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Bou Ghannam A, Istambouli R, Hamam MS, Chalhoub JM, Fahed AC, Hamam RN. Ocular manifestations of severe familial hypercholesterolemia. Heliyon 2024; 10:e30487. [PMID: 38737271 PMCID: PMC11088316 DOI: 10.1016/j.heliyon.2024.e30487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/27/2024] [Accepted: 04/28/2024] [Indexed: 05/14/2024] Open
Abstract
Background To study ocular manifestations of patients with severe familial hypercholesterolemia (FH). Methods In this population-based case-control study, patients suffering from severe familial hypercholesterolemia from the Lebanese Familial Hypercholesterolemia Registry, along with age and gender-matched healthy controls were recruited. All participants underwent a comprehensive eye examination, and patients underwent fluorescein angiography as well. Logistic regression models were used to identify any association between patients with severe familial hypercholesterolemia and abnormal eye findings, while adjusting for hypertension and pack-year smoking. The main outcome measure of this study was the development of ocular vascular abnormalities. Results 28 patients and 28 controls were recruited. Patients with severe familial hypercholesterolemia had significantly greater odds of developing corneal arcus and xanthelasmas than the control group (p < 0.001). Retinal vascular abnormalities (plaques) were exclusively and more significantly present in patients with familial hypercholesterolemia (18 %). Similarly, retinal arteriosclerosis was exclusively and significantly more prevalent in the familial hypercholesterolemia group (p < 0.001, adjusted odds ratio 6.8). Stratification by LDL levels and genotypes did not show any significant change in the prevalence of any ocular finding. Conclusion In addition to the well-established increase in incidence of corneal arcus and xanthelasmas, severe familial hypercholesterolemia patients have more prevalent retinal vascular abnormalities that include vascular plaques and arteriosclerosis.
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Affiliation(s)
- Alaa Bou Ghannam
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rachid Istambouli
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohamed S. Hamam
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jean M. Chalhoub
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Akl C. Fahed
- Department of Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rola N. Hamam
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
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2
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Choi Y, Kim SJ, Lee JJ, Zaidi MH, Shin YU, Byon IS, Lee JE, Park SW. Case series of branch retinal vein occlusion secondary to rhegmatogenous retinal detachment and its surgical management. BMC Ophthalmol 2023; 23:513. [PMID: 38110856 PMCID: PMC10729475 DOI: 10.1186/s12886-023-03244-1] [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: 09/06/2023] [Accepted: 11/24/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND To review cases of branch retinal vein occlusion (BRVO) secondary to rhegmatogenous retinal detachment (RRD) and its surgical management and presume their mechanism. METHODS Medical records of patients who underwent surgery for RRD between 2015 and 2019 at a single tertiary care center were retrospectively reviewed. New BRVO secondary to RRD or its surgical procedure was diagnosed based on the fundus examination and its clinical course. RESULTS A total of 734 RRD surgeries were performed for five years, and six cases of new BRVOs were noticed in the first year after surgery (incidence was 0.68%: six cases of BRVO / 734 cases of surgical RRD); five cases occurred after vitrectomy, and one occurred after scleral buckling. In three cases, retinal veins were presumed to already be partially occluded related due to a kink of the retinal vein seen before surgery. In the other three cases, the retinal veins were presumed to have incurred damage during vitrectomy. CONCLUSION In the present cohort, RRD or its related procedures caused BRVO within a year of surgery at an incidence of 0.68%. The proposed mechanisms are kinks of the retinal vein on the detached retina and damage to the retinal vein during vitrectomy.
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Affiliation(s)
- Youna Choi
- Department of Ophthalmology, School of Medicine, Pusan National University, Pusan, South Korea
| | - Sung Jun Kim
- Department of Ophthalmology, School of Medicine, Pusan National University, Pusan, South Korea
| | - Jae Jung Lee
- Department of Ophthalmology, School of Medicine, Pusan National University, Pusan, South Korea
| | - Moosa Hasan Zaidi
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Yong Un Shin
- Department of Ophthalmology, College of Medicine, Hanyang University, Seoul, South Korea
| | - Ik Soo Byon
- Department of Ophthalmology, School of Medicine, Pusan National University, Pusan, South Korea
| | - Ji Eun Lee
- Department of Ophthalmology, School of Medicine, Pusan National University, Pusan, South Korea
| | - Sung Who Park
- Department of Ophthalmology, School of Medicine, Pusan National University, Pusan, South Korea.
- Department of Ophthalmology, Pusan National University & Biomedical Research Institute, Pusan National University Hospital, 1-10 Ami-dong, Seo-gu, 602-739, Pusan, South Korea.
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Rachman MJ, Kalanjati VP, Rimbun R, Khadijah F. Retinal Vein Occlusion Amongst People Vaccinated by mRNA- and Viral Vector- COVID-19 Vaccines: A Systematic Review. Clin Ophthalmol 2023; 17:2825-2842. [PMID: 37794952 PMCID: PMC10545804 DOI: 10.2147/opth.s426428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 09/18/2023] [Indexed: 10/06/2023] Open
Abstract
Vaccines are highly effective in lowering the mortality due to COVID-19. Although several suspected adverse events or side effects after vaccination including retinal vein occlusion (RVO) have been reported. We conducted a systematic review using PRISMA methods to analyze the occurrence of RVO among people vaccinated by COVID-19 mRNA- vs viral vector- vaccines on 4 databases from 1-1-2021 to 31-12-2022 using specified MeSH terms. All included studies were assessed using JBI critical appraisal tools for eligibility. The final included studies are 31 studies (n=78 cases from 75 patients; 3 of these patients suffered twice). The median age of the patients was 61 years (28 to 96 years old) and most of them were female (52.00%). Thirty-nine patients received the mRNA vaccine (52.00%), while 36 patients received the viral vector vaccine (48.00%) before the event. The RVO diagnoses are based on physical examination confirmed by Fluorescein Angiography (FA), and/or Optical Coherence Tomography (OCT). The median time interval between vaccination and RVO was 6 days in the mRNA vaccine group and 4 days in the viral vector vaccine group. Central retinal vein occlusion (CRVO) and Branch Retinal Vein Occlusion (BRVO) were tied as the most common diagnosis in the mRNA vaccine group (20.51% and 20.51%), whilst in the viral vector vaccine group CRVO was the most common diagnosis (17.94%). Most of these cases had good outcomes with improved visual impairment in one or both eyes. From this review, we could not ascertain that the RVO occurs due to the type of COVID-19 vaccines because of the detailed data on the dosage and the history of illness of each patient. However, the awareness that the RVO could develop after COVID-19 vaccination must be taken into consideration, even though it is rare.
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Affiliation(s)
- Maria Jessica Rachman
- Master Program of Basic Medical Science, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
- Faculty of Medicine, Universitas Ciputra, Surabaya, East Java, Indonesia
| | - Viskasari P Kalanjati
- Department of Anatomy, Histology, and Pharmacology, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
| | - Rimbun Rimbun
- Department of Anatomy, Histology, and Pharmacology, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
| | - Fira Khadijah
- Master Program of Basic Medical Science, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
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Hernández JL, Napal JJ, Icardo M, Bores PG, Pérez-Montes R, Cerveró A, Salmón Z, Olmos JM, Martínez-Taboada VM. Adjusted global antiphospholipid syndrome score (aGAPSS) is useful to predict relapses in patients with retinal vein occlusion. Thromb Res 2023; 221:113-119. [PMID: 36525919 DOI: 10.1016/j.thromres.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND A significant proportion of patients with retinal vein occlusion (RVO) are antiphospholipid antibodies (aPL) carriers. Relapsing disease occurs in nearly 10 % of cases and the role of aPL has not been established. The adjusted global antiphospholipid syndrome score (aGAPSS) was developed to assess the risk of clinical events in aPL carriers and its role in the management of RVO patients is unknown. OBJECTIVE To analyze the values of aGAPSS in a large cohort of patients with RVO and population-based controls, and to assess its usefulness to predict RVO relapses. METHODS Case-control study of RVO patients and population-based controls of similar age and sex. We have assessed and compared the aPL profile and the aGAPSS score in patients with and without relapsing disease and controls. RESULTS Four-hundred and seventy-two RVO patients and 346 controls were included. Fifty-seven RVO patients had antiphospholipid syndrome (RVO-APS). Of them, 75.4 % had a high-risk profile compared to 3 % in controls (p = 0.0001). The median aGAPSS values were 8 [7-13], 3 [1-4], and 3 [0-4], in RVO-APS, RVO no-APS, and controls. Nineteen patients had had a recurrence of RVO before inclusion and 8 during the follow-up. APS was more prevalent in relapsing patients. In the adjusted multivariable regression model, the best predictor for RVO recurrence during the follow-up was an aGAPSS score ≥6 (OR 5.5, CI95% 1.3-23.7; p = 0.023). CONCLUSIONS In patients with RVO, once the control of vascular risk factors has been optimized, the aGAPSS might help to identify those at risk of relapsing disease.
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Affiliation(s)
- José L Hernández
- Internal Medicine Division, Hospital Marqués de Valdecilla, Santander, Spain; Department of Medicine and Psychiatry, University of Cantabria, Santander, Spain; Valdecilla Research Institute (IDIVAL), Santander, Spain
| | - José J Napal
- Internal Medicine Division, Hospital Marqués de Valdecilla, Santander, Spain
| | - Miguel Icardo
- Department of Medicine and Psychiatry, University of Cantabria, Santander, Spain
| | | | - R Pérez-Montes
- Hematology Division, Hospital Sierrallana, Torrelavega, Cantabria, Spain
| | - A Cerveró
- Ophthalmology Division, Hospital Marqués de Valdecilla, Santander, Spain; Rheumatology Division, Hospital Marqués de Valdecilla, Santander, Spain
| | - Zaida Salmón
- Internal Medicine Division, Hospital Marqués de Valdecilla, Santander, Spain; Department of Medicine and Psychiatry, University of Cantabria, Santander, Spain.
| | - José M Olmos
- Internal Medicine Division, Hospital Marqués de Valdecilla, Santander, Spain; Department of Medicine and Psychiatry, University of Cantabria, Santander, Spain; Valdecilla Research Institute (IDIVAL), Santander, Spain
| | - Víctor M Martínez-Taboada
- Rheumatology Division, Hospital Marqués de Valdecilla, Santander, Spain; Department of Medicine and Psychiatry, University of Cantabria, Santander, Spain; Valdecilla Research Institute (IDIVAL), Santander, Spain
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Martín Romero M, Salazar Rosa V, Demelo Rodríguez P, Visonà A, Farfán Sedano AI, Peris Sifre ML, Skride A, Usandizaga E, Meireles J, Monreal M. Clinical characteristics and outcomes in patients with retinal vein occlusion. Vasc Med 2022; 27:590-592. [PMID: 36178134 DOI: 10.1177/1358863x221122505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Miguel Martín Romero
- Department of Internal Medicine, Hospital Universitario Virgen de Arrixaca, Murcia, Spain
| | - Vladimir Salazar Rosa
- Department of Internal Medicine, Hospital Universitario Virgen de Arrixaca, Murcia, Spain
| | - Pablo Demelo Rodríguez
- Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Adriana Visonà
- Department of Vascular Medicine, Ospedale Castelfranco Veneto, Castelfranco Veneto, Italy
| | - Ana I Farfán Sedano
- Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - M Luisa Peris Sifre
- Department of Internal Medicine, Consorcio Hospitalario Provincial de Castellón, CEU Cardenal Herrera University, Castellón, Spain
| | - Andris Skride
- Department of Cardiology, Ospedale Pauls Stradins Clinical University Hospital, Riga Stradiņš University, Riga, Latvia
| | - Esther Usandizaga
- Department of Internal Medicine, Hospital Sant Joan Despí-Moises Broggi, Barcelona, Spain
| | - Jose Meireles
- Department of Internal Medicine, Centro Hospitalar de Entre o Douro e Vouga, Santa María da Feira, Portugal
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain.,Chair for the Study of Thromboembolic Disease, Faculty of Health Sciences, UCAM - Universidad Católica San Antonio de Murcia, Murcia, Spain
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Antithrombotic treatment of retinal vein occlusion: a position statement from the Italian Society on Thrombosis and Haemostasis (SISET). BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2022; 20:341-347. [PMID: 35175186 PMCID: PMC9256508 DOI: 10.2450/2022.0276-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/26/2021] [Indexed: 01/24/2023]
Abstract
Retinal vein occlusion (RVO) represents a common cause of visual impairment and blindness. RVO may be associated with both local (e.g., hyperopia, glaucoma) and systemic (e.g., hypertension, diabetes, smoking, obesity, and dyslipidaemia) risk factors. The association with thrombophilia remains controversial. Data on the use of antithrombotic therapy for RVO are poor and inconsistent with most of the information being derived from observational studies. Here we provide a position statement from the Italian Society on Thrombosis and Haemostasis (SISET) to guide the clinical and therapeutic management of patients with RVO based on the available evidence and expert opinion.
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7
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Characteristics of Somatic Status and Individual Biochemical Markers in Patients with Retinal Vein Occlusion. ACTA BIOMEDICA SCIENTIFICA 2019. [DOI: 10.29413/abs.2019-4.4.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Retinal vein occlusion is one of the most severe vascular lesions of the organ of vision, usually accompanied by somatic pathology.The aim of the study was to study the somatic status and individual biochemical markers in patients with retinal vein occlusion and comparison in groups opposing the effectiveness of anti-VEGF therapy.Methods. 84 patients with macular edema were examined on the background of retinal vein occlusion, who underwent intravitreal injections of an angiogenesis inhibitor for therapeutic purposes. Further, depending on the effectiveness of treatment, the patients were divided into 2 groups, in which a retrospective comparative analysis of somatic status and laboratory data was performed.Results. It was shown that patients with occlusion of the retinal veins have significant impairments in terms of somatic status, blood biochemical parameters and coagulogram. Moreover, there is a direct relationship between the severity of somatic changes and ocular manifestations of the disease. The data obtained reflect a clear tendency in patients with occlusion of the retinal veins to a high risk of cardiovascular complications, including occlusive lesions. In patients with an insufficient treatment effect, a more severe course of arterial hypertension with an increased risk of stratification was detected.Conclusion. The somatic status and laboratory parameters of patients with retinal vein occlusion are significantly different from the norm, which must be taken into account in the prognosis of the course of an ophthalmologic disease.
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Dodson PM, Clough CG, Downes SM, Kritzinger EE. Does Type II Diabetes Predispose to Retinal Vein Occlusion? Eur J Ophthalmol 2018; 3:109-13. [PMID: 8219732 DOI: 10.1177/112067219300300301] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Retinal vein occlusion (RVO) not infrequently occurs in diabetic patients. Although the aetiology is unclear, it could relate to the other microvascular complications of diabetes. In the non-diabetic, both the central (CRVO) and branch (BRVO) forms are commonly associated with hypertension and hyperlipidaemia. We have therefore studied fifty type II diabetic patients with RVO compared to a carefully matched diabetic control group (n = 50) to elucidate underlying medical conditions and hence the aetiology of RVO in diabetic patients. The two groups were well matched. Diabetics with RVO showed a strikingly high prevalence of hypertension compared to the controls (72% versus 32%: p < 0.001) and a trend to increased hyperlipidaemia (54% versus 36%). Diabetic microvascular complications were more common in the control group (diabetic retinopathy and proteinuria). No significant differences were observed in mean HbA1 or weight, but current smoking habits and blood pressure levels were increased in the diabetics with RVO. 80% of diabetic patients with the BRVO form, were hypertensive. We conclude that the main underlying medical conditions for RVO in diabetics are hypertension and hyperlipidaemia, and these may be important in the aetiology as in the non-diabetic. RVO is more common in type II rather than type I diabetes, and does not associate with the presence of diabetic microvascular complications. Clinical assessment for hypertension and hyperlipidaemia is therefore important in diabetic patients with RVO, especially if recurrence of the condition and further visual loss is to be prevented.
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Affiliation(s)
- P M Dodson
- Department of Diabetes, Dudley Road Hospital, Birmingham, U.K
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9
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Chhablani J, Stewart M, Paulose R, Gallego-Pinazo R, Dolz-Marco R. Clinical Characteristics and Treatment Outcomes of Recurrent Central Retinal Vein Occlusions. Semin Ophthalmol 2016; 33:191-197. [PMID: 27610480 DOI: 10.1080/08820538.2016.1188130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To report the ocular findings, systemic hematologic parameters, and treatment outcomes of patients with recurrent central retinal vein occlusions (CRVO). METHODS A retrospective analysis of eyes that developed recurrent CRVO was performed. Key exclusion criteria were follow-up of less than six months after the recurrence, incomplete documentation, and recurrent macular edema in an eye with a CRVO but without evidence of increased superficial hemorrhage or disc edema (recurrent CRVO). Collected data included demographic information, history of presenting illness including the previous CRVO, ocular and systemic co-morbidities, and clinical examination findings that included visual acuities and imaging details from the time of initial CRVO diagnosis until the final examination. RESULTS Thirteen eyes of 12 subjects with recurrent CRVO were evaluated. The mean age of the patients was 63 years (range: 42 to 79 years). The mean interval between treatment of the initial CRVO and the onset of the recurrent CRVO was 9.0 ± 9.3 months. The visual acuity declined by approximately eight lines at the time of recurrence. Treatment with vascular endothelial growth factor inhibitors and corticosteroids significantly improved mean central macular thickness (CMT) from the time of recurrence until the final examination (808 ± 169 vs. 511 ± 302 µm; P = 0.004), but failed to change visual acuity (1.28 ± 0.31 logMAR vs. 1.24 ± 0.43 logMAR; P = 0.8). No uncontrolled systemic risk factors were associated with recurrences. CONCLUSION Recurrent CRVO in the same eye occurs infrequently and may not be associated with an uncontrolled systemic disease. Despite multimodal therapy, most eyes do not recover vision to the pre-recurrence level.
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Affiliation(s)
- Jay Chhablani
- a Srimati Kanuri Santhamma Centre for Vitreo-Retinal Diseases, Hyderabad Eye Research Foundation, L. V. Prasad Eye Institute , Hyderabad , India
| | - Michael Stewart
- b Department of Ophthalmology , Mayo Clinic , Minnesota, FL , USA
| | - Remya Paulose
- a Srimati Kanuri Santhamma Centre for Vitreo-Retinal Diseases, Hyderabad Eye Research Foundation, L. V. Prasad Eye Institute , Hyderabad , India
| | - Roberto Gallego-Pinazo
- c Unit of Macula, Department of Ophthalmology , University and Polytechnic Hospital La Fe , Valencia , Spain
| | - Rosa Dolz-Marco
- c Unit of Macula, Department of Ophthalmology , University and Polytechnic Hospital La Fe , Valencia , Spain
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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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Ferrazzi P, Di Micco P, Quaglia I, Rossi LS, Bellatorre AG, Gaspari G, Rota LL, Lodigiani C. Homocysteine, MTHFR C677T gene polymorphism, folic acid and vitamin B 12 in patients with retinal vein occlusion. Thromb J 2005; 3:13. [PMID: 16144556 PMCID: PMC1224880 DOI: 10.1186/1477-9560-3-13] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2005] [Accepted: 09/07/2005] [Indexed: 11/10/2022] Open
Abstract
Background Many available data have suggested that hyperhomocysteinaemia, an established independent risk factor for thrombosis (arterial and venous), may be associated with an increased risk of retinal vein occlusion (RVO). Aim of the study To evaluate homocysteine metabolism in consecutive caucasian patients affected by RVO from Northern Italy. Patients and Methods 69 consecutive patients from Northern Italy (mean age 64.1 ± 14.6 yy) with recent RVO, were tested for plasma levels of homocysteine (tHcy: fasting and after loading with methionine), cyanocobalamine and folic acid levels (CMIA-Abbot) and looking for MTHFR C677T mutation (Light Cycler-Roche) and compared to 50 volunteers, enrolled as a control group. Results Fasting levels of tHcy were significantly higher in patients than in controls: mean value 14.7 ± 7.7 vs 10.2 ± 8 nmol/ml. Post load levels were also significantly higher: mean value 42.7 ± 23.7 vs 30.4 ± 13.3 nmol/ml; Total homocysteine increase was also evaluated (i.e. Δ-tHcy) after methionine load and was also significantly higher in patients compared to control subjects: mean Δ-tHcy 27.8 ± 21.5 vs 21.0 ± 16 nmol/ml (normal value < 25 nmol/ml). Furthermore, patients affected by RVO show low folic acid and/or vitamin B12 levels, although differences with control group did not reach statistical significance. Heterozygous and homozygous MTHFR mutation were respectively in study group 46% and 29% vs control group 56% and 4%. Conclusion our data confirm that hyperhomocysteinaemia is a risk factor for RVO, and also that TT genotype of MTHFR C677T is more frequently associated with RVO: if the mutation per se is a risk factor for RVO remains an open question to be confirmed because another study from US did not reveal this aspect. Hyperomocysteinemia is modifiable risk factor for thrombotic diseases. Therefore, a screening for tHcy plasma levels in patients with recent retinal vein occlusion could allow to identify patients who might benefit from supplementation with vitamins and normalization of homocysteine levels, in fasting and after methionine load.
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Affiliation(s)
- Paola Ferrazzi
- Thrombosis Center, Istituto Clinico Humanitas "IRCCS", Milan, Italy
| | | | - Ilaria Quaglia
- Thrombosis Center, Istituto Clinico Humanitas "IRCCS", Milan, Italy
| | | | | | - Giorgio Gaspari
- Ophtalmology Unit, Istituto Clinico Humanitas "IRCCS", Milan, Italy
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Hasan S, Elbedawi M, Castro O, Gladwin M, Palestine A. Central retinal vein occlusion in sickle cell disease. South Med J 2004; 97:202-4. [PMID: 14982276 DOI: 10.1097/01.smj.0000100266.87750.f5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Central retinal vein occlusion has not been reported previously in patients with sickle cell anemia. We describe the case of a 31-year-old man with sickle cell anemia who developed this complication. The search for risk factors for central retinal vein occlusion in this young patient revealed protein S deficiency and a history of iron deficiency. He was treated with anticoagulation therapy, and his vision improved gradually.
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Affiliation(s)
- Syed Hasan
- Department of Medicine, Center for Sickle Cell Disease, Howard University, Washington, DC 20059, USA.
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Tsaloumas MD, Kirwan J, Vinall H, O'Leary MB, Prior P, Kritzinger EE, Dodson PM. Nine year follow-up study of morbidity and mortality in retinal vein occlusion. Eye (Lond) 2000; 14:821-7. [PMID: 11584836 DOI: 10.1038/eye.2000.230] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The aim of this study was to conduct a detailed retrospective follow-up of a large cohort of patients with retinal vein occlusion (RVO), examining morbidity and mortality, to investigate a possible relationship between RVO, large vessel disease and stroke, and to determine whether recurrence of RVO was influenced by treatment of associated medical conditions. METHODS A follow-up study was undertaken in 1994 of all patients (n = 588) who presented to the medical ophthalmology clinics of the Birmingham and Midland Eye Hospital between 1982 and 1989 with a definitive diagnosis of RVO. RESULTS Follow-up data were obtained on 549 patients (93%). Results showed that recurrence of RVO in the same or fellow eye was decreased by more than half in the follow-up group (3.3%) when compared with the known recurrence rate at initial presentation (8.8%). Comparison of the deceased with the survivors showed that the deceased patients were significantly older (mean age 70.2 vs 63.4 years). The prevalence of rubeosis iridis and smoking were statistically significantly increased when comparing the deceased with the survivors (p < 0.016 and p < 0.008 respectively). The deceased had a higher prevalence of diabetes (15.8% vs 10.1%), and there was a trend towards increased clinically evident macrovascular disease in those patients who had died (23.2% vs 19.5%). Neither hypertension nor hyperlipidaemia predicted death, as the prevalence rates of the two conditions were similar in survivors and those who had died (60.0% vs 60.6% and 48.4% vs 53.3%). The percentage of patients taking antiplatelet drug therapy was not different in the two groups (36.8% vs 38.3%). Analysis of the causes of death of the RVO population (n = 95) compared with the causes of death in the West Midlands population as a whole, showed that the percentage of deaths from myocardial infarction in the RVO population was significantly higher (23.1% vs 14.4%, p < 0.05). There was no statistical difference between the populations for ischaemic heart disease and stroke, although there was a trend for increased mortality from stroke (19% vs 13.5%). CONCLUSION These data suggest a relationship between RVO, mortality and increased cardiovascular risk factors (smoking, diabetes and macrovascular disease), and support the possibility of an association between RVO and stroke. They also support the potential value of medical treatment of underlying medical conditions in preventing recurrence of RVO.
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Affiliation(s)
- M D Tsaloumas
- Birmingham and Midland Eye Centre, City Hospital NHS Trust and Birmingham Heartlands NHS Trust Hospital, Birmingham, UK
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16
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Bhagat N, Goldberg MF, Gascon P, Bell W, Haberman J, Zarbin MA. Central retinal vein occlusion: review of management. Eur J Ophthalmol 1999; 9:165-80. [PMID: 10544972 DOI: 10.1177/112067219900900304] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Central retinal vein occlusion is usually a disease of the elderly and is often associated with systemic vascular disease, e.g., hypertension, diabetes mellitus, arteriosclerotic vascular disease. Younger patients, especially those less than 45 years of age, with retinal vein occlusion should be evaluated carefully for the possibility of an underlying thrombotic tendency. The authors describe the ocular manifestations, pathogenesis, associated conditions, patient evaluation, and treatment of patients with central retinal vein occlusion.
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Affiliation(s)
- N Bhagat
- Department of Ophthalmology, New Jersey Medical School, Newark 07103-2499, USA
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17
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Affiliation(s)
- T H Williamson
- Department of Ophthalmology, St Thomas's Hospital, London
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18
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Dodson PM, Kritzinger EE. Medical cardiovascular treatment trials: relevant to medical ophthalmology in 1997? Eye (Lond) 1997; 11 ( Pt 1):3-11. [PMID: 9246268 DOI: 10.1038/eye.1997.2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- P M Dodson
- Department of Diabetes, Birmingham Heartlands Hospital and Birmingham and Midland Eye Centre, Birmingham, UK
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19
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Arend O, Remky A, Jung F, Kiesewetter H, Reim M, Wolf S. Role of rheologic factors in patients with acute central retinal vein occlusion. Ophthalmology 1996; 103:80-6. [PMID: 8628564 DOI: 10.1016/s0161-6420(96)30729-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
PURPOSE To assess the rheologic findings in acute central retinal vein occlusion (CRVO) with respect to associated risk factors, the clinical appearance of ischemic or nonischemic CRVO, and to elucidate the etiology of possible changes. METHODS The authors enrolled 173 patients with acute CRVO (ischemic, 33%; nonischemic, 67%) in this prospective study. One hundred seventy-three patients who were matched for age, sex, and cardiovascular risk factors served as control subjects. All patients underwent testing to determine hematocrit values, plasma viscosity (PV), erythrocyte aggregation (SEA), and erythrocyte rigidity (SER). RESULTS Hemocrit values and PV were increased significantly (P<0.01) in patients with ischemic and nonischemic CRVO compared with control subjects but did not differ significantly between the two groups. No significant differences were found in SEA and SER values between the clinical subsets of patients with CRVO and when the patients were compared with matched control subjects. Analysis revealed that hemocrit and PV values were (P<0.001) increased significantly independent of associated cardiovascular risk factors. CONCLUSION These results suggest that increased hemocrit and PV values may be contributing factors in the pathogenesis of CRVO.
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Affiliation(s)
- O Arend
- Augenklinik der Med. Fak. der RWTH Aachen, Germany
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20
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Abstract
Central retinal vein occlusion (CRVO) is usually seen in older adults and is often associated with systemic vascular disease. CRVO can be seen in young adults, and although it is occasionally associated with a systemic disease, in the majority of cases it occurs in an otherwise healthy patient with no known systemic disease or ocular problem. Inflammation of the central retinal vein has been proposed as a cause of the occlusion in young adults and for that reason it has been called papillophlebitis. The appearance of unilateral optic disc edema, dilatation, and tortuosity of the major retinal veins with a variable amount of retinal hemorrhage in young, healthy adults with complaints of blurred vision or photopsias has been called, in addition to papillophlebitis, benign retinal vasculitis, optic disc vasculitis, nonischemic CRVO, big blind spot syndrome, and presumed phlebitis of the optic disc. An approach to the diagnostic evaluation of the young adult with CRVO is presented. Although most eyes recover vision to better than 20/40, about one-fifth have significant visual loss, and many suffer ocular sequelae. Many treatment modalities have been tried for this entity, but no conclusive evidence exists that any treatment alters its natural history.
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Affiliation(s)
- A C Fong
- St. Mary's Hospital and Medical Center, San Francisco, California
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21
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Abstract
The investigation of patients with retinal artery occlusion, retinal vein occlusion and cotton wool spots is discussed. The majority are due to either emboli or atheroma and occur in elderly patients. A full clinical history and examination remain the essential part of the investigation but the ophthalmologist must select patients in whom further investigation is warranted. The recent recognition of the importance of antiphospholipid antibodies and natural anticoagulant deficiency states in the pathogenesis of thrombosis has identified a group of young people in whom specific therapy may be indicated.
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Affiliation(s)
- E M Graham
- Medical Eye Unit, St Thomas' Hospital, London
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22
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Cole MD, Dodson PM, Hendeles S. Medical conditions underlying retinal vein occlusion in patients with glaucoma or ocular hypertension. Br J Ophthalmol 1989; 73:693-8. [PMID: 2804022 PMCID: PMC1041860 DOI: 10.1136/bjo.73.9.693] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Forty-three patients with glaucoma and 24 patients with ocular hypertension presenting with a retinal vein occlusion were medically assessed. The prevalence of systemic hypertension was 60.5% in those with glaucoma and 66.6% with ocular hypertension. The prevalence of hyperlipidaemia was 38.1% in those with glaucoma and 37.5% in those with ocular hypertension. These findings were compared with those from a carefully age-sex matched group of patients presenting with a retinal vein occlusion without evidence of glaucoma or ocular hypertension. There were no statistical differences between any of the groups (52.2% had systemic hypertension and 28.8% had hyperlipidaemia). There was also a strikingly high prevalence of systemic hypertension (89%) and hyperlipidaemia (55.5%) in nine of the patients who had evidence of a recurrent retinal vein occlusion associated with glaucoma, and these prevalence rates were strikingly similar to the rates in patients with recurrence but without glaucoma. The data suggest that glaucoma or ocular hypertension has a less prominent aetiological role in the development of a retinal vein occlusion than underlying medical causes and that full medical assessment is worthwhile.
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Affiliation(s)
- M D Cole
- Birmingham and Midland Eye Hospital
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23
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Dodson PM, Kritzinger EE. Management of retinal vein occlusion. BMJ : BRITISH MEDICAL JOURNAL 1987; 295:1434-5. [PMID: 3121051 PMCID: PMC1248598 DOI: 10.1136/bmj.295.6611.1434] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- P M Dodson
- Clinical Investigation Unit, Dudley Road Hospital, Birmingham
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