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Dr Dansingani
Dr Dansingani, Ophthalmic Surgeon
Category: Eye
Satisfied Customers: 15
Experience:  BA, MA (Cambridge) MB,BS (London) FRCOphth (London)
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My mother has been diagnosed with central retina vein occlusion

Customer Question

My mother has been diagnosed with central retina vein occlusion in her right eye- her left eye is fine - she does not have diabetes.

Is there any treatment for this? She is keen to have surgery. She has been told that there is no treatment just laser treatment if eye becomes painful. I know eye injections is an option but can these really help for CRVO? Also what can she do to prevent her eye condition getting worse.

Also can you recommend any anti depressants? She has taken 3 lots from the doctors and they have all affected her eye by making them abit blury. She is pannicking that this will happen to her other eye but been told thats just a slim chance.

Any information would be appreciated.

Thank you (UK)
Submitted: 6 years ago.
Category: Eye
Expert:  Dr Dansingani replied 6 years ago.
Hi there,

I'm not sure in how much detail the diagnosis has been explained to you. CRVO refers to a blockage in the circulation of blood in the retina. In a CRVO the blockage occurs at the point where the blood leaves the retina to exit the eye. This blockage is caused in most cases by a blood clot. In practical terms, it amounts to having something akin to a stroke, but in the retina rather than the brain.

CRVOs can vary in severity, and it is difficult to judge this without seeing the patient in person. Some spontaneous recovery is possible in some cases (20% approx). Another 20% tend to remain the same, and in many cases the vision can deteriorate further.

The main reasons for visual deterioration in CRVOs include:

1. oedema (swelling) of the retina
2. ischaemia (retina not getting enough blood/oxygen)

Oedema can be relieved in some cases by steroid injection into the eye, or Avastin injection. However, if there is ischaemia of the central retina, vision is unlikely to improve.

In the presence of ischaemia, the eye can develop a painful type of glaucoma called rubeotic glaucoma. This is because ischaemic retina produces growth factors that cause compensatory growth of new blood vessels. Unfortunately these vessels tend to grow abnormally in undesirable parts of the eye, where they can obstruct the circulation of fluid inside the eyeball and cause the pressure to rise. This scenario is usually treated by laser (known as PRP laser) to shutdown the ischaemic parts of the retina. This procedure does not improve vision but can prevent the eye becoming painful in the long term.

Given that PRP has been discussed by your docs, you mum may have an ischaemic type of CRVO. Unfortunately there is currently no effective treatment to restore central retinal circulation in ischaemic cases.

Importantly, you mother should have investigations to look for (and address) risk factors for vein occlusion. These include diabetes, hypertension, cholesterol, smoking. The eye pressures should also be checked. The main aim of all this is to minimise the chances of the good eye developing a CRVO. However, in many patients we don't find a clear risk factor and the CRVO is attributed to 'bad luck.'

The antidepressants are best prescribed by you GP. In certain cases, some antidepressants can affect pupil tone and eye pressure, but it is difficult to know whether your mother is susceptible to these interactions without examining the eyes in person. Your GP should be able to liaise with your local ophthalmologist to work out something more suitable.

I hope the info is helpful. If so please click the 'accept' link.

Best wishes.
Dr Dansingani and other Eye Specialists are ready to help you
Customer: replied 6 years ago.

Thank you. Just another question I have found out my mother has non ischaemia of CRVO.

 

Is there any proven treatments for her eye condition that can help her eye. I have heard of eye injections and retina surgery?

 

Any help on treatments would be very helpful

 

Also is she able to still fly?

 

Thank you

Expert:  Dr Dansingani replied 6 years ago.
Hi again,

It's good that the vein occlusion is non-ischaemic - it means that a degree of recovery may be possible.

If the vision is limited mainly by macular oedema, some treatment may be possible. My understanding is this:

1. Possibilities are injection with steroid (triamcinolone) or anti-VEGF (Avastin or Lucentis).
2. If they work, they do so by reducing the oedema, which may improve vision to an extent.
3. The improvement is likely to be temporary, and may require repeat injections to sustain.
4. If the first injection yields no benefit at all, it is probably not worth repeating the injection.
5. A CRVO that has potential to recover will probably do so anyway, without intervention; but intervention may 'help it along.'
6. The steroid is cheap and has side effects: it causes cataract and ca,n in some patients, cause pressure increase, leading to glaucoma.
7. The anti-VEGF is newer and more expensive, and does not cause these side effects. However, there is a very small risk of causing stroke. These injections may not be available on the NHS, depending on where you live.
8. Any injection carries a small risk of infection that can damage vision further.
9. A sensible strategy may be to try a single steroid injection first, but you should take your ophthalmologists advice, depending on the exact state of the retina.

Flying is OK.

If she is not already taking aspirin, this may be recommended to reduce the risk of future events, provided there are no contraindications.

I hope it all goes well.
Best wishes.