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Sex Differences in Presentation, Treatment Patterns, and Clinical Outcomes in Central Retinal Vein Occlusion
BACKGROUND AND OBJECTIVE: To evaluate the impact of sex differences on the presenting features, treatment patterns, and clinical outcomes in patients with central retinal vein occlusions (CRVO).
PATIENTS AND METHODS: This retrospective, longitudinal cohort study included 476 patients diagnosed with CRVO over a 7-year period. Charts were reviewed and clinical data were abstracted.
RESULTS: The average age at CRVO onset was lower in males (63.8 years vs. 66.1 years; P=.048). More males (104/224, 54%) had an ischemic CRVO compared to females (113/252, 45%) at 12 months (P=.05). Males with CRVO had a greater central subfield thickness at the baseline (546.7 +/- 306.8 mu m vs. 438.4 +/- 252.9 mu m; P=.003) and final visits (343 +/- 179.5 mu m vs. 304.6 +/- 176.2 mu m; P=.005). Foveal avascular zone enlargement was more likely in males (39/102, 38% vs. 29/116, 25%; P=.04).
CONCLUSIONS: Sex differences exist in presenting features of patients with CRVO. Further inquiry may help provide individualized recommendations for management of CRVO
Risk Factors for Corneal Striae in Eyes after Glaucoma Surgery
Eyes with corneal striae had steeper cornea, induced astigmatism, and higher corneal hysteresis (CH), which implies a relationship between striae, corneal shape, and the cornea's resistance to deformation at low intraocular pressures (IOPs).
Anterior corneal striae (ACS) are associated with low IOP. However, the clinical significance of ACS is unclear. Here, we aim to evaluate differences in eyes with striae compared with eyes without striae.
Adults with ACS (cases) and without ACS (controls) ≥8 weeks after glaucoma surgery with an IOP ≤10 mm Hg were enrolled. Optical coherence tomography and optical biometry were performed. CH, defined as the difference in pressure between corneal indentation and reformation in response to an air jet, was obtained by the ocular response analyzer. Hypotony maculopathy (HM) was defined as optic disc swelling, vascular tortuosity attributed to hypotony, or clinical presence of chorioretinal folds confirmed on OCT.
One hundred sixteen eyes (76 cases, 40 controls) were included. Cases had a lower IOP compared with controls (6.5±2.3 vs. 8.5±1, P<0.0001). A 1 mm Hg increase in CH increased ACS odds [odds ratio (OR)=1.51, P=0.01]. A 1 D increase in the flattest presurgical and postsurgical corneal power increased ACS odds by 1.83 (P=0.01) and 1.41 (P=0.02), respectively. Astigmatism increased in eyes with ACS by 1.11 D (P<0.001). ACS odds were increased with every 1 minute increase in mitomycin-C duration (OR=1.58, P=0.047) and decreased with the use of topical glaucoma medication (OR=0.62, P=0.03). Visual acuity decreased from logarithm of the minimal angle of resolution 0.22 (20/33 Snellen) presurgery to 0.28 (20/38) postsurgery (P=0.008), independent of ACS. HM occurred in 19% of cases (P=0.05). A higher postsurgical CH increased HM odds (OR=1.8, P=0.003). HM predicted a 0.41 mm decrease in axial length (P<0.0001), independent of IOP.
ACS were associated with a steeper cornea, induced astigmatism, and higher CH, suggesting a relationship between striae, corneal shape, and the cornea's ability to resist deformations at lower IOP. CH, HM, and axial length shortening were associated independently of IOP