title: Differentiation of ischemic from non-ischemic central retinal vein occlusion during the early acute phase.
abstract: We investigated prospectively in 128 patients (140 eyes) the role of six routine clinical tests in the differentiation of ischemic central retinal vein occlusion (CRVO) from non-ischemic CRVO during its early acute phase. There were four functional tests [visual acuity, visual fields, relative afferent pupillary defect (RAPD), electroretinography (ERG)] and two morphologic tests (ophthalmoscopy and fluorescein fundus angiography). We found that none of the six tests had 100% sensitivity and specificity in such a differentiation during the early, acute phase, so that no one test can be considered a "gold standard"; however, combined information from all six is almost always reliable. Overall, the four functional tests proved far superior to the two morphologic tests in differentiating ischemic from non-ischemic CRVO:RAPD was most reliable in uniocular CRVO (with a normal fellow eye), followed closely by ERG in all cases; combined information from RAPD and ERG differentiated 97% of cases; perimetry was the next most reliable, followed by visual acuity. The two morphologic tests performed worst; fluorescein angiography provided either no information at all on retinal capillary nonperfusion (in at least one-third of the eyes during the early, acute phase) because of multiple limitations, or sometimes provided misleading information. Ophthalmoscopic appearance is the least reliable, most misleading parameter.
authors.affiliation: Department of Ophthalmology, University of Iowa, Iowa City 52242.
authors.forename: S S
authors.initials: SS
authors.lastname: Hayreh
authors.forename: M R
authors.initials: MR
authors.lastname: Klugman
authors.forename: M
authors.initials: M
authors.lastname: Beri
authors.forename: A E
authors.initials: AE
authors.lastname: Kimura
authors.forename: P
authors.initials: P
authors.lastname: Podhajsky
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D004596:Electroretinography; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005654:Fundus Oculi; D006801:Humans; D007511:Ischemia; D008875:Middle Aged; D009887:Ophthalmoscopy; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011681:Pupil Disorders / Q000175:diagnosis; D012164:Retinal Diseases / Q000175:diagnosis; D012170:Retinal Vein Occlusion / Q000175:diagnosis* / Q000473:pathology; D012171:Retinal Vessels / Q000473:pathology*; D014792:Visual Acuity; D014794:Visual Fields