CRVO question

[RobinG]

I have CRVO, and had read that scuba was not a problem as the fluid in the eye does not compress.

But I had been diving last year about a month before the last hemorrhage which was a doozy, and then I read about Terson's Syndrome, which is basically a hemorrhage caused by the pressure created by valsalva.

Does anyone know where I can find out more information? If I already have CRVO, could valsalva be contributing to another hemorrhage?

Anyone have any experience?

Thanks
Robin

 

[caruso]

CRVO is not something you have, it's an acute condition that resolves once the underlying cause is determined and treated accordingly. Depending on what that cause may be diving could be contraindicated. If you get repeated CRVOs then diving is the least of your worries.

 

[gert7to3]

If you had a month pass before your occlusion, that does not seem causative. Were you able to determine why you did suffer a CRVO? Tersen's Syndrome is mostly associated with intra-cranial pressure. You also show over 500 dives logged.

 

[Duke Dive Medicine]

@caruso and @gert7to3 , for my own edification, how would this condition be influenced by mask squeeze or valsalva? And is it really acute? I don't know much about it, but in doing some reading it seems that people with CRVO have elevated levels of VEGF so it could me more chronic and recurring. Also seems that it would make the eye sensitive to changes in pressure as with (even mild) mask barotrauma or valsalva. What is y'all's experience?

Thanks,
DDM

 

[caruso]

@Duke Dive Medicine an intact globe is relatively noncompressable and I have read nothing to the contrary so I expect that mild to moderate amounts of mask squeeze would not be a causal factor in a retinal vein occlusion that is typically due to extremely elevated intraocular pressures or a systemic vascular disorder.

A CRVO or branch occlusion are acute events in that a blood vessel breaks, blood leaks all around the retina and may or may not cause visual symptoms and rarely results in permanent vision loss because it's the returning blood not the oxygenated supply.

It resolves rather quickly depending on the underlying cause and treatment rendered, if any. Think of a subconjuctival hemorrhage which appears as a bright red blood spot on the sclera (white part of the eye for the casual reader). Typically fades and clears as the blood is reabsorbed within about a week.

Don't know anything about a possible VEGF connection to CRVO.

 

[Duke Dive Medicine]

Thanks!

 

[gert7to3]

Here's the American Academy of Ophthalmology take on CRVO:
What Is Central Retinal Vein Occlusion (CRVO)?

American Society of Retinal Surgeons:
Central Retinal Vein Occlusion - The American Society of Retina Specialists - The American Society of Retina Specialists

And finally anti-VEGF treatment for CRVO:

Anti-vascular endothelial growth factor for macular edema secondary to central retinal vein occlusion

 

[caruso]

The links above, while somewhat informative and rather lengthly, can be summarized as: There are several underlying conditions that can cause a CRVO, either ocular, which results in high pressure such as glaucoma, or systemic conditions including hypertension, diabetes, and blood clotting disorders to name a few. Treatments (if any) vary according to the underlying cause.

While anti VEGF treatments have been clinically trialed to treat macular edema associated with CRVO, there is no conclusive evidence that they are effective, even though they have been proven effective to delay or stop progression in age related macular degeneration.

There is nothing in the articles about a connection between systemic blood levels of VEGF and CRVO.

 

[Duke Dive Medicine]

The links above, while somewhat informative and rather lengthly, can be summarized as: There are several underlying conditions that can cause a CRVO, either ocular, which results in high pressure such as glaucoma, or systemic conditions including hypertension, diabetes, and blood clotting disorders to name a few. Treatments (if any) vary according to the underlying cause.

While anti VEGF treatments have been clinically trialed to treat macular edema associated with CRVO, there is no conclusive evidence that they are effective, even though they have been proven effective to delay or stop progression in age related macular degeneration.

There is nothing in the articles about a connection between systemic blood levels of VEGF and CRVO.

Here's where I found it. This is in no way a claim of expertise on my part, please feel free to provide context.

Central Retinal Vein Occlusion - The American Society of Retina Specialists - The American Society of Retina Specialists

Best regards,
DDM

 

[caruso]

Here's where I found it.

I think what the article is saying is that VEGF is elevated following a CRVO . It's the result of, not a cause of, CRVO, the levels increase because they are triggered by the hypoxic state of the tissues.

Here's an article that suggests as much.

Vascular endothelial growth factor (VEGF), a key mediator of intraocular neovascularization, is triggered by hypoxia and has been shown in the eyes of animal models of central retinal vein occlusion (CRVO).

Vascular endothelial growth factor upregulation in human central retinal vein occlusion - ScienceDirect