title: The effect of central retinal venous pressure in patients with central retinal vein occlusion and a high mean area of nonperfusion.
abstract: OBJECTIVE
  To evaluate the effect of central venous pressure (CVP) on visual outcomes and retinal ischemic consequences in patients with central retinal vein occlusion (CRVO).
  
  
  METHODS
  Prospective, single-center cohort study.
  
  
  METHODS
  Eighty-eight patients with CRVO and a high overall mean area (21.6 disc areas) of capillary nonperfusion (CNP) who were followed for 18 months before the availability of intravitreal therapy and who were offered standard care of the time.
  
  
  METHODS
  Patients were evaluated at baseline and at 3, 8, and 18 months. At each study visit, measurements of CVP, best-corrected visual acuity (BCVA), area of CNP, retinal fluorescein transit time (FTT), and an evaluation for rubeosis iridis were performed.
  
  
  METHODS
  Evaluation of the effect of different levels of CVP on BCVA, retinal blood flow, and the development of retinal ischemia and rubeosis iridis.
  
  
  RESULTS
  Mean BCVA was significantly higher in patients with lower CVP at all time points (P<0.0001). The area of CNP increased significantly with higher levels of CVP and progressed with time. The development of rubeosis iridis was significantly associated with CVP at all time points and was present in 5.6%, 27.9%, and 88.9% of those with low, moderate, and high CVP levels, respectively (P<0.0001), at the 18-month conclusion. Retinal blood flow as measured by FTT was reduced with higher levels of CVP. Spontaneous lowering of CVP had beneficial effects on BCVA, although this diminished with time.
  
  
  CONCLUSIONS
  Eyes with increased CVP after more severe CRVO demonstrate significantly reduced vision, reduced retinal blood flow, a higher incidence of rubeosis iridis, and larger areas of CNP that correlate with the degree of CVP elevation.
authors.affiliation: Centre for Ophthalmology and Visual Science, Lions Eye Institute, The University of Western Australia, Perth, Australia. Electronic address: ianmcallister@lei.org.au.
authors.forename: Ian L
authors.initials: IL
authors.lastname: McAllister
authors.affiliation: Centre for Ophthalmology and Visual Science, Lions Eye Institute, The University of Western Australia, Perth, Australia.
authors.forename: Mei H
authors.initials: MH
authors.lastname: Tan
authors.affiliation: Centre for Ophthalmology and Visual Science, Lions Eye Institute, The University of Western Australia, Perth, Australia.
authors.forename: Lynne A
authors.initials: LA
authors.lastname: Smithies
authors.affiliation: Singapore Eye Research Institute, National University of Singapore, Singapore.
authors.forename: Wan L
authors.initials: WL
authors.lastname: Wong
mesh_terms: D000368:Aged; D001794:Blood Pressure; D015331:Cohort Studies; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D007498:Iris / Q000098:blood supply; D007511:Ischemia / Q000503:physiopathology*; D008297:Male; D009389:Neovascularization, Pathologic / Q000503:physiopathology; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology; D012170:Retinal Vein Occlusion / Q000503:physiopathology*; D012171:Retinal Vessels / Q000503:physiopathology*; D014690:Venous Pressure / Q000502:physiology*; D014792:Visual Acuity / Q000502:physiology*