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ARTICLES
Year : 1971  |  Volume : 19  |  Issue : 4  |  Page : 183-184

Developmental glaucoma and branch vein occlusion in thee retina


Department of Ophthalmology, Maulana Azad Medical College, New Delhi, India

Correspondence Address:
D K Sen
Department of Ophthalmology, Maulana Azad Medical College, New Delhi
India
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Source of Support: None, Conflict of Interest: None


PMID: 15745418

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How to cite this article:
Sen D K, Sood G C, Dewan R. Developmental glaucoma and branch vein occlusion in thee retina. Indian J Ophthalmol 1971;19:183-4

How to cite this URL:
Sen D K, Sood G C, Dewan R. Developmental glaucoma and branch vein occlusion in thee retina. Indian J Ophthalmol [serial online] 1971 [cited 2020 May 28];19:183-4. Available from: http://www.ijo.in/text.asp?1971/19/4/183/34968

The relationship between pre­existing chronic simple glaucoma and the subsequent development of retinal vein occlusion has re­ceived emphasis in recent years. It has been observed that patient with chronic simple glaucoma more often develop retinal vein occlusion than normotensive in­ dividuals. Bertelsen[2] noted a 43% incidence of simple glaucoma in his series of vein occlusion patients. Dryden[3] examined clini­cally 26 patients with venous oc­clusion, 7 of whom had been seen prior to the occlusion and of whom 5 had bilateral simple glaucoma; in the remaining 19 patients first seen after the occlusion, 13 were found with simple glaucoma in the contra lateral eye. However, in all the :cases there was occlu­sion of the central vein of the retina and not of a branch vein.

The idea of the present commu­nication is to report a case of branch vein occlusion in a case of developmental glaucoma. The ob­struction originated at the arte­riovenous crossing where the ar­tery passed over the vein.


  Case Report Top


R.S., a 17-year-old male report­ed to the hospital with the com­plaints of progressive painless diminution of vision on the left side for about 3 years.


  Examination Top


Right eye: Normal in all res­pects, visual acuity 6/5 with full visual fields, tension 10.2 mm. Hg. (Schiotz).

Left eye: visual acuity finger counting at a distance of 0.50 metre with defective projection on the nasal side. Pupil was semi­dilated and reacting sluggishly to light. Retinoscopy revealed that the eye was myopic - 5 D sph. but there was no subjective im­ provement.

Fundus examination revealed advanced glaucomatous cupping of the disc with marked atrophy. Distal to the first arteriovenous crossing, the superior temporal vein and all its tributaries were very much engorged and tortuous. The blood column was more dark in colour. Nearer the site of ob­struction the retina was oedema­tous, in which the macula was also involved. Large superficial flame-shaped haemorrhages and exudates were found scattered along the course of the vein. Re­tinal arteries were normal. There was no evidence of arteriosclero­sis. Tension 43.4 mm. Hg. (Schiotz). Gonioscopy revealed open angle with heavily pigmented trabecu­lar meshwork.

B.P. 110/80 mm. Hg. Urine and blood studies were, normal. No abnormal globulin could be de­tected in the plasma. Bleeding and clotting times - were normal. ESR 20 mm first hour (Westergreen). Mantoux test 8 mm. Serological tests for syphilis were negative­

The patient was treated with diamox and 2% pilocarpine which was followed by, iridencleisis. Follow up revealed a good filter­ing bleb. The tension was under control. Oedema disappeared and haemorrhages and exudates got absorbed almost completely leav­ing a few signs. However, there was no visual improvement.


  Discussion and Comments Top


In venous branch occlusion the impediment is probably mechani­cal which occurs in patients with evidence of systemic hyperten­sion and arteriosclerosis in the retinal arteries of the affected eye. The walls of adjacent arteries and veins are intimately connected. Thickening of the arterial wall tends to obliterate the lumen of the vein and this occurs especially at the disc and at arteriovenous crossings and- it is here that one finds the obstruction. However, in this case there was no associated systemic hypertension or arte­riosclerosis. There was also no increased viscosity of blood to cause venous stasis. So it appears that long-standing glaucoma, which was the only pathology as­sociated, had something to do to bring about the obstruction but its exact role in the present case is not clear. Long-standing glau­coma may produce proliferative degenerative changes in the vein Verhoeff which would facilitate or hasten the occlusive event es­pecially in the presence of con­current venous stenosis. Theories of backward bulging of the lamina cribrosa due to raised intra ocular pressure. - Behrman [1] and sudden drop of retinal venous pressure beyond lamina cribrosa have no relevance in the present case as the site of obstruction was at, the, arterio venous crossing. beyond the level of the disc.


  Summary Top


Retinal venous occlusion in a case of developmental glaucoma is presented. The case is interest­ing because the block was at the arterio venous crossing and the patient was too young for such an event[4].

 
  References Top

1.
BEHRMAN, S. Retinal vein ob­struction. Brit. J. Ophth. 46, 336 (1962).  Back to cited text no. 1
    
2.
BERTELSEN, T. I. Relationship between thrombosis in retinal veins and primary glaucoma. Acta. Oph­thal. 39, 603 (1961).  Back to cited text no. 2
    
3.
DRYDEN, R. M. Central retinal vein occlusions and chronic simple glaucoma. A.M.A. - Arch. Ophthal. 73: 659 (1965).  Back to cited text no. 3
    
4.
VERHOEFE, F. H. Effect of chronic glaucoma on central retinal vessels, Arch. Ophth. 42, 145 (1913).  Back to cited text no. 4
    




 

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