Regulation of retinal blood flow in health and disease

The clinical and histopathologic features of 29 eyes from 29 patients with central retinal vein occlusion (CRVO) are reported. A fresh or a recanalized thrombus was observed in each eye. This study considers the temporal aspects of the cases, and it notes the different morphologic features of the occlusion. These observations explain most of the variability of the changes observed in previous reports. We believe that these different features represent the various stages in the natural evolution of such a thrombus. The interval between CRVO and histopathologic study in our series ranged from six hours to more than 10 years. Local and systemic factors were reviewed and were found to be important in the pathogenesis of thrombus formation. Local diseases with a predisposing effect on CRVO included: glaucoma, papilledema, subdural hemorrhage, optic nerve hemorrhage, and drusen of the optic nerve head. Associated systemic diseases included: hypertension, cardiovascular and cerebrovascular disease, diabetes mellitus, and leukemia with thrombocytopenia. A fresh thrombus in the CRVO was observed in three (10.3%), and a recanalized thrombus in 26 eyes (89.7%). Endothelial-cell proliferation was a conspicuous feature in 14 (48.3%) of the eyes. Chronic inflammation in the area of the thrombus, and/or vein wall or perivenular area was observed in 14 (48.3%) of the eyes. Arterial occlusive disease was observed in seven eyes (24.6%). Cystoid macular edema was found in 26 (89.7%) of the eyes.

Central retinal vein occlusion: a prospective histopathologic study of 29 eyes in 28 cases.

Ocular Neovascularization with Retinal Vascular Occlusion-III: Incidence of Ocular Neovascularization with Retinal Vein Occlusion

• Occlusions of nine branch retinal veins in eight eyes of seven patients were studied histopathologically by serial sections through the affected areas. Intravitreal neovascularization from the disc, retina, or both was noted in four eyes. Two additional eyes had intraretinal neovascularization (intraretinal microvascular abnormalities). Cystoid macular edema was present in five eyes. A fresh or recanalized thrombus was noted at the site of vein occlusion in all eyes. Inner ischemic atrophy of the retina was found distal to the area of occlusion in six of the nine affected quadrants of the eight eyes. Although the corresponding branch retinal arteries showed varying degrees of sclerosis (severe, three eyes; moderate, five eyes; and minimal, one eye), no definite thrombus was observed in any of them.

Histopathologic Study of Nine Branch Retinal Vein Occlusions

Ocular Neovascularization: The Krill Memorial Lecture

Branch and hemisphere vein occlusion were produced in rhesus monkeys by argon laser photocoagulation. The following observations were made: (1) Immediately after occlusion there was venous dilatation, delayed filling of the artery, delayed drainage by the occluded vein, and capillary leakage. (2) Two patterns of evolution were identified within the first week. In some animals the fundus changes resolved and the retina returned to normal, while in others there was progressive retinal capillary closure. (3) Those animals destined to have capillary closure had diffuse or cluster retinal haemorrhages at 24 hours. (4) Capillary closure took place over 1 week and was usually complete over large areas of retina. (5) Retinal atrophy and major vessel changes occurred over several weeks. (6) Retinal revascularisation occurred in those areas of closure, though this was often limited. It was concluded that the early changes mimicked those seen in human retinal vein occlusion, though persistent retinal oedema and preretinal neovascularisation were not identified.

https://bjo.bmj.com/content/bjophthalmol/63/6/377.full.pdf

Experimental retinal branch vein occlusion in rhesus monkeys. I. Clinical appearances.

Experimental branch vein occlusion by laser photocoagulation in the rhesus monkey leads to early, marked, and lasting reduction of blood flow to the affected retinal region. The radioactive microsphere method demonstrates this reduction of blood flow in both gamma counting and autoradiography. The reduction of flow becomes evident as early as 2 hours after occlusion and persists up to 1 week. The mechanism of the altered flow is discussed.

https://bjo.bmj.com/content/bjophthalmol/63/6/388.full.pdf

D A Rosen

Papers

Experimental retinal branch vein occlusion in rhesus monkeys. I. Clinical appearances.

Experimental retinal branch vein occlusion in rhesus monkeys. II. Retinal blood flow studies.

Experimental venous occlusion.

Experimental retinal vein occlusion in the rhesus monkey. Radioactive microsphere and radioautographic studies [proceedings].