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Lee JY, Choi JA, Park SP, Jee D. Association Between High Blood Folate Levels and Glaucoma in a Representative Korean Population. Invest Ophthalmol Vis Sci 2024; 65:6. [PMID: 38170538 PMCID: PMC10768708 DOI: 10.1167/iovs.65.1.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 11/19/2023] [Indexed: 01/05/2024] Open
Abstract
Purpose This study aimed to investigate the association between folate levels and the prevalence of glaucoma. Methods This nationwide population-based cross-sectional study included 1790 participants aged ≥40 years. We analyzed data regarding the participants obtained in the 2016-2018 Korean National Health and Nutrition Examination Survey. The diagnosis of glaucoma was defined according to the International Society of Geographical and Epidemiological Ophthalmology criteria. Logistic regression analyses were used to investigate the relationship between blood folate levels and glaucoma. Results There was a significantly lower prevalence of glaucoma in the highest quartile of blood folate levels than in the lowest quartile, after adjusting for confounding factors such as age, sex, systemic hypertension, diabetes, hypercholesterolemia, and smoking (odds ratio [OR] = 0.470; 95% confidence interval [CI], 0.291-0.759; P for trend = 0.017). There was a significantly lower risk of glaucoma in the highest quartile of blood folate levels than in the lowest quartile among women (OR = 0.188; 95% CI, 0.099-0.357; P for trend <0.001) and younger participants (OR =0.443; 95% CI, 0.229-0.856; P for trend = 0.045). Conclusions Our findings indicate a strong inverse correlation between blood folate levels and glaucoma.
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Affiliation(s)
- Ji Young Lee
- Department of Ophthalmology and Visual Science, College of Medicine, Daejeon St. Marys’ Hospital, Catholic University of Korea, Seoul, Korea
| | - Jin A. Choi
- Department of Ophthalmology and Visual Science, College of Medicine, St. Vincent's Hospital, Catholic University of Korea, Seoul, Korea
| | - Sung Pyo Park
- Department of Ophthalmology, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Donghyun Jee
- Department of Ophthalmology and Visual Science, College of Medicine, St. Vincent's Hospital, Catholic University of Korea, Seoul, Korea
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Gu J, Lei C, Zhang M. Folate and retinal vascular diseases. BMC Ophthalmol 2023; 23:413. [PMID: 37833663 PMCID: PMC10571445 DOI: 10.1186/s12886-023-03149-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
Folate, a pteroylglutamic acid derivative, participates in fundamental cellular metabolism. Homocysteine, an amino acid, serves as an intermediate of the methionine cycle and can be converted back to methionine. Hyperhomocysteinemia is a recognized risk factor for atherosclerotic and cardiovascular diseases. In recent decades, elevated plasma homocysteine levels and low folate status have been observed in many patients with retinal vascular diseases, such as retinal vascular occlusions, diabetic retinopathy, and age-related degeneration. Homocysteine-induced toxicity toward vascular endothelial cells might participate in the formation of retinal vascular diseases. Folate is an important dietary determinant of homocysteine. Folate deficiency is the most common cause of hyperhomocysteinemia. Folate supplementation can eliminate excess homocysteine in plasma. In in vitro experiments, folic acid had a protective effect on vascular endothelial cells against high glucose. Many studies have explored the relationship between folate and various retinal vascular diseases. This review summarizes the most important findings that lead to the conclusion that folic acid supplementation might be a protective treatment in patients with retinal vascular diseases with high homocysteine or glucose status. More research is still needed to validate the effect of folate and its supplementation in retinal vascular diseases.
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Affiliation(s)
- Jinyue Gu
- Department of Ophthalmology, West China Hospital, Sichuan University, 610041, Chengdu, China
- Research Laboratory of Macular Disease, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Chunyan Lei
- Department of Ophthalmology, West China Hospital, Sichuan University, 610041, Chengdu, China
- Research Laboratory of Macular Disease, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Meixia Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, 610041, Chengdu, China.
- Research Laboratory of Macular Disease, West China Hospital, Sichuan University, 610041, Chengdu, China.
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Lendzioszek M, Mrugacz M, Bryl A, Poppe E, Zorena K. Prevention and Treatment of Retinal Vein Occlusion: The Role of Diet-A Review. Nutrients 2023; 15:3237. [PMID: 37513655 PMCID: PMC10383741 DOI: 10.3390/nu15143237] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Retinal vein occlusion (RVO) is the second most common retinal disorder. In comparison to diabetic retinopathy or age-related macular degeneration, RVO is usually an unexpected event that carries a greater psychological impact. There is strong evidence to suggest that cardiovascular diseases are the most common risk factors in this pathology and it has long been known that a higher consumption of fish, nuts, fruits, and vegetables has a protective effect against these types of conditions. In the last several years, interest in plant-based diets has grown in both the general population and in the scientific community, to the point to which it has become one of the main dietary patterns adopted in Western countries. The aim of this review is to investigate the potential impact of macro- and micronutrients on retinal vein occlusion.
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Affiliation(s)
- Maja Lendzioszek
- Department of Ophthalmology, Voivodship Hospital in Lomza, 18-400 Lomza, Poland
| | - Małgorzata Mrugacz
- Department of Ophthalmology and Eye Rehabilitation, Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Anna Bryl
- Department of Ophthalmology and Eye Rehabilitation, Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Ewa Poppe
- Department of Ophthalmology, Voivodship Hospital in Lomza, 18-400 Lomza, Poland
| | - Katarzyna Zorena
- Department of Immunobiology and Environmental Microbiology, Medical University of Gdansk, 80-211 Gdansk, Poland
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Kazantzis D, Theodossiadis P, Kroupis C, Theodossiadis G, Chatziralli I. Vitamin B12 and Folate as Risk Factors for Retinal Vein Occlusion: A Meta-Analysis. Klin Monbl Augenheilkd 2021; 239:709-716. [PMID: 34000749 DOI: 10.1055/a-1473-5897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the association between serum vitamin B12/folate and retinal vein occlusion (RVO). METHODS A comprehensive search of the PubMed database was performed, which identified 271 abstracts to be screened. Ten studies met our inclusion criteria and a meta-analysis of these comparative case-control studies was performed on the mean ± standard deviation serum vitamin B12 and folate levels, without language restrictions. Nine studies with 720 patients with RVO and 613 controls were included in the meta-analysis for vitamin B12, and 10 studies with 784 patients with RVO and 677 controls in the meta-analysis for folate. RESULTS There was no statistically significant difference between patients with RVO and controls in serum vitamin B12 levels (mean difference: - 40.25 pg/mL, p = 0.28), either central RVO (mean difference: - 18.24 pg/mL, p = 0.71) or branch RVO (mean difference: - 23.56 pg/mL, p = 0.48). On the contrary, the plasma folate level was significantly lower in RVO patients than in controls (mean difference: - 1.34 ng/mL, p = 0.001), as well as in patients with CRVO compared to controls (mean difference: - 1.48 ng/mL, p = 0.006), but not in BRVO patients (mean difference: - 0.72 ng/mL, p = 0.11). CONCLUSIONS RVO is associated with low serum folate levels, but not with serum vitamin B12 levels.
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Affiliation(s)
- Dimitrios Kazantzis
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Christos Kroupis
- Department of Clinical Biochemistry, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - George Theodossiadis
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | - Irini Chatziralli
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
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Abstract
The aim is to study risk factors for retinal vein occlusion (RVO), such as thrombophilic and cardiovascular risk factors (CRF). A retrospective consecutive case series of 60 patients with RVO was made, tested for CRF, hyperhomocysteinemia, lupic anticoagulant, antiphospholipid antibody and 5 gene variants: factor V (FV) Leiden (G1691A), factor II (PT G20210A), 5,1-methylenetetra-hydrofolate reductase (MTHFR; 677 C > T and 1298 A > C), plasminogen activator inhibitor 1 (PAI-1; 4 G/5 G). More than 1 CRF were present in 36 patients (60%), which had a significantly higher mean age at diagnosis (66.7 ± 12.9 versus 59.5 ± 13.7 with ≤1 CRF, [t(57) = −2.05, p = 0.045, d = 0.54). Patients with thermolabile MTHFR forms with decreased enzyme activity (T677T or C677T/A1298C) had a significant lower mean age [57.6 ± 15.1; t (58) = 3.32; p = 0.002; d = 0.846] than patients with normal MTHFR enzyme activity (68.5 ± 10.2). Regarding CRF and thermolabile forms of MTHFR, the mean age at diagnosis could be significantly predicted [F(2,56) = 7.18; p = 0.002] by the equation: 64.8 − 10.3 × (thermolabile MTHFR) − 5.31 × ( ≤ 1CRF). Screening of MTHFR polymorphisms may be useful in younger RVO patients, particularly when multiple CRF are absent.
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Li D, Zhou M, Peng X, Sun H. Homocysteine, methylenetetrahydrofolate reductase C677T polymorphism, and risk of retinal vein occlusion: an updated meta-analysis. BMC Ophthalmol 2014; 14:147. [PMID: 25428529 PMCID: PMC4255450 DOI: 10.1186/1471-2415-14-147] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 11/15/2014] [Indexed: 01/06/2023] Open
Abstract
Background To evaluate the role of plasma total homocysteine (tHcy) and homozygosity for the thermolabile variant of the methylenetetrahydrofolate reductase (MTHFR) C677T genotype in the risk of retinal vein occlusion (RVO). Methods Relevant studies were selected through an extensive search of PubMed, EMBASE, and the Web of Science databases. Summary weighted mean differences (WMDs) or odds ratios (ORs) and 95% confidence intervals (CI) were calculated with a random-effects model. Results Forty-two studies with 6445 participants were included in this updated systematic review and meta-analysis. The mean plasma tHcy level in the RVO patients was significantly higher than in the controls (WMD =2.13 μmol/L; 95% CI: 1.29 to 2.98, P < 0.001), but there was evidence of between-study heterogeneity (P < 0.001). No significant association between MTHFR C677T genotype and RVO was found under all genetic models. Conclusion There was some evidence that plasma tHcy is associated with an increased risk of RVO. There was no evidence to suggest an association between homozygosity for the MTHFR C677T genotype and RVO.
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Affiliation(s)
| | | | - Xiaoyan Peng
- Department of Ophthalmology, Beijing Institute of Ophthalmology, Beijing Ophthalmology and Visual Science Key Lab, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, 17 Hougou Lane, Chongnei Street, Beijing 100005, China.
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Sowka JW, Vollmer LA, Au M. Atypical retinal vaso-occlusion with structural and functional resolution. Optom Vis Sci 2014; 92:e6-11. [PMID: 25360702 DOI: 10.1097/opx.0000000000000446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The purpose is to report a patient with primary open-angle glaucoma that developed sudden painless unilateral vision loss, a sequential ophthalmoscopic appearance with features of both central retinal artery and later central retinal vein occlusion, and objective visual system dysfunction in the form of a relative afferent pupil defect, who spontaneously recovered vision along with complete resolution of the pupillary defect over several weeks. CASE REPORT A 50-year-old woman with a long-standing history of glaucoma presented with acute, painless vision loss in one eye, a pallid retina with a cherry red macula, diffuse retinal hemorrhages, and a relative afferent pupil defect. Spectral domain optical coherence tomography and fluorescein angiography were essentially normal with neither retinal edema nor retinal ischemia to account for the visual dysfunction. Over the course of 2 months, the patient regained vision and the relative afferent pupil defect, typically a permanent manifestation of retinal destruction, resolved. CONCLUSIONS Not all retinal vaso-occlusive phenomena can be completely attributed to a central retinal vein or artery occlusion. In the patient presented, there was no objective diagnostic testing that revealed a cause for the patient's vision loss or relative afferent pupillary defect. This combined with the complete recovery of vision and resolution of the relative afferent pupillary defect underscores a lack of comprehensive understanding of retinal vaso-occlusive disease.
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Affiliation(s)
- Joseph W Sowka
- *OD, FAAO †OD Nova Southeastern University, College of Optometry, Ft. Lauderdale, Florida (all authors)
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Al Wadani F, Khandekar R, Salim G, Al Ali M, Ramzi S. Hyperhomocysteinia is a risk factor for retinal venous occlusion: a case control study. Indian J Ophthalmol 2014; 62:291-4. [PMID: 23619502 PMCID: PMC4061665 DOI: 10.4103/0301-4738.111213] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Accepted: 07/13/2012] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND We evaluated the role of hyperhomocysteinemia as a risk factor for retinal vein occlusion (RVO) in Indian patients. TYPE OF STUDY Matched case control type of longitudinal study was conducted in 2006-2007. MATERIALS AND METHODS Two medical retina specialists examined the eyes having an event of RVO in the last 15 days. A similar number of eyes without RVO were also examined. The serum and urine homocysteine levels of these persons were tested. Matched pair analysis was carried out to determine the risk of RVO among those with hyperhomocysteinemia. RESULTS We included 20 cases of RVO and 20 age- and sex-matched persons without RVO. The risk of RVO was significantly higher in persons with hyperhomocysteinemia [difference of mean 31.62 μmol/L (95% Confidence Interval 16.60-47 . 86), P = 2.1 × 10-13 ]. The mean urine homocysteine level among cases and controls was not statistically significant. There were 12 persons with hypertension in both cases and control groups. CONCLUSION Hyperhomocysteinemia is a risk factor for RVO. Any list of investigations for a case of RVO should include total plasma homocysteine (tHcy) levels.
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Affiliation(s)
- Fahad Al Wadani
- Department of Ophthalmology, Al Jabr Eye and Ear Hospital, Ministry of Health, Al Hassa, Kingdom of Saudi Arabia
| | - Rajiv Khandekar
- Eye and Ear Health Care, Deaprtment of Non communicable Diseases control, Ministry of Health, Muscat, Oman
| | - Gigani Salim
- Department of Ophthalmology, Al Jabr Eye and Ear Hospital, Ministry of Health, Al Hassa, Kingdom of Saudi Arabia
| | - Mohammed Al Ali
- Department of Ophthalmology, Al Jabr Eye and Ear Hospital, Ministry of Health, Al Hassa, Kingdom of Saudi Arabia
| | - Salman Ramzi
- Department of Ophthalmology, Al Jabr Eye and Ear Hospital, Ministry of Health, Al Hassa, Kingdom of Saudi Arabia
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Dong N, Wang B, Chu L, Xiao L. Plasma Homocysteine Concentrations in the Acute Phase After Central Retinal Vein Occlusion in a Chinese Population. Curr Eye Res 2013; 38:1153-8. [DOI: 10.3109/02713683.2013.809124] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Stem MS, Talwar N, Comer GM, Stein JD. A longitudinal analysis of risk factors associated with central retinal vein occlusion. Ophthalmology 2012. [PMID: 23177364 DOI: 10.1016/j.ophtha.2012.07.080] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To identify risk factors associated with central retinal vein occlusion (CRVO) among a diverse group of patients throughout the United States. DESIGN Longitudinal cohort study. PARTICIPANTS All beneficiaries aged ≥ 55 years who were continuously enrolled in a managed care network for at least 2 years and who had ≥ 2 visits to an eye care provider from 2001 to 2009. METHODS Insurance billing codes were used to identify individuals with a newly diagnosed CRVO. Multivariable Cox regression was performed to determine the factors associated with CRVO development. MAIN OUTCOME MEASURES Adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of being diagnosed with CRVO. RESULTS Of the 494 165 enrollees who met the study inclusion criteria, 1302 (0.26%) were diagnosed with CRVO over 5.4 (± 1.8) years. After adjustment for known confounders, blacks had a 58% increased risk of CRVO compared with whites (HR, 1.58; 95% CI, 1.25-1.99), and women had a 25% decreased risk of CRVO compared with men (HR, 0.75; 95% CI, 0.66-0.85). A diagnosis of stroke increased the hazard of CRVO by 44% (HR, 1.44; 95% CI, 1.23-1.68), and hypercoagulable state was associated with a 145% increased CRVO risk (HR, 2.45; 95% CI, 1.40-4.28). Individuals with end-organ damage from hypertension (HTN) or diabetes mellitus (DM) had a 92% (HR, 1.92; 95% CI, 1.52-2.42) and 53% (HR, 1.53; 95% CI, 1.28-1.84) increased risk of CRVO, respectively, relative to those without these conditions. CONCLUSIONS This study confirms that HTN and vascular diseases are important risk factors for CRVO. We also identify black race as being associated with CRVO, which was not well appreciated previously. Furthermore, we show that compared with patients without DM, individuals with end-organ damage from DM have a heightened risk of CRVO, whereas those with uncomplicated DM are not at increased risk of CRVO. This finding may provide a potential explanation for the conflicting reports in the literature on the association between CRVO and DM. Information from analyses such as this can be used to create a risk calculator to identify possible individuals at greatest risk for CRVO.
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Affiliation(s)
- Maxwell S Stem
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Lahiri KD, Dutta J, Datta H, Das HN. Hyperhomocysteinemia, as an independent risk factor for retinal venous occlusion in an Indian population. Indian J Clin Biochem 2012; 28:61-4. [PMID: 24381423 DOI: 10.1007/s12291-012-0238-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Accepted: 06/20/2012] [Indexed: 11/29/2022]
Abstract
Total plasma homocysteine was analysed in 64 cases of retinal vein occlusion (RVO) of which 24 cases of central retinal vein occlusion (CRVO) and 40 cases of branch retinal vein occlusion (BRVO) and compared with 45 age and sex matched control. Homocysteine was significantly increased in RVO cases in respect to control (P < 0.001). Analysis also revealed that prevalence of rise of plasma homocysteine was more in cases of CRVO (OR = 13) than that of BRVO (OR = 5.03).
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Affiliation(s)
- Kapil D Lahiri
- Department of Biochemistry, RG Kar Medical College and Hospital, Kolkata, India ; 4/2 Shibchandra Sarbabhowma Lane, Baranagar, Kolkata, 700036 West Bengal India
| | - Jayanta Dutta
- Department of Ophthalmology, Regional Institute of Ophthalmology, Kolkata, India
| | - Himadri Datta
- Department of Ophthalmology, Regional Institute of Ophthalmology, Kolkata, India
| | - Harendra N Das
- Department of Biochemistry, RG Kar Medical College and Hospital, Kolkata, India
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Pinna A, Zinellu A, Franconi F, Carru C. Plasma Thiols and Taurine Levels in Central Retinal Vein Occlusion. Curr Eye Res 2010; 35:644-50. [DOI: 10.3109/02713681003698863] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Central retinal vein occlusion in a young Chinese population: risk factors and associated morbidity and mortality. Retina 2010; 30:479-84. [PMID: 20010454 DOI: 10.1097/iae.0b013e3181b9b3a0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to assess the risk factors for central retinal vein occlusion and associated morbidity and mortality in a Chinese population. METHODS The participants included patients with central retinal vein occlusion 40 years old and younger. Predisposing factors, mortality, and systemic complications were examined in this group. RESULTS Unilateral (n = 19) and bilateral (n = 3) central retinal vein occlusions were identified in a total of 22 patients (25 eyes), with a mean follow-up time of 37 months. Hypercholesterolemia (65%), hypertriglyceridemia (64%), and hyperhomocysteinemia (42%) were all identified as risk factors. Three patients (14%) developed stroke and 1 (5%) developed transient ischemic attacks during follow-up. Renal failure and pulmonary hypertension resulted in the death of two patients. The mean initial and final visual acuities (+ or - standard deviation) were 20/400 (+ or - 20/250) and 20/500 (+ or - 20/320), respectively, and treatments did not result in vision improvement (P = 0.57). The poor visual prognosis was likely due to macular edema in 7 eyes (28%), optic atrophy in 4 eyes (16%), and secondary glaucoma in 3 eyes (12%). CONCLUSION Morbidity and mortality are high in young Chinese patients with central retinal vein occlusion who may have associated serious complications including stroke, blindness, and death. Central retinal vein occlusion may serve as an initial clinical presentation of serious systemic diseases.
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Sottilotta G, Siboni SM, Latella C, Oriana V, Romeo E, Santoro R, Consonni D, Trapani Lombardo V. Hyperhomocysteinemia and C677T MTHFR genotype in patients with retinal vein thrombosis. Clin Appl Thromb Hemost 2009; 16:549-53. [PMID: 19825913 DOI: 10.1177/1076029609348644] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Elevated homocysteine (Hcy) is associated with the risk of deep vein thrombosis, pulmonary embolism, ischemic heart disease, and stroke. Several studies have suggested that hyperhomocysteinemia (HHcy) may predispose to retinal vein thrombosis (RVT) development. The aim of this study is to investigate the relationship between Hcy, C677T methylenetetrahydrofolate reductase (MTHFR) genotype, and RVT in patients compared with controls. MATERIALS AND METHODS We evaluated the Hcy plasma level of 3114 consecutive participants in 2 Italian centers during a 2-year period. Hyperhomocysteinemia was found in 99 patients and 136 healthy participants. Of the 99 patients, 20 had RVT with a high prevalence of HHcy in the RVT subgroup (20.2%). This result suggested a possible relationship between HHcy and RVT development. We investigated 105 consecutive patients with recent diagnosis of RVT, and we compared them with 226 healthy controls to evaluate whether HHcy may be a risk factor for RVT. RESULTS the prevalence of HHcy was higher in patients compared with controls (34.3% vs 14.2%; P < .001). The MTHFR C677T genotype was found in 69 of 105 (65.7%) patients with RVT (heterozygosity: 40 of 105 and homozygosity: 29 of 105). The control group showed the presence of MTHFR C677T genotype in 169 of 226 participants (74.8%; heterozygosity: 100 of 226 and homozygosity: 69 of 226) without difference between the 2 groups (P = .08). CONCLUSION our study suggests that HHcy is a possible risk factor for RVT development, while no association was found between RVT and the C677T MTHFR genotype.
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Affiliation(s)
- Gianluca Sottilotta
- Hemophilia Centre, Hemostasis and Thrombosis Service, Azienda Ospedaliera "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy.
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McGimpsey SJ, Woodside JV, Cardwell C, Cahill M, Chakravarthy U. Homocysteine, methylenetetrahydrofolate reductase C677T polymorphism, and risk of retinal vein occlusion: a meta-analysis. Ophthalmology 2009; 116:1778-1787.e1. [PMID: 19729099 DOI: 10.1016/j.ophtha.2009.02.033] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2008] [Revised: 02/02/2009] [Accepted: 02/03/2009] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To assess the role of plasma total homocysteine (tHcy) concentrations and homozygosity for the thermolabile variant of the methylenetetrahydrofolate reductase (MTHFR) C677T gene as risk factors for retinal vascular occlusive disease. DESIGN Retinal vein occlusion (RVO) is an important cause of vision loss. Early meta-analyses showed that tHcy was associated with an increased risk of RVO, but a significant number of new studies have been published. PARTICIPANTS AND/OR CONTROLS RVO patients and controls. METHODS Data sources included MEDLINE, Web of Science, and PubMed searches and searching reference lists of relevant articles and reviews. Reviewers searched the databases, selected the studies, and then extracted data. Results were pooled quantitatively using meta-analytic methods. MAIN OUTCOME MEASURES tHcy concentrations and MTHFR genotype. RESULTS There were 25 case-control studies for tHcy (1533 cases and 1708 controls) and 18 case-control studies for MTHFR (1082 cases and 4706 controls). The mean tHcy was on average 2.8 micromol/L (95% confidence interval [CI], 1.8-3.7) greater in the RVO cases compared with controls, but there was evidence of between-study heterogeneity (P<0.001, I(2) = 93%). There was funnel plot asymmetry suggesting publication bias. There was no evidence of association between homozygosity for the MTHFR C677T genotype and RVO (odds ratio [OR] 1.20; 95% CI, 0.84-1.71), but again marked heterogeneity (P = 0.004, I(2) = 53%) was observed. CONCLUSIONS There was some evidence that elevated tHcy was associated with RVO, but not homozygosity for the MTHFR C677T genotype. Both analyses should be interpreted cautiously because of marked heterogeneity between the study estimates and possible effect of publication bias on the tHcy findings. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Stuart J McGimpsey
- Directorate of Ophthalmology, The Royal Victoria Hospital, The Belfast Health and Social Care Trust, Grosvenor Road, Belfast, Ireland
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Glueck CJ, Ping Wang, Hutchins R, Petersen MR, Golnik K. Ocular vascular thrombotic events: central retinal vein and central retinal artery occlusions. Clin Appl Thromb Hemost 2007; 14:286-94. [PMID: 18160589 DOI: 10.1177/1076029607304726] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We prospectively assessed associations of thrombophilia- hypofibrinolysis with central retinal vein occlusion (CRVO) (40 patients) and central retinal artery occlusion (CRAO) (9 patients). We used polymerase chain reaction measures for thrombophilia (factor V Leiden, prothrombin, C677T MTHFR, platelet glycoprotein PlA1/A2) and hypofibrinolysis (plasminogen activator inhibitor-1 4G4G). Serologic thrombophilia measures included protein C, protein S (total and free) and antithrombin III, homocysteine, lupus anticoagulant, anticardiolipin antibodies IgG-IgM, and factors VIII and XI. Serologic hypofibrinolysis measures included Lp(a) and plasminogen activator inhibitor activity. For comparison with 40 CRVO and 9 CRAO patients, 80 and 45 race-gender matched controls were studied. The factor V mutation was more common in CRVO (3/40, 8%) than controls (0/79, 0%), P = .036, as was high (>150%) factor VIII (12/40, 30%) versus (4/77, 5%), P = .0002. Low antithrombin III (<80%) was more common in CRVO (5/39, 13%) than in controls (2/73, 3%), P = .049. Homocysteine was high (> or =13.5 micromol/L) in 5/39 (13%) CRVO patients versus 2/78 controls (3%), P = .04. Three of 9 CRAO patients (33%) had low (<73%) protein C versus 2/37 controls (5%), P = .044. Two of 9 CRAO patients (22%) had high (> or =13.5 micromol/L) homocysteine versus 0/42 controls (0%), P =. 028. Four of 9 CRAO patients had the lupus anticoagulant (44%) versus 4/33 (12%) controls (P = .050). CRVO is associated with familial thrombophilia (factor V Leiden, factor VIII, low antithrombin III, homocysteinemia), and CRAO is associated with familial and acquired thrombophilia (low protein C, homocysteinemia, lupus anticoagulant), providing avenues for thromboprophylaxis, and triggering family screening.
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Serum PON1 arylesterase activity in relation to hyperhomocysteinaemia and oxidative stress in young adult central retinal venous occlusion patients. Eye (Lond) 2007; 22:969-74. [PMID: 18084236 DOI: 10.1038/sj.eye.6703062] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
AIM To estimate the arylesterase activity of serum paraoxonase-1 (PON1-ARE), which is reported to have an antioxidant and antiatherogenic potential and to correlate with plasma homocysteine (Hcys) and plasma TBARS in young adult central retinal venous occlusion (CRVO) patients. METHODS A case-control prospective study carried out in 10 CRVO patients (mean age 27+/-5 years; 7 males, 3 females) and 20 healthy controls (mean age 29+/-5 years; 15 males, 5 females). RESULTS The CRVO patients showed a significantly lowered serum PON1-ARE activity (P=0.009) along with a significant increase in the levels of plasma Hcys (P=0.018) when compared to the control subjects. There was a negative correlation between serum PON1-ARE and plasma Hcys levels (P=0.058) as well as between PON1-ARE and plasma TBARS levels (P=0.001) in the CRVO patients. CONCLUSION This is the first report of lowered serum PON1-ARE level as a risk factor for CRVO (OR= 1.108, CI=0.914, 1.314; P=0.296), which is found to correlate with oxidative stress.
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Low vitamin B6 and folic acid levels are associated with retinal vein occlusion independently of homocysteine levels. Atherosclerosis 2007; 198:223-7. [PMID: 17945240 DOI: 10.1016/j.atherosclerosis.2007.09.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2007] [Revised: 08/30/2007] [Accepted: 09/06/2007] [Indexed: 11/21/2022]
Abstract
Retinal vein occlusion (RVO) is one of the most common retinal vascular disorders. During the last years, high levels of homocysteine (Hcy) have been demonstrated to be an independent risk factor for RVO. Aim of this study was to investigate the association among circulating B-group vitamins, Hcy and RVO. Thus, we studied 262 RVO patients and 262 age- and sex-comparable healthy subjects. Serum vitamin B6 was measured by HPLC, serum folic acid and vitamin B12 by radioimmunoassay and plasma Hcy by FPIA. Blood levels of vitamin B6, folate and Hcy, but not of vitamin B12, were found to be significantly different in patients as compared to healthy subjects. At the univariate analysis, the lowest tertile of vitamin B6 [odds ratio (OR) 4.03; 95% confidence interval (CI) 2.58-6.31; P<0.0001)] and folate (OR 6.13; 95% CI 3.85-9.76, P<0.0001), and the highest tertile of Hcy (OR 8.08; 95% CI 5.05-12.92, P<0.0001) were found to be significantly associated with RVO. Moreover, at multivariate analysis, after adjustment for traditional cardiovascular risk factors, Hcy, and circulating levels of vitamins, respectively, the lowest tertile of vitamin B6 (OR 3.29; 95% CI 1.89-5.70, P<0.0001) and folate (OR 5.41; 95% CI 3.08-9.51, P<0.0001) and the highest tertile of Hcy (OR 2.58; 95% CI 1.12-5.94, P<0.0001) maintained their significant association with RVO. In conclusion, the present study documents, on a large sample of patients, that low vitamin B6 levels, low folic acid levels and elevated Hcy levels are each independently associated with RVO.
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Gao W, Wang YS, Zhang P, Wang HY. MTHFR C677T mutation in central retinal vein occlusion: a case-control study in Chinese population. Thromb Res 2007; 121:699-703. [PMID: 17719079 DOI: 10.1016/j.thromres.2007.05.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2007] [Revised: 04/29/2007] [Accepted: 05/05/2007] [Indexed: 11/23/2022]
Abstract
Our previous study found that hyperhomocysteinemia was strongly associated with central retinal vein occlusion (CRVO) in the Chinese population. The aim of this study is to determine whether MTHFR C677T mutation is an independent risk factor for CRVO in the Chinese population. A matched case-control study was conducted between July 2004 and May 2005. The study cohort consisted of 64 individuals that had been diagnosed with CRVO and 64 healthy controls (matched for age, gender, hypertension, smoking, and drinking habits). None of the cases or controls had a history of diabetes, glaucoma, medication or any other vascular events that might influence plasma homocysteine levels. A cross-sectional analysis among the 64 cases was performed to compare the prevalence of MTHFR C677T mutation among subjects with and without ischemia and subjects aged above 45 and below 45 years. MTHFR C677T mutation was determined by the template-directed dye-terminator incorporation with fluorescence polarization (TDI-FP) method. The result showed that the prevalence of the MTHFR 677 TT genotype did not significantly differ between patients and controls. However, 10 (34.5%) MTHFR C677 TT genotype was found in the ischemic group but only 4 (14.3%) in the nonischemic group (p=0.026). And we found that 6 MTHFR C677 TT genotype patients who have hyperhomocysteinemia in the ischemic group but only 2 in the nonischemic group (p=0.016). It suggests that MTHFR C677T mutation is associated with hyperhomocysteinemia in the ischemic CRVO in the Chinese population. It may contribute to hyperhomocysteinemia and associate with the development of CRVO.
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Affiliation(s)
- Wei Gao
- Department of Ophthalmology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
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Moghimi S, Najmi Z, Faghihi H, Karkhaneh R, Farahvash MS, Maghsoudipour M. Hyperhomocysteinemia and central retinal vein occlusion in Iranian population. Int Ophthalmol 2007; 28:23-8. [PMID: 17636432 DOI: 10.1007/s10792-007-9103-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2007] [Accepted: 05/10/2007] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate total plasma homocysteine level during the acute phase of central retinal vein occlusion (CRVO) in the Iranian population and determine whether hyperhomocysteinemia is also a risk factor for CRVO. METHODS Fifty-four patients with recently diagnosed CRVO were studied. Their fasting total plasma homocysteine level was compared 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 14.76+/-7.67 micromol/l in cases, and 11.42+/-3.74 micromol/l in control subjects. It showed a significant difference (P=0.005) in mean plasma homocysteine level between 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 micromol/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.
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Affiliation(s)
- Sasan Moghimi
- Farabi Eye Research Center, Department of Ophthalmology, Tehran University of Medical Sciences, Quazvin Square, Tehran 1336616351, Iran.
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Giannopoulos N, Salam T, Pollock WST. Visual side effects after prolonged MRSA treatment. Eye (Lond) 2006; 21:556-62. [PMID: 17128204 DOI: 10.1038/sj.eye.6702640] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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