THROMBOPHILIC RISK FACTORS ARE UNCOMMON IN YOUNG PATIENTS WITH RETINAL VEIN OCCLUSION

Hypertension, hyperlipidaemia and thrombophilia as the most common risk factors for retinal vein occlusion in patients under 50 years

BACKGROUND AND AIMS

Cardiovascular (CV) diseases are the most common risk factors (RFs) for retinal vein occlusion (RVO) development in general. The aim of this study was to identify the most frequent causes of RVO in patients under 50.

METHODS

We retrospectively evaluated a group of patients with RVO under 50 years. The parameters of interest included age and sex, RVO type, presence of arterial hypertension (HT), hyperlipidaemia (HLD), diabetes mellitus (DM), congenital thrombophilic disorder (TD), obstructive sleep apnoea syndrome (OSAS), thyroid eye disease (TED), use of hormone contraception (HC) or hormone replacement therapy (HRT), glaucoma and other potential RFs. Patients with central RVO (CRVO), hemi-central RVO (HRVO), branch RVO (BRVO), impending CRVO and combined arterial-venous (AV) occlusion were included.

RESULTS

The group consisted of 110 eyes of 103 patients. CV disease was the most common systemic abnormality. 55.3% patients had HT, 17.5% had HLD. TD was the third most frequent RF (12.6%). The cohort also included patients with DM (6.8%), glaucoma (6.8%) and women using HC/HRT (26.2% of female patients). There were isolated cases of RVO due to retinal vasculitis, intense exercise, antiphospholipid syndrome and COVID-19 pneumonia. None of the patients had OSAS, TED or a haemato-oncological disease. The etiology remained unexplained in 20.4% patients. No difference was observed in RF occurrence between patients with CRVO and HRVO and those with BRVO.

CONCLUSION

The most common systemic abnormality in our cohort was CV disease, especially HT and HLD. The risk factors for central, hemi-central and branch RVOs were similar.

Antithrombotic treatment for retinal vein occlusion: a systematic review and meta-analysis

BACKGROUND

Retinal vein occlusion (RVO) represents a common thrombotic disorder.

OBJECTIVES

In this meta-analysis, we evaluated the efficacy and safety of anticoagulant and antiplatelet therapy in RVO.

METHODS

MEDLINE and EMBASE were searched up to December 2021 for observational studies and randomized controlled trials including patients with RVO. Efficacy outcomes were best-corrected visual acuity improvement, recurrent RVO, fluorescein angiography improvement, cardiovascular events, and safety outcomes were major bleeding and intraocular bleeding.

RESULTS

A total of 1422 patients (15 studies) were included. Antiplatelet therapy was administered to 477 patients (13 studies), anticoagulant therapy to 312 patients (12 studies), and 609 (7 studies) patients received no antithrombotic treatment. The treatment duration ranged between 0.5 and 3 months. The median follow-up duration was 12 months. Best-corrected visual acuity improvement was reported in 58% of the patients (95% confidence interval [CI], 45%-69%) overall, 64% (95% CI, 58%-71%) in those on anticoagulant therapy, and 33% (95% CI, 21%-47%) in those on antiplatelet therapy. The rates of recurrent RVO was 11% (95% CI, 7%-17%), 7% (95% CI, 2%-19%), and 15% (95% CI, 8%-28%), respectively. The rate of recurrent RVO in untreated patients was 9% (95% CI, 6%-14%). The rate of major bleeding was 5% (95% CI, 3%-9%) overall, 4% (95% CI, 2%-9%) in those on anticoagulant therapy, and 7% (95% CI, 2%-23%) in those on antiplatelet therapy.

CONCLUSION

Anticoagulant therapy was associated with higher visual acuity improvement and fewer recurrent RVO events than antiplatelet therapy, at the cost of an acceptable proportion of bleeding complications.

Clinical Features of Central Retinal Vein Occlusion in Young Patients

Retinal vein occlusion (RVO) is the second most common retinal vascular disease. Central RVO (CRVO), in which obstruction occurs posterior to the lamina cribrosa due to various causes, manifests with extensive venous tortuosity, dilatation of blood vessels in the four quadrants, and retinal hemorrhage. The presence of macular edema decreases visual acuity in patients with CRVO, especially in elderly patients with hypertension, hyperlipidemia, and diabetes. In the last decade, treatment modalities for CRVO have improved, with anti-vascular endothelial growth factor agents being widely used as treatment. However, there are cases of refractory or recurrent macular edema. Moreover, CRVO also occurs in young patients. This article reviews previous studies and case reports and summarizes the differences in etiological factors, clinical manifestations, treatment, and prognosis between young and elderly patients. Due to the low incidence of CRVO in young patients, clinical data from these age groups are limited. Hence, further studies are warranted to explore the differences between age groups to improve individualization of treatment of young patients.

Hypercoagulability Testing and Hypercoagulable Disorders in Young Central Retinal Vein Occlusion Patients

PURPOSE

To determine frequency of hypercoagulability testing and hypercoagulable states in patients with central retinal vein occlusion (CRVO) younger than 50 years.

DESIGN

Retrospective cohort study.

PARTICIPANTS

Deidentified patients younger than 50 years with newly diagnosed CRVO from a national insurance claims database.

METHODS

The de-identified Clinformatics Data Mart Database (Optum) containing medical claims from a commercial and Medicare Advantage insurance database was used. All outpatient medical claims (office visits, associated diagnoses, and laboratory testing) and demographic data for each beneficiary during their enrollment were accessible.

MAIN OUTCOME MEASURES

Prevalence of (1) laboratory hypercoagulable workup within 90 days of CRVO diagnosis, (2) new diagnosis of a hypercoagulable state within 1 year of CRVO diagnosis, and (3) diagnosis of hypertension, diabetes mellitus (DM), and hyperlipidemia.

RESULTS

One thousand one hundred eighty-one patients met inclusion criteria. Six hundred seventy-one patients (56.8%) were men, 450 patients (38.1%) had undergone hypercoagulable testing within 90 days, and 136 patients (11.5%) were diagnosed with a hypercoagulable state within 1 year after CRVO diagnosis. This proportion was similar between those patients with DM, hypertension, or hyperlipidemia (10.5% [65/620]) and those without (12.7% [71/561]; P = 0.28). Of the 136 patients diagnosed with a hypercoagulability state, 68.4% (93/136) had undergone testing within 90 days of CRVO diagnosis and 31.6% (43/136) did not. Of those who had not undergone hypercoagulability testing, 5.9% (43/731) were diagnosed with a hypercoagulable state within 1 year compared with 20.7% (93/450) in those who were tested (P < 0.001).

CONCLUSIONS

The prevalence of a hypercoagulable state within 1 year of CRVO diagnosis in patients younger than 50 years was 11.5%, and the prevalence was similar between patients with atherosclerotic risk factors and those without. Rate of testing was only 38.1%. Future research should examine the usefulness of uniform hypercoagulable testing in young CRVO patients.

Systemic abnormalities associated with retinal vein occlusion in young patients

OBJECTIVES

To study the systemic abnormalities associated with retinal vein occlusion in patients aged ≤50 years with a particular emphasis on atherosclerotic diseases and thrombophilic disorders.

METHODS

Medical charts of patients, aged ≤50 years whose diagnoses were retinal vein occlusions during the period 1995-2015 were retrospectively reviewed. The primary outcome was the number of systemic abnormalities associated with these patients. Secondary outcomes included types of retinal vein occlusion and sites of occlusion.

RESULTS

Atherosclerotic diseases were the most common systemic abnormalities associated with retinal vein occlusion and accounted for 55.1% of the patients in the study. Hypertension in 27.55%, diabetes mellitus in 16.33%, and 5.1% with dyslipidemia were noted. The number of thrombophilic disorders seemed to be less than expected and were noted in only 5.1%. Other systemic abnormalities included viral hepatitis infection, systemic lupus erythematosus, and acquired immunodeficiency syndrome. Oral contraceptives were used by some patients.

CONCLUSION

Atherosclerotic diseases remained the most commonly associated systemic diseases in the majority of these patients. Approach to these patients should include a screening for hypertension, diabetes mellitus, and lipid abnormalities. Thrombophilia should also be considered where no obvious atherosclerotic diseases are found or if the patient is <40 years old, a history of thrombosis or a family history of thrombosis is possible.

[Retinal vein occlusion : Epidemiology, classification and clinical findings]

Since the introduction of intravitreal operative medication injections (IVOM), the therapy of retinal vein occlusion (RVO) has permanently changed. The growing acceptance of IVOM is undoubtedly due to the generally positive outcome after RVO. During the pharmaceutical trials required to obtain medication approval, extensive data were collected on the spontaneous course of the disease and the risk factors responsible for the disease. As RVO is a complication of systemic or local risk factors, these data are also useful for the therapy of the underlying risk factors. In this article the currently available data are presented and evaluated to provide the reader with key guidelines to diagnose and treat this complex syndrome.