Central and Hemicentral Retinal Vein Occlusion Role of Anti-Platelet Aggregation Agents and Anticoagulants Sohan Singh Hayreh

MD,Ph D, Patricia A. Podhajsky, BSN, M.Bridget Zimmerman,PhD Objective : To investigate systematically the role of anti-platelet-aggregating drugs or anticoagu lants in central retinal vein occlusion (CRVO) and hemi-CRVO. Design : Cohort study. Participants : Six hundred eighty-six consecutive patients with CRVO (567 patients, 585 eyes) and non ischemic hemi- CRVO (119 patients,122 eyes). Methods : At first visit, all patients had a detailed ophthalmic and medical history (including the use of anti-platelet aggregating drugs or anticoagulants), and comprehensive ophthal mic and retinal evaluation. Visual evaluation was carried out by recording visual acuity, using the Snellen visual acuity chart, and visual fields with a Goldman perimeter.The same ophthalmic evaluation was performed at each follow-up visit. At the initial visit, CRVO and hemi- CRVO were classified as nonischemic and ischemic. Main Outcome Measures : Visual acuity, visual fields, and severity of retinal hemorrhages. Results : All 3 types of CVRO, showed a significantly greater greater severity of retinal hemorrhages among aspirin users than nonusers (P<0.001). Initial visual acuity and visual fields were he significantly worse in aspirin users than nonusers in nonischemic CRVO and hemi-CRVO, but did not differ for ischemic CRVO. Among patients with nonischemic CRVO who initially had 20/60 or better visual acuity, there was a significant association of aspirin use with visual deterioration. The odds ratio of visual acuity deterioration, adjusting for age,di,abe tes, ischemic heart disease,and hypertension, for aspirin users relative to nonusers was 2.24 ( 95% confidence interval [CI], 1.14- 4.41 ; P=0.020). Of those whose macular edema resolved, overall cumulative visual acuity o utcome also suggested a higher percentage with deterioration among aspirin users, odds ratio for deteriora tion of 3.62 ( 95% CI.0.97 -13.54 ;P=0.05) for aspirin users relative to nonusers. For the nonischemic CRVO patients With 20/70 or worse visual acuity at the initial visit,after resolution of macular edema,

Improvement in visual acuity was less likely in the aspirin users than in nonusers (odds ratio, 0.18 ;95% CI, 0.04-0.72 ;P=0.016) Conclusions: Findings of this study indicate that, for patients with CRVO and hemi-CRVO, the use of aspirin, other anti-platelet aggregating agents, or anticoagulants was associated with a worse visual outcome and no apparent benefit. Ophthalmology 2011 ;118 : 1603-1611 @ 2011 by the American Academy of Ophthalmology August 2011.