Followed by DM, dyslipidemia, hyperhomocysteinemia, and OAG in decreasing frequency. Hypertension causes chronic endothelial injury, stimulates prothrombotic activity of endothelium and thereby initiates & accelerates atherosclerosis. Also hypertension disturbs laminar blood flow making platelet coming in contact with injured prothrombotic. Similar association was reported by S.L.Teoh & K.Amarjeet (1993) in their retrospective study. endothelium. In our study 9% cases had glaucoma. Anatomic variations at the level of lamina cribrosa are important in the development of CRVO. Within the retrolaminar portion of the optic nerve CRA and CRV are aligned parallel to each other in a common tissue sheath.CRA and CRV are naturally compressed as they pass through rigid sieve –like openings in the lamina cribrosa .With increase in IOP there is mechanical stretching of the lamina ,which may cause subsequent bowing of lamina and subsequent impingement on the central retinal vein. Superotemporal quadrant is most frequently seen in BRVO patient’s. Thapa (2010) Hospital based case control study was found 63.9% of branch retinal vein occlusion in the Superotemporal.
CONCLUSION: RVO causes significant ocular morbidity contributing 0.09% with CRVO more common than BRVO in Tertiary center. There is significant association with increase in age. Hypertension was most prevalent risk factor in RVO patients, followed by diabetes and dyslipidemia, hence improved understanding of medical conditions associated with these diseases may have implications for the patient’s general health
REFERENCES
1 Hayreh.Retinal vein occlusion.IJO.1994;42(3):109-132
2 Rogers S ,McIntosh RL,Cheung N, et al.The prevalence of retinal vein occlusion :pooled data from population studies from the United States ,Europe,Asia, and Australia .Ophthalmology.117(2):313-319 2010