Clinical course of younger patients with central retinal vein occlusion.

OBJECTIVE: To describe the clinical course of patients 55 years and younger with central retinal vein occlusion (CRVO). DESIGN AND METHODS: Retrospective, noncomparative case series. Medical records of 67 patients were reviewed for demographic, photographic, clinical, and visual acuity (VA) data. Data from 57 patients with at least 6 months of follow-up (mean, 29.2 months) were analyzed statistically. MAIN OUTCOME MEASURES: Best-corrected visual acuity and incidence of intraocular neovascularization.
RESULTS: Of 67 consecutive patients (55% men; mean age, 45 years), the median presenting VA was 20/50. Forty-five patients (67%) were found to have at least 1 systemic disease. In 57 patients with at least 6 months of follow-up, the final VA was 20/40 or better in 42%, 20/50 to 20/100 in 18%, and 20/200 or worse in 40%. Visual decline was most common within 3 to 6 months of CRVO onset. Visual improvement was uncommon after 12 months. Of the 22 patients with a presenting VA of 20/40 or better, 36% declined to 20/400 or worse at the most recent examination. Of the 10 patients with a presenting VA of 20/200 to 20/400, 8 improved to 20/60 or better. None of the 6 patients with a presenting VA of counting fingers or worse improved. Intraocular neovascularization was diagnosed at 1 to 9 months following CRVO in 10 patients (18%). Neovascularization of the anterior segment developed in 6 patients (11%), including neovascular glaucoma in 3 (5%). The occurrence of neovascularization appeared to be unrelated to sex, age, presence of associated disease, duration of symptoms, or presenting VA.
CONCLUSIONS: Younger patients with CRVO have a variable clinical course. Presenting VA does not appear to be predictive of visual or anatomic outcome. As a significant number of patients with good vision at presentation develop legal blindness, therapeutic intervention during periods of visual decline may be considered in these patients.