Treatment of Patients with Central Retinal Vein Occlusion by Anticoagulation

Purpose: For patients with central retinal vein occlusion (CRVO) no effective causal therapy preserving the visual function has been described to date. The aim of our study was to assess the safety and efficacy of anticoagulation with warfarin in patients with CRVO.
Study design: Retrospective interventional study
Methods: 74 patients with non-ischemic CRVO and 20 patients with ischemic CRVO treated with warfarin for one year were evaluated. Patients were divided into two subgroups according to the initial best corrected visual acuity (BCVA) measured by Early Treatment Diabetic Retinopathy Study (ETDRS) charts. Group A included patients with BCVA 20/200 or worse (logMAR ? 1,0), group B with 20/40 or better (logMAR ? 0,3). Main outcome was BCVA, the frequency of unfavourable final BCVA (20/200 or worse) was evaluated and the results were compared with published results of the natural course of CRVO (Quinlann et al, Am J Ophthalmol. 1990).
Results: The part of patients with unfavourable final BCVA (20/200 and worse) was significantly smaller in patients treated with warfarin compared to untreated patients (21,6 %; versus 49,5 %). The significant effect of anticoagulation to final BCVA was found in patients with non-ischemic CRVO and initial VA 20/200 or worse (37,5 % versus 88,2 %). In patients with initial VA 20/40 and better as well as in patients with ischemic CRVO no significant effect of anticoagulation was found. Relevant is the reduction of neovascular glaucoma in patients with ischemic CRVO. No adverse events (i.e. severe bleeding) were observed.
Conclusion: Anticoagulation seems to be an effective method affecting the causality of CRVO and reduces the frequency of unfavourable final BCVA in patients with initial BCVA 20/200 or worse. Further prospective, randomized and controlled studies are required to confirm the observed effect of anticoagulation.