A 59-year-old woman with history of noninsulin dependent diabetes mellitus and systemic hypertension presented with decreased vision in her left eye since 2 months ago. Bestcorrected visual acuity (BCVA) was 20/20 and 20/400 in the right and left eyes respectively.Relative afferent pupillary defect was negative. Anterior segment examination was unremarkable except for mild posterior subcapsular cataracts bilaterally.

Purpose: To evaluate role of axial length in CENTRAL RETINAL VEIN OCCLUSION (CRVO). Patients and Methods: The study group consisted of 30 patients with unilateral CRVO (19 ischemic & 11 nonischemic). The control group included 29 individuals who matched the study group patients in age, sex systemic hypertension and diabetes mellitus status.The axial lengths of affected and fellow eyes of patients and controls were measured using A-scan ultrasonography.Results: The mean axial length of affected eyes was not statistically significantly shorter than that of unaffected eyes in the CRVO group (22.88mm vs 22.90 mm) & its two ischemic & nonischemic subgroups (P>0.05). There were not statistically significant differences in axial length between control eyes and affected eyes in the CRVO group (23.11mm vs 22.88mm) & ischemic & nonischemic subgroups (P>0.05) as well.Conclusion: Our study did not demonstrate a significantly shorter axial length in CRVO eyes without macular edema. Axial length as a measurement of axial hyperopia may not be a risk factor for CRVO.

When several and very different treatment modalities exist for one ailment, it usually means that none of them is generally effective or superior to others. CENTRAL RETINAL VEIN OCCLUSION (CRVO) is a condition for which various types of management have been proposed.However, the only standard care suggested by the CENTRAL VEIN OCCLUSION Study Group (CVOSG) is panRETINAL photocoagulation when the condition is complicated by iris neovascularization.

Purpose: To evaluate total plasma homocysteine level during the acute phase of CENTRAL RETINAL VEIN OCCLUSION (CRVO) compared with a matched healthy group in Iranian population, and determine whether hyperhomocysteinemia is also a risk factor for CRVO.Methods: A study group contains 54 patients presenting with CRVO in recent one month, acute phase of the decease, was compared for fasting total plasma homocysteine level with a matched control group of 51 patients evaluated in the same clinic for a non RETINAL disease diagnosis.Results: The mean total plasma homocysteine level was 14.7±7.67 mmol/l in cases, and 11.42±3.74 mmol/l in control subjects. It shows a significant difference (p=0.005) in mean plasma homocysteine level between the cases and control group. Odds ratio of CRVO for individuals with hyperhomocysteinemia was 2.88 (95% CI=1.08-7.71 and p=0.03). The overall multivariable-adjusted odds of CRVO in participants with plasma homocysteine level above 15 mmol/l was 4.71 (95% CI=1.46-15.19 and p=0.009) Hyperhomocysteinemia was not statistically different in each age group (<60 years: 27%, 61-70 years: 33.3%, 71-80 years: 31.6%, >81 years: 33.3%, Chi-square test, p=0.98).Conclusion: Elevated total plasma homocysteine level is an independent risk factor for CRVO in Iranian population. In addition to an evaluation of all conventional cardiovascular risk factors, measurement of total homocysteine for evidence of hyperhomocysteinemia may be important in the initial investigation and management of patients with CRVO.

Purpose: To compare the effect of Dalteparin (Low molecular weight heparin) versus Aspirin on recent-onset CENTRAL RETINAL VEIN OCCLUSION (CRVO). Patients & Methods: A randomized controlled clinical trial was conducted on patients with definite CRVO of less than 21 days duration. Patients in the Dalteparin group received subcutaneous Dalteparin (100 IU/kg bid for 10 days and 100 IU/kg daily for another 10 days); patients in the aspirin group were given Aspirin (100 mg daily). Results: Thirty-eight patients were enrolled, 18 in the Dalteparin group and 20 in the Aspirin group. The duration of follow-up was 6 months. Visual outcome was compared between two groups and no significant difference was found (P=0.74). All 3 patients who received Dalteparin within 7 days of onset of CRVO had dramatic improvement in visual acuity (mean change in logMAR=1.16). NVI occurred significantly less frequently in Dalteparin treated cases as compared with Aspirin (0.55% vs. 30%, P=0.006). Conclusion: Patients treated with Dalteparin within 21 days of onset of CRVO were less likely to develop NVI. There was no significant difference in visual acuity between the two groups at 6 months.  

Purpose: To compare the effect of tissue plasminogen activator (TPA) and aspirin in patients with CENTRAL RETINAL VEIN OCCLUSION.Methods: A prospective interventional study was conducted on patients with CENTRAL RETINAL VEIN OCCLUSION of less than 28 days' duration. Patients in the TPA group received 100 mg intravitreal tissue plasminogen activator and the patients who declined intravitreal injection were considered as Aspirin group. Patients were followed up for 6 months.Results: sixty five patients were enrolled, 19 in the TPA group and 46 in the Aspirin group. The mean 6-month change in visual acuity for TPA-treated patients was -0.29±0.42 (range: -1.4 to +0.5) while in the Aspirin group, it was 0.28±0.79 with a range of -1 to +2.5. TPA group had a significantly better visual improvement in comparison to Aspirin group (P<0.0005). Conclusion: Intravitreal tissue plasminogen activator can be injected safely and easily. Patients treated with intravitreal tissue plasminogen activator within 28 days of the onset of CENTRAL RETINAL VEIN OCCLUSION are more likely to improve visual acuity.