Silent Killer Next door : Beware of Glaucoma

Presenting Author :Dr Rahul Achlerkar

Co-Authors :Dr.Rita Dhamankar

Dr . Vijay Shetty Dr. Sachin Fegde

IntroductionPatients with retinal venous occlusion do have a poor visual

outcome We would certainly like to avoid progression of disease like

glaucoma in such patients which results in irreversible blindness by diagnosing it early.

In many cases, perimetry cannot be performed in the affected eye because of poor vision.

In cases where perimetry can be performed, field changes due to the vascular occlusion itself may mask glaucomatous changes.

AIM To asses the prevalence of glaucoma in fellow eyes of

patients with unilateral venous occlusion

To study the clinical features of glaucoma in these eyes.

Methodology: This is Cross-sectional study of 54 patients with retinal venous

occlusion .

Fellow apparently-normal eye evaluated by applanation tonometer ,Gonioscopy, perimetry, Oct.

Depending on clinical features Venous occlusion further classified into central & branched venous occlusion . Ischemic & non ischemic central venous occlusion

Full description of the study design, methods and procedures:

Study site Laxmi Eye Institute , Panvel

Study design – prospective cross sectional study

Sample size - 54 eyes with unilateral vein occlusion

Sampling – consecutive consenting

Inclusion criteria All Patients with unilateral retinal venous occlusion

EXCLUSION CRITERIA:Known case of glaucoma

Patients with rubeosis in fellow eye

cases where perimetry could not be done in unaffected eye due to other causes

Results:The mean age of our population 60.30 yrs, 57% males, 43%

females

The prevalence of glaucoma in fellow eyes was 26% (95% confidence intervals [CI]: 15%-40%);

most common type POAG 69.33 %.

Results:

The prevalence was significantly higher in CRVO patients compared with BRVO patients (48% vs 7%, p=0.001)

CRVO BRVO0

5

10

15

20

25

30

35

40

45

50

44

7

%

p=0.01

Odds Ratio (OR) unadjusted 9.8(CI 1.5 -50.7)

Results:Even after adjusting for age and sex, fellow eyes of CRVO

were significantly more likely to have glaucoma compared with BRVO (OR: 12.9; 95% CI: 2.1 to 79.5)

Among CRVO, ischemics were likely to have glaucoma compared with non-ischemics (77% vs 33%, p=0.07).

ResultsPatients more than 75 years

and 61-75 years were more likely to have glaucoma compared with those between the ages of 25 and 60 years.

<61 61-75 >750

10

20

30

40

50

60

8

39

50

%

P=0.02

(OR: 14.8, 95% CI: 1.1 to >200)

(OR: 7.3, 95% CI: 1.1-48.9)

Conclusion:We found a significant number of previously undetected

glaucomas in our studyPatients with unilateral venous occlusion shows

preponderance of glaucoma in fellow eye Among CRVO, ischemics were likely to have glaucoma

compared with non-ischemicsElderly CRVO patients were most likely to have glaucoma in

fellow eyes.Glaucoma screening of the normal eye is mandatory in persons

with unilateral venous occlusion

References1. Verhoeff FH. The effect of chronic glaucoma on the central

retinal vessels. Arch Ophthalmol 1913; 42: 145-152.2. Leber T. Die Krankheiten der Netzhaut. In: Graefe AC, Saemisch

ET, Hess C, Eds. Handbuch der Gesammten Augen heilkunde. 2nd Ed. Leipzig: Wilhelm Engelmann; 1915; 355.

3. Vadala G, Zanini A, Favero C, et al. Evaluation of the clinical course of Central Retinal Vein Occlusion in eyes with and without glaucoma. Acta Ophthalmol Scand. 1997; suppl 224: 16-17.

4. Saatchi OA, Ferliel ST, Ferliel M, et al. Pseudoexfoliation and glaucoma in eyes with retinal vein occlusion. Int Ophthalmol 1999; 23: 75-78.

Thank you