Central vein occlusion in the eye
| Classification according to ICD-10 | |
|---|---|
| H34.8 | Other retinal vascular occlusion - Venous retinal vascular occlusion: central |
| ICD-10 online (WHO version 2019) | |
A central vein occlusion in the eye (ZVV) is an occlusion of the central blood-carrying vessel in the retina ( Vena centralis retinae ). The primary consequence is a painless deterioration in vision . The central vein occlusion must be distinguished from the branch vein occlusion (VAV), in which a branch of the central blood-carrying vessel in the retina is partially or completely closed.
Complaints and findings
The patient mostly notices a painless decrease in visual acuity or a blurred vision ("like through a curtain"). When mirroring the fundus ( funduscopy ), the ophthalmologist finds streaky bleeding in the retina , cotton-wool spots or at least swelling of the optic nerve outlet ( papillary edema ). With the help of fluorescein angiography of the retina (representation of the blood flow in the retina with a contrast medium), the severity of the blood flow disturbance in the retina is examined. A rough distinction is made between the non-ischemic form and the ischemic form (the latter with a more severe course), whereby the forms can merge into one another. The visual impairment noticed by the patient may particularly concern the decrease or loss of reading ability, which is caused or worsened by fluid retention in the macula ( macular edema ). The extent of the macular edema is examined with the help of optical coherence tomography (OCT).
Causes and consequences
The cause is not sufficiently clear. Elevations in hematocrit as they occur after altitude training and general risk factors for thrombosis are believed to play a role, e.g. B. hypertension and diabetes mellitus . Increased intraocular pressure is also suspected to favor vascular occlusions in the retina. As a complication , there may be a permanent decrease in visual acuity up to blindness of the eye. An increase in intraocular pressure (neovascular glaucoma ) can also occur. The pathophysiology is reminiscent of that of sinus thrombosis in the cranial cavity .
therapy
Laser surgery (panretinal photocoagulation) can reduce the blood supply in the non-perfused retinal area, thus avoiding an increase in intraocular pressure caused by secondary glaucoma. In the case of macular edema , the injection of drugs ( VEGF inhibitors, steroids ) into the vitreous humor is the therapy of choice. Further, a can thrombolytic (clot dissolving with biologically active substances) or hemodilution (dilution of the blood by infusions ) can be tried. In recent years, surgical procedures have also been developed (for example “radial neurotomy ” or “decompression” of the optic nerve ), but their benefits have not yet been sufficiently proven.
Individual evidence
- ↑ LO Hattenbach u. a .: Visual outcome after treatment with low-dose recombinant tissue plasminogen activator or hemodilution in ischemic central retinal vein occlusion. In: Ophthalmologica , 1999, 213 (6), pp. 360-366. PMID 10567867
- ↑ H. Shahid et al. a .: The management of retinal vein occlusion: is interventional ophthalmology the way forward? In: Br J Ophthalmol. , 2006 May, 90 (5), pp. 627-639. PMID 16622095 .
