Evaluation of Glaucomatous Damage in the Fellow Eyes of Patients With Unilateral Retinal Vein Occlusion

Sam Young Yoon; Jaewan Choi; Chang Hwan Lee; Mincheol Seong; Kyung Rim Sung; Michael S. Kook

doi:10.3341/jkos.2009.50.1.120

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Yoon, Choi, Lee, Seong, Sung, and Kook: Evaluation of Glaucomatous Damage in the Fellow Eyes of Patients With Unilateral Retinal Vein Occlusion

Original Article

J Korean Ophthalmol Soc 2009;50(1):120-127.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.1.120

Evaluation of Glaucomatous Damage in the Fellow Eyes of Patients With Unilateral Retinal Vein Occlusion

Sam Young Yoon, M.D.¹, Jaewan Choi, M.D.², Chang Hwan Lee, M.D.³, Mincheol Seong, M.D.⁴, Kyung Rim Sung, M.D.¹, Michael S. Kook, M.D.¹

¹Department of Ophthalmolgy, University of Ulsan, Asan Medical Center, Seoul, Korea

²Han-Gil Eye Hospital, Incheon, Korea

³Cheil Eye Hospital, Daegu, Korea

⁴Hanyang University GURI Hospital, Guri-si, Gyeonggi-do, Korea

Address reprint requests to Michael S. Kook, MD Department of Ophthalmolgy, University of Ulsan, Asan Medical Center #388-1 Pungnap-2dong, Songpa-gu, Seoul 138-736, Korea Tel: 82-2-3010-3677, Fax: 82-2-470-6440, E-mail: mskook@amc.seoul.kr

Received 30 September 2008 Accepted 2 June 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the visual field (VF) and retinal nerve fiber layer (RNFL) status of the fellow eyes in patients with unilateral retinal vein occlusion (RVO).

Methods

Fifty patients with unilateral RVO and 35 normal control subjects wereconsecutively recruited. Humphrey VF parameters and RNFL status using scanning laser polarimetry with variable corneal compensation (GDx-VCC) were compared between the fellow eyes of the patients with unilateral RVO and control eyes. We also assessed the risk factors for the development of glaucomatous damage in the fellow eyes of unilateral RVO patients.

Results

Twelve fellow eyes out of 50 patients with unilateral RVO showed glaucomatous VF and RNFL changes assessed by GDx-VCC. VF indices and RNFL thickness parameters in the study group were significantly lower than those in the control group (p<0.05). Increased age and vertical cup-to-disc ratio were significantly associated with severity of VF and RNFL damage in the fellow eye of unilateral RVO patients (p<0.05).

Conclusions

The fellow eyes in patients with unilateral RVO showed significantly worse VF indices and lower RNFL thickness than normal control eyes. The glaucomatous change should be carefully monitored in the fellow eyes of unilateral RVO patients.

Keywords: BRVO, CRVO, Fellow eye, Glaucoma, Retinal vein occlusion

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Figure 1.

Comparison of visual field indices of the fellow eyes of branch retinal vein occlusion (BRVO) patients, the fellow eyes of central retinal vein occlusion (CRVO) patients and controls; MD=mean deviation; PSD=pattern standard deviation; BRVO=branch retinal vein occlusion; CRVO=central retinal vein ^* Statistical significance was found with occlusion; unpaired t-test (p<0.001).

Figure 2.

Global and sectoral RNFL retardation values based on GDx-VCC of the fellow eyes of branch retinal vein occlusion (BRVO) patients, the fellow eyes of central retinal vein occlusion (CRVO) patients and controls; TSNIT=temporal, superior, nasal, inferior and temporal AV=average; SD=standard deviation; BRVO= branch retinal vein occlusion; CRVO=central retinal vein occlusion; ^* Statistical significance was found with unpaired t-test (p<0.001).

Table 1.

Demographics and clinical characteristics of participant

	BRVO^∗ patients (n=26)	CRVO^† patients (n=24)	Controls (n=35)	p-value
Age (year, mean± SD^‡)	59.9±9.9	56.8±18.3	55.9±7.9	0.442^§
Gender (male:female)	12:14	14:10	14:21	0.380^∏
Hypertension (n)	11	12	10	0.229^∏
Diabetes mellitus (n)	6	5	5	0.656^∏
RVO duration^＃ (week) Range of RVO duration (week)	71 2-286	1025-312	n/a^∗∗ n/a	0.198^††

^∗ BRVO=branch retinal vein occlusion

^† CRVO=central retinal vein occlusion

^‡ SD=standard deviation

^§ One-way ANOVA testamong three groups (p>0.05)

^∏ Chi-square test among three groups (p>0.05)

^＃ RVO duration=time after retinal vein occlusion occurrence

^∗∗ n/a=no account

^†† Unpaired t-test between BRVO fellow eye and CRVO fellow eye (p>0.05)

Table 2.

Comparison of clinical characteristics, visual field indices and GDx-VCC parameters between the fellow eyes of retinal vein occlusion (RVO) patients and control (mean± standard deviation)

	RVO^∗ fellow eye (n=50)	Control (n=35)	p-value^††
BCVA^‡ (logMAR) RE^§ (diopter)	0.15±0.21-0.38±1.74	0.09±0.12-0.13±1.22	0.0910.463
IOP^∏ (mmHg)	16.4±4.1	15.1±3.8	0.148
Vertical C/D ratio^＃	0.71±0.19	0.35±0.11	<0.001
Visual field indices
MD^∗∗ (dB^††)	-6.7±8.5	-1.0±1.6	<0.001
PSD^‡‡ (dB)	4.6±3.8	1.9±0.5	<0.001
Global and sectoral RNFL retardation values
TSNIT^§§ average (µm)	48.2±11.2	59.4±5.3	<0.001
Superior average (µm)	56.9±13.1	72.4±9.0	<0.001
Inferior average (µm)	53.9±13.0	68.7±8.5	<0.001
TSNIT SD^∏∏ (µm)	16.5±5.4	22.8±5.3	<0.001

^∗ RVO=retinal vein occlusion

^† Unpaired t-test (statistical significance: p<0.05)

^‡ BCVA=best corrected visual acuity

^§ RE= refractive error

^∏ IOP=intraocular pressure

^＃ Vertical C/D ratio=vertical cup to disc ratio

^∗∗ MD=mean deviation

^†† dB=decibel

^‡‡ PSD=pattern standard deviation

^§§ TSNIT=temporal, superior, nasal, inferior and temporal

^∏∏ SD=standard deviation.

Table 3.

Comparison of clinical characteristics, visual field indices and GDx-VCC parameters among the fellow eyes of branch retinal vein occlusion (BRVO) patients, the fellow eyes of central retinal vein occlusion (CRVO) patients and control (mean± standard deviation)

	BRVO^∗ fellow eye (n=26)	CRVO^† fellow eye (n=24)	Control (n=35)	p-value^‡
BCVA^§ (logMAR) RE^∏ (diopter)	0.13±0.14-0.03±1.41	0.17±0.30-0.81±2.03	0.09±0.12-0.13±1.15	0.1430.758
IOP^＃ (mmHg)	16.9±3.6	15.9±4.6	15.1±3.8	0.230
Vertical C/D ratio^∗∗	0.78±0.13	0.59±0.22	0.35±0.11	<0.001
Visual field indices
MD^†† (dB^‡‡)	-6.7±8.4	-6.8±8.6	-1.0±1.6	0.001
PSD^§§ (dB)	4.7±3.7	4.5±4.2	1.9±0.5	<0.001
Global and sectoral RNFL retardation values
TSNIT^∏∏ average (µm)	45.8±8.7	50.7±13.0	59.4±5.3	<0.001
Superior average (µm)	55.0±11.8	59.0±14.3	72.4±9.0	<0.001
Inferior average (µm)	51.7±11.1	56.3±14.7	68.7±8.5	<0.001
TSNIT SD^＃＃ (µm)	15.9±5.1	17.2±5.7	22.8±5.3	<0.001

^∗ BRVO=branch retinal vein occlusion

^† CRVO=central retinal vein occlusion

^‡ One-way ANOVA test among three groups (statistical significance: p<0.05)

^§ BCVA=best corrected visual acuity

^∏ RE=Refractive error

^＃ IOP=intraocular pressure

^∗∗ Vertical C/D ratio=vertical cup to disc ratio

^†† MD=mean deviation

^‡‡ dB=decibel

^§§ PSD=pattern standard deviation

^∏∏ TSNIT=temporal, superior, nasal, inferior and temporal

^＃＃ SD=standard deviation

Table 4.

Number of eyes with glaucomatous visual field defect and NFI≥40 on GDx VCC in each group

	BRVO^∗ fellow eye	CRVO^† fellow eye	Control
	(n=26)	(n=24)	(n=35)
G-VFD^‡(%)	10 (30.8%)^§	9 (37.5%)^§	0 (0%)
NFI∏ ≥ 40 (%)	8 (30.8%)^§	6 (25.0%)^§	0 (0%)
G-VFD or NFI ≥ 40 (%)	14 (53.8%)^§	12 (50.0%)^§	0 (0%)
G-VFD and NFI ≥ 40 (%)	7 (26.9%)^§	5 (20.8%)^§	0 (0%)

^∗ BRVO=branch retinal vein occlusion

^† CRVO=central retinal vein occlusion

^‡ G-VFD=glaucomatous visual field defect- Glaucoma Hemifield Test (GHT) outside 99% of age-specific normal limits or pattern standard deviation (PSD) outside 95% of normal limits

^§ There were significant differences in glaucomatous visual field defectsand number of eyes with an NFI of ≥40 between RVO patients and controls (Chi-square test, p<0.001)

^∏ NFI=nerve fiber indicator.

Table 5.

Correlation of risk factors for glaucoma with functional and structural glaucomatous damage in the fellow eyes of retinal vein occlusion patients

		MD^∗	PSD^†	TSNIT^‡ average	Superior average	Inferior average	TSNIT SD^§
Age (year)	p-value	0.025^∏	0.125	0.013^∏	<0.001^∏	0.001^∏	<0.001^∏
	R^＃	-0.319	0.222	-0.347	-0.485	-0.442	-0.572
IOP^∗∗	p-value	0.615	0.865	0.645	0.564	0.764	0.701
(mm Hg)	R	-0.074	-0.025	-0.067	-0.084	-0.044	-0.056
Vertical C/D	p-value	0.027^∏	0.605	0.036^∏	0.012^∏	0.063	0.010^∏
ratio^††	R	-0.369	0.089	-0.351	-0.416	-0.313	-0.424
RVO onset^‡‡	p-value	0.546	0.533	0.342	0.306	0.277	0.552
(week)	R	0.089	-0.092	-0.139	-0.149	-0.158	-0.087

^∗ MD=mean deviation

^† PSD=pattern standard deviation

^‡ TSNIT=temporal, superior, nasal, inferior and temporal

^§ SD= standard deviation

^∏ Statistical significance was found using Pearson’s correlation analysis (p<0.05).

^＃ R=Pearson’s correlation coefficient

^∗∗ IOP=intraocular pressure;

^†† Vertical C/D ratio=vertical cup to disc ratio

^‡‡ RVO onset=time after retinal vein occlusion occurrence.

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