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Daxer B, Radner W, Fischer F, Cocoșilă AL, Ettl A. Aetiology, Diagnosis and Treatment of Arterial Occlusions of the Retina-A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:526. [PMID: 38674172 PMCID: PMC11052062 DOI: 10.3390/medicina60040526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/28/2024]
Abstract
Arterial occlusions of the retina are potentially sight-threatening diseases which often result in profound visual loss. The aim of this narrative review is to provide an overview of the aetiology, discuss major risk factors, describe the management and systemic assessments and evaluate existing therapies. For this review, an extensive literature search in PubMed was performed. Emboli from the heart or the carotid arteries can cause ophthalmic artery occlusion (OAO), central retinal artery occlusion (CRAO) and branch retinal artery occlusion (BRAO). Most patients with arterial occlusions have vascular risk factors such as arterial hypertension, hyperhomocysteinaemia, carotid stenosis and atrial fibrillation, which also increase the risk of cerebral stroke and myocardial infarction. Therapies such as ocular massage, thrombolysis and anterior chamber paracentesis have been suggested but are still equivocal. However, it is evident that retinal artery occlusion should be immediately treated and accompanied by interdisciplinary collaboration, since early diagnosis and the proper treatment of possible risk factors are important to reduce the risk of further damage, recurrences, other vascular diseases and mortality.
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Affiliation(s)
- Barbara Daxer
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500 Krems, Austria
- Department of Ophthalmology and Orbital Surgery, University Hospital St. Pölten, Dunantplatz 1, 3100 St. Pölten, Austria
| | - Wolfgang Radner
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500 Krems, Austria
- Department of Ophthalmology and Orbital Surgery, University Hospital St. Pölten, Dunantplatz 1, 3100 St. Pölten, Austria
- Austrian Academy of Ophthalmology, Mollgasse 11, 1180 Vienna, Austria
| | - Florian Fischer
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500 Krems, Austria
- Department of Ophthalmology and Orbital Surgery, University Hospital St. Pölten, Dunantplatz 1, 3100 St. Pölten, Austria
| | - Andreea-Liliana Cocoșilă
- Faculty of Medicine and Pharmacy, University of Oradea, 1 Decembrie Square 10, 410068 Oradea, Romania
| | - Armin Ettl
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500 Krems, Austria
- Department of Ophthalmology and Orbital Surgery, University Hospital St. Pölten, Dunantplatz 1, 3100 St. Pölten, Austria
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Lee MY, Han K, Koo HYR, Yu DS, Lee YB. PSORIASIS INCREASES RETINAL VEIN OCCLUSION RISK IN DIABETIC PATIENTS: A Nationwide Population-Based Study. Retina 2024; 44:151-158. [PMID: 37606285 DOI: 10.1097/iae.0000000000003916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
PURPOSE The objective of this research was to explore how psoriasis is linked to the occurrence of retinal vein occlusion (RVO) in diabetic population. METHODS This was a retrospective, nationwide, population-based cohort study that examined medical records from January 2009 to December 2012. The study focused on patients ≥20 years of age who had been diagnosed with Type 2 diabetes mellitus (DM). The authors compared the incidence rate of RVO between a group of patients with psoriasis and a group of patients without psoriasis until December 2018 in all subjects. RESULTS Of the 2,745,689 Type 2 DM patients, 23,725 patients were classified in the psoriasis group and the rest of the 2,547,121 individuals in the control group. A total of 497 RVO cases occurred in the psoriasis group (3.14/1,000 person-years) and 42,388 RVO cases in the control group (2.44/1,000 person-years). According to multivariable Cox proportional hazard models, individuals with psoriasis had a significantly greater risk of developing RVO compared with control subjects (hazard ratio: 1.216, 95% confidence interval: 1.11-1.33) after adjustments for covariates. CONCLUSION This study demonstrated that psoriasis was an independent risk factor for developing RVO in DM patients. Therefore, physicians need to be vigilant for the occurrence of RVO in DM patients who also have psoriasis.
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Affiliation(s)
- Mee Yon Lee
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, College of Natural Sciences, Soongsil University, Republic of Korea; and
| | - Ha Yeh Rin Koo
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Republic of Korea
| | - Dong Soo Yu
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Republic of Korea
| | - Young Bok Lee
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Republic of 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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Rana V, Dangi M, Bandopadhayay S, Sharma VK, Srikumar S, Goyal J, Rao BV. Hyperhomocysteinemia, High Altitude, and Varied Retinal Manifestations: Unravelling the Enigma. High Alt Med Biol 2023; 24:234-237. [PMID: 37405780 DOI: 10.1089/ham.2023.0028] [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] [Indexed: 07/06/2023] Open
Abstract
Rana, Vipin, Meenu Dangi, Sandepan Bandopadhayay, Vijay K. Sharma, Satyabrat Srikumar, Jitesh Goyal, and B.V. Rao. Hyperhomocysteinemia, High Altitude, and Varied Retinal Manifestations: Unravelling the Enigma. High Alt Med Biol. 24:234-237, 2023.-We present five cases of young defense personnel, who were posted at high altitude (HA) for >6 months and presented with reduction of vision between June 2022 and February 2023. The diagnosis made were ocular ischemic syndrome, central retinal artery occlusion, central retinal vein occlusion, branch retinal vein occlusion, and branch retinal artery occlusion. There were no associated comorbidities. Hematological workup revealed increased serum homocysteine and hemoglobin in all patients. Computed tomography angiography was done in cases of ocular ischemic syndrome, and central retinal artery occlusion, which revealed occlusion of carotid artery. All patients were given tab folic acid in view of hyperhomocysteinemia (HHcy). This case series highlights that prolonged exposure to HA may lead to HHcy, which can directly or indirectly lead to various sight-threatening retinal diseases. Thus, effective preventive strategies, such as dietary or pharmacological interventions aimed at lowering serum homocysteine levels, are crucial for individuals posted at HA for longer duration.
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Affiliation(s)
- Vipin Rana
- Command Hospital Eastern Command, Kolkata, India
| | - Meenu Dangi
- Command Hospital Western Command, Haryana, India
| | | | | | | | - Jitesh Goyal
- Command Hospital Eastern Command, Kolkata, India
| | - B V Rao
- Command Hospital Eastern Command, Kolkata, India
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Chandrasekaran PR. A Curious Case of Occlusive Retinal Vasculitis in a Young Individual Associated with COVID-19 Vaccination. Ocul Immunol Inflamm 2022:1-7. [PMID: 36306426 DOI: 10.1080/09273948.2022.2137046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
A 23-year-old man presented with the blurring of vision in the left eye for 4 days. Best-corrected visual acuity was 6/6 N6 in both eyes. Examination revealed an unremarkable right eye while the left eye showed occlusive retinal vasculitis with no retinitis, choroiditis, or macular involvement. Fundus fluorescein angiography confirmed the same. History revealed the patient had received 2nd dose of Covishield vaccination 4 weeks before the onset of symptoms. Blood investigations were negative for infectious or any systemic autoimmune disease. Serum homocysteine and serum CMV IgG levels were grossly increased while tests for antiphospholipid syndrome were weakly positive. He responded well to a combination of intravitreal and oral antivirals, oral steroids for vasculitis and tablets Clopilet and Homin. This case is extremely intriguing in terms of the involvement of the adenoviral vector vaccine either as a causative factor or being just a coincidental finding.
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Affiliation(s)
- Priya R. Chandrasekaran
- Department of Medical Retina, Uvea and Neuro-ophthalmology, Lotus Eye Hospital, Coimbatore, India
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Lee SW, Koo HYR, Han KD, Lee YB. Association between Retinal Vein Occlusion and Psoriasis in Korea: A Nationwide Population-based Prospective Cohort Study. Acta Derm Venereol 2022. [DOI: 10.2340/actadv.v101.2299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Psoriasis is a chronic inflammatory skin disease imparting increased risk of cardiovascular diseases. Until now, few studies have reported an increased incidence of ophthalmological retinal vasculopathy in individuals with psoriasis. This study aimed to investigate the association between psoriasis and retinal vein occlusion in the Korean population. Data collected by the National Health Insurance Service between 2009 and 2015 in Korea were analysed. Participants who underwent national health examinations from 2009 to 2012 were enrolled in this study and were divided into either the psoriasis group (n = 3,088) or the control group (n = 465,205). All occurrences of retinal vein occlusion were observed, and the incidence rate of retinal vein occlusion was compared between the psoriasis and control groups. A Cox proportional hazards regression analysis was used to assess the association between psoriasis and newly developed retinal vein occlusion. During a mean 4.37-year follow-up period, 2,034 patients developed retinal vein occlusion. According to multivariable Cox proportional hazard models, individuals with psoriasis had a significantly higher risk of retinal vein occlusion compared with controls (hazard ratio 1.72, 95% confidence interval 1.18–2.51) after adjustments for covariates. This study found that psoriasis was positively associated with retinal vein occlusion.
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Lee SW, Koo HYR, Han KD, Lee YB. Association between Retinal Vein Occlusion and Psoriasis in Korea: A Nationwide Population-based Prospective Cohort Study. Acta Derm Venereol 2022; 102:adv00767. [PMID: 36017679 PMCID: PMC9593496 DOI: 10.2340/actadv.v102.2299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Psoriasis is a chronic inflammatory skin disease imparting increased risk of cardiovascular diseases. Until now, few studies have reported an increased incidence of ophthalmological retinal vasculopathy in individuals with psoriasis. This study aimed to investigate the association between psoriasis and retinal vein occlusion in the Korean population. Data collected by the National Health Insurance Service between 2009 and 2015 in Korea were analysed. Participants who underwent national health examinations from 2009 to 2012 were enrolled in this study and were divided into either the psoriasis group (n = 3,088) or the control group (n = 465,205). All occurrences of retinal vein occlusion were observed, and the incidence rate of retinal vein occlusion was compared between the psoriasis and control groups. A Cox proportional hazards regression analysis was used to assess the association between psoriasis and newly developed retinal vein occlusion. During a mean 4.37-year follow-up period, 2,034 patients developed retinal vein occlusion. According to multivariable Cox proportional hazard models, individuals with psoriasis had a significantly higher risk of retinal vein occlusion compared with controls (hazard ratio 1.72, 95% confidence interval 1.18-2.51) after adjustments for covariates. This study found that psoriasis was positively associated with retinal vein occlusion.
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Affiliation(s)
| | | | | | - Young Bok Lee
- Department of Dermatology, Uijeongbu St Mary's Hospital, College of Medicine, The Catholic University of Korea, 271 Cheon Bo-ro, Uijeongbu, Gyeonggi-Do, 11765, Republic of Korea..
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Shute C. A case report of branch retinal artery occlusion in a teenager due to hyperhomocysteinaemia; the interplay of genetic and nutritional defects. BMC Ophthalmol 2018; 18:220. [PMID: 30255822 PMCID: PMC6156839 DOI: 10.1186/s12886-018-0859-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Retinal vascular occlusions are uncommon in young people and require more in-depth investigation into the cause. Studies have revealed that a high level of circulating homocysteine poses a risk for retinal vaso-occlusive events across a wide age range. This case report reflects on how the interplay of genetic mutation and vitamin deficiency can cause a pathological level of homocysteine with resultant branch retinal artery occlusion in a young patient. Case presentation A 16-year-old boy presented to eye casualty with acute inferior visual field loss in the left eye. Visual acuity remained normal at 6/6 each eye and the event was painless. Initial assessment, and retinal photography revealed a left superior hemi-field branch retinal artery occlusion with macular sparing. Given the patient’s age, extensive investigation into the cause was carried out. Positive findings were of an elevated level of homocysteine as a result of vitamin B12 and folic acid deficiency as well as a genetic mutation in the MTHFR gene (encoding MTHFR enzyme which is vital in normal homocysteine metabolism). Vitamin B12 and folic acid were replaced which in turn normalized the patient’s homocysteine levels. At two months, the patient’s visual fields had also improved, and no further vascular event had occurred. Conclusions This case report has highlighted the link between hyperhomocysteinaemia and retinal artery occlusion. However, despite vitamin replacement being shown to normalize homocysteine levels, no evidence exists to date as to whether this will reduce the risk of further retinal vascular occlusion.
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Affiliation(s)
- Clare Shute
- Royal Victoria Hospital, Belfast, Northern Ireland.
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Nowak M, Świetochowska E, Wielkoszyński T, Marek B, Kos-kudła B, Szapska B, Kajdaniuk D, Głogowska-szelág J, Siemińska L, Ostrowska Z, Kozioł H, Klimek J. Homocysteine, Vitamin B12, and Folic Acid in Age-Related Macular Degeneration. Eur J Ophthalmol 2018. [DOI: 10.1177/112067210501500617] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- M. Nowak
- Pathophysiology Division, Department of Pathophysiology and Endocrinology, Zabrze - Poland
| | | | | | - B. Marek
- Pathophysiology Division, Department of Pathophysiology and Endocrinology, Zabrze - Poland
| | - B. Kos-kudła
- Endocrinology Division, Department of Pathophysiology and Endocrinology, Zabrze - Poland
| | - B. Szapska
- Department of Clinical Biochemistry, Zabrze - Poland
| | - D. Kajdaniuk
- Pathophysiology Division, Department of Pathophysiology and Endocrinology, Zabrze - Poland
| | - J. Głogowska-szelág
- Pathophysiology Division, Department of Pathophysiology and Endocrinology, Zabrze - Poland
| | - L. Siemińska
- Pathophysiology Division, Department of Pathophysiology and Endocrinology, Zabrze - Poland
| | - Z. Ostrowska
- Department of Clinical Biochemistry, Zabrze - Poland
| | - H. Kozioł
- Ophthalmology Clinic, Medical University of Silesia, Zabrze - Poland
| | - J. Klimek
- Ophthalmology Clinic, Medical University of Silesia, Zabrze - Poland
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Huang X, Yang Y, Duan Y, Kuang YQ, Lin D. Homocysteine in retinal artery occlusive disease: A meta-analysis of cohort studies. Sci Rep 2017; 7:15708. [PMID: 29146987 PMCID: PMC5691205 DOI: 10.1038/s41598-017-16065-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 11/07/2017] [Indexed: 11/28/2022] Open
Abstract
Few studies have reported the relationship between retinal artery occlusion (RAO) and plasma homocysteine (Hcy) levels. Our goal was to evaluate the association between the plasma Hcy level and the risk of RAO disease. Several databases were searched for all published studies that involved Hcy and RAO. Six studies evaluated hyperhomocysteinemia (hHcy) in retinal artery occlusion patients and controls; the incidence of hHcy in patients with RAO was higher than the control and the pooled odds ratio (OR) was 6.64 (95% confidence interval (CI): 3.42, 12.89). Subgroup analyses showed that the ORs were 4.77 (95% CI: 2.69, 8.46) in Western countries, 22.19 (95% CI: 2.46, 200.37) in Asian countries, 9.70 (95% CI: 4.43, 21.20) in the age matched group, 11.41 (95% CI: 3.32, 39.18) in the sex matched group, 9.70 (95% CI: 4.37, 21.53) in the healthy control group, and 6.82 (95% CI: 4.19, 11.10) in the sample size >30. The mean plasma Hcy level from 5 case-control studies was higher than controls, and the weighted mean difference (WMD) was 6.54 (95% CI: 2.79, 10.29). Retinal artery occlusion is associated with elevated plasma Hcy levels. Our study results suggest that hHcy is probably an independent risk factor for RAO.
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Affiliation(s)
- Xuetao Huang
- Department of Ophthalmology, Changsha Aier Hospital, Aier School of Ophthalmology, Central South University, Changsha, 410007, China.,Department of Ophthalmology, Huaihe Hospital of Henan University, Kaifeng, 475000, China
| | - Yezhen Yang
- Department of Ophthalmology, Changsha Aier Hospital, Aier School of Ophthalmology, Central South University, Changsha, 410007, China
| | - Yiqin Duan
- Department of Ophthalmology, Changsha Aier Hospital, Aier School of Ophthalmology, Central South University, Changsha, 410007, China
| | - Yi-Qun Kuang
- Institute of Infection and Immunity, Henan University & Centre for Translational Medicine, Huaihe Clinical College, Huaihe Hospital of Henan University, Kaifeng, 475000, China.
| | - Ding Lin
- Department of Ophthalmology, Changsha Aier Hospital, Aier School of Ophthalmology, Central South University, Changsha, 410007, China.
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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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Palmero-Fernández L, Fernández-Treguerres F, Santos-Bueso E, Sáenz-Francés F, Martínez-de-la-Casa JM, García-Feijóo J, García-Sánchez J. Hyperhomocysteinemia in chronic alcoholism: A case with retinal manifestations. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2014; 89:336-339. [PMID: 24269416 DOI: 10.1016/j.oftal.2013.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 06/05/2013] [Accepted: 07/08/2013] [Indexed: 06/02/2023]
Abstract
CASE REPORT An alcoholic patient with loss of vision in his right eye and a peripapillar haemorrhage, who then presented with a venous thrombosis. Blood analysis revealed hyperhomocysteinemia with coagulation parameters within the normal range. In the follow-up he developed a bilateral optic neuropathy. DISCUSSION An increase in homocysteine levels is common in alcoholics, and it has been considered a vascular risk factor. Folic acid and vitamins B6 and B12 deficiency may lead to hyperhomocysteinemia, as they participate in its metabolism. CONCLUSIONS When presented with a retinal occlusive disease or ischemic optic neuropathy in young patients, coagulation disorders and elevated levels of homocysteine should be ruled out.
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Affiliation(s)
- L Palmero-Fernández
- Departamento de Neuro-oftalmología, Hospital Clínico San Carlos, Madrid, España.
| | | | - E Santos-Bueso
- Departamento de Neuro-oftalmología, Hospital Clínico San Carlos, Madrid, España
| | - F Sáenz-Francés
- Departamento de Neuro-oftalmología, Hospital Clínico San Carlos, Madrid, España
| | | | - J García-Feijóo
- Departamento de Neuro-oftalmología, Hospital Clínico San Carlos, Madrid, España
| | - J García-Sánchez
- Departamento de Neuro-oftalmología, Hospital Clínico San Carlos, Madrid, España
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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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Aggregation and Fibrillation of Eye Lens Crystallins by Homocysteinylation; Implication in the Eye Pathological Disorders. Protein J 2012; 31:717-27. [DOI: 10.1007/s10930-012-9451-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Glueck CJ, Hutchins RK, Jurantee J, Khan Z, Wang P. Thrombophilia and retinal vascular occlusion. Clin Ophthalmol 2012; 6:1377-84. [PMID: 22969282 PMCID: PMC3437951 DOI: 10.2147/opth.s34627] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this research was to assess associations of thrombophilia with central retinal vein occlusion (CRVO), central retinal artery occlusion (CRAO), and amaurosis fugax (AF); to evaluate outcomes of normalizing high homocysteine; and to study CRVO, CRAO, and AF developing in estrogens/estrogen agonists in women subsequently shown to have thrombophilia. Methods Measures of thrombophilia–hypofibrinolysis were obtained in 132 CRVO cases, 15 CRAO cases, and 17 AF cases. Cases were compared to 105 healthy control subjects who did not differ by race or sex and were free of any ophthalmologic disorders. All cardiovascular disease (CVD) risk factors were compared to healthy general populations. Main outcome measures The main outcome measure of this study was thrombophilia. Results CRVO cases were more likely than controls to have high homocysteine (odds ratio [OR] 8.64, 95% confidence intervals [CI]: 1.96–38), high anticardiolipin immunoglobulin M (IgM; OR 6.26, 95% CI: 1.4–28.2), and high Factor VIII (OR 2.47, 95% CI: 1.31–7.9). CRAO-AF cases were more likely than controls to have high homocysteine (OR 14, 95% CI: 2.7–71.6) or the lupus anticoagulant (OR 4.1, 95% CI: 1.3–13.2). In four of 77 women with CRVO (two found to have high homocysteine, two with inherited high Factor XI), CRVO occurred after starting estrogen–progestins, estrogen–testosterone, or estrogen agonists. In one of eight women with CRAO found to have high anticardiolipin antibody IgG, CRAO occurred after starting conjugated estrogens, and AF occurred after starting conjugated estrogens in one of eleven women with AF (inherited protein S deficiency). Therapy for medians of 21 months (CRVO) and 6 months (CRAO-AF) was 5 mg folic acid, 100 mg B6, and 2000 mcg/day B12 normalized homocysteine in 13 of 16 (81%) CRVO cases and all five CRAO-AF cases with pretreatment hyperhomocysteinemia. The CRVO cases had an excess of hypertension; CRAO-AF cases had an excess of type 2 diabetes and hypertension. Conclusion Treatable thrombophilia, hyperhomocysteinemia in particular, is more common in RVO cases than in normal controls. RVO occurs after estrogens or estrogen agonists were administered in women subsequently shown to have thrombophilia.
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Affiliation(s)
- Charles J Glueck
- Cholesterol Center, Jewish Hospital of Cincinnati, Cincinnati, OH, USA
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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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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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Marcucci R, Sodi A, Giambene B, Liotta AA, Poli D, Mannini L, Falciani M, Abbate R, Menchini U, Prisco D. Cardiovascular and thrombophilic risk factors in patients with retinal artery occlusion. Blood Coagul Fibrinolysis 2007; 18:321-6. [PMID: 17473572 DOI: 10.1097/mbc.0b013e32809cc922] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article evaluates the prevalence of cardiovascular and thrombophilic risk factors in patients with retinal artery occlusion. Forty-one patients with a first episode of a retinal artery occlusion underwent complete ophthalmic examination, routine blood testing and specific laboratory tests for thrombophilia, such as fasting and postmethionine homocysteine, lipoprotein(a), plasminogen activator inhibitor-1, factor VIII, factor V Leiden, factor II G20210A polymorphism, lupus anticoagulant and anticardiolipin antibodies. The control population consisted of 100 healthy individuals comparable as regards age and sex. At univariate analysis, hypertension, smoking, dyslipidaemia (both high cholesterol and triglyceride levels), antiphospholipid antibodies, hyperhomocysteinaemia, elevated factor VIII and lipoprotein(a) levels were significantly associated with retinal artery occlusion; at multivariate analysis, adjusted for age, sex, traditional and thrombophilic risk factors, smoking, hypercholesterolaemia, elevated homocysteine and lipoprotein(a) levels confirmed their independent role as risk factors for retinal artery occlusion. In conclusion, the results of the present pilot study demonstrate that the prevalence of hypercholesterolaemia and smoking and the 'thrombophilic burden' are increased in patients with retinal artery occlusion. Our findings may have implications for the management of these patients, suggesting the need for an intensive and tailored secondary prevention and new therapeutic approaches.
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Affiliation(s)
- Rossella Marcucci
- Department of Heart and Vessels, Thrombosis Center, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134 Florence, Italy.
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22
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Gao W, Wang YS, Zhang P, Wang HY. Hyperhomocysteinemia and low plasma folate as risk factors for central retinal vein occlusion: a case-control study in a Chinese population. Graefes Arch Clin Exp Ophthalmol 2006; 244:1246-9. [PMID: 16538453 DOI: 10.1007/s00417-005-0191-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2005] [Revised: 10/25/2005] [Accepted: 10/26/2005] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To determine whether hyperhomocysteinemia and low plasma folate are risk factors for central retinal vein occlusion (CRVO) in the Chinese population. METHODS A matched case-control study was conducted between July 2004 and May 2005. The study cohort consisted of 64 individuals that had been diagnosed to have CRVO and 64 normal 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 minimize the influence on plasma homocysteine levels. A cross-sectional analysis among the 64 cases was performed to compare the prevalence of hyperhomocysteinemia and low plasma folate among subjects with and without ischemia and subjects with age above 45 and below 45 years. Plasma homocysteine level was measured by means of high-performance liquid chromatography and plasma folate concentration by radioimmunoassay. RESULTS The CRVO patients had a significantly higher homocysteine level (13.83+/-1.71 micromol/l) than the normal controls (8.05+/-0.58 micromol/l; p=0.003). The plasma folate levels were significantly lower in CRVO patients than in controls (5.62+/-0.39 ng/dl vs 7.23+/-0.60 ng/dl; p=0.032). A 1 micromol/l increase of plasma homocysteine level was associated with an odds ratio of 1.368. Hyperhomocysteinemia was defined as a homocysteine level of >14.97 micromol/l and was seen in 11 patients in the ischemic group, significantly more often than in the non-ischemic group (5 patients; p=0.030). CONCLUSIONS The results suggest that hyperhomocysteinemia and low plasma folate are independent risk factors for CRVO and are associated with the development of CRVO in the Chinese population.
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Affiliation(s)
- Wei Gao
- Department of Ophthalmology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, People's Republic of China
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23
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Lattanzio R, Sampietro F, Ramoni A, Fattorini A, Brancato R, D'Angelo A. MODERATE HYPERHOMOCYSTEINEMIA AND EARLY-ONSET CENTRAL RETINAL VEIN OCCLUSION. Retina 2006; 26:65-70. [PMID: 16395141 DOI: 10.1097/00006982-200601000-00011] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the prevalence of moderate fasting hyperhomocysteinemia (HHcy) and postmethionine load (PML) HHcy among patients with early-onset central retinal vein occlusion (CRVO). METHODS The prevalence of fasting HHcy and that of PML HHcy were evaluated in a consecutive series of 58 patients with CRVO who were younger than 56 years of age (mean age, 40.3 years) and in 103 controls (mean age, 39.6 years). Plasma folate, vitamin B12, and pyridoxal-5'-phosphate (PLP) levels were measured in 42 patients and 67 controls. RESULTS Mantel-Haenszel odds ratios for CRVO patients were 3.00 (95% confidence interval [CI], 0.83-10.8) for fasting HHcy, 3.50 (95% CI, 1.07-11.4) for PML HHcy, and 3.00 (1.18-7.6) for fasting HHcy and PML HHcy in subjects with normal fasting total homocysteine (tHcy) levels. Moderate HHcy was associated with reduced plasma levels of folate and PLP (P < or = 0.04). There was no significant dependence of fasting and PML tHcy levels on any traditional risk factor evaluated. CONCLUSIONS Moderate HHcy is an independent risk factor for early-onset CRVO.
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Affiliation(s)
- Rosangela Lattanzio
- Department of Ophthalmology & Visual Sciences, University Hospital S. Raffaele, Milan, Italy.
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24
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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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Puustjärvi T, Blomster H, Kontkanen M, Punnonen K, Teräsvirta M. Plasma and aqueous humour levels of homocysteine in exfoliation syndrome. Graefes Arch Clin Exp Ophthalmol 2005; 242:749-54. [PMID: 15052489 DOI: 10.1007/s00417-004-0918-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Recent studies have suggested that the relationship between elevated plasma homocysteine (Hcy) and increased risk of vascular disease holds also for certain diseases of the eye with vascular aetiology. Elevated plasma Hcy levels have been noted among patients with exfoliation syndrome (XFS). The purpose of this study was to establish whether subjects with XFS have higher plasma and aqueous humour Hcy levels values than non-XFS subjects, particularly in relation to vitamin B status. METHODS Using a cross-sectional study design, 36 subjects with XFS and 36 non-XFS subjects with intraocular pressure (IOP) lower than 23 mmHg, matched by age and gender, were first selected. The participant exclusion criteria included parameters known to alter Hcy metabolism. In the XFS group, 11 subjects had a concurrent diagnosis of exfoliative glaucoma (XFG). Fasting plasma and aqueous humour Hcy samples were collected, along with erythrocyte folate (E-Fol) and serum vitamin B6 and B12 samples. The Hcy samples were analysed using a fluorescence polarization immunoassay method. RESULTS Plasma Hcy level was significantly higher (P=0.020, after Bonferroni correction for multiple testing) in the XFS group than in the controls. The Hcy concentrations in the aqueous humour did not differ statistically between the two groups. Plasma and aqueous humour Hcy concentrations were not statistically significantly correlated within the groups of exfoliation-positive and -negative subjects. E-Fol, and serum vitamin B6 and B 12 levels did not differ statistically between the XFS group and the control group. CONCLUSIONS The finding that subjects with XFS are more prone to elevated plasma Hcy emphasizes exfoliation as a clinical sign and a marker of thromboembolic vasculopathies induced by hyperhomocysteinaemia.
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Affiliation(s)
- Tuomo Puustjärvi
- Department of Ophthalmology, Kuopio University Hospital, PO Box 1777, 70211 Kuopio, Finland.
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26
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Palmowski-Wolfe AM, Denninger E, Geisel J, Pindur G, Ruprecht KW. Homocysteine in Ocular Arterial and Venous Occlusive Disease. Neuroophthalmology 2005. [DOI: 10.1080/01658100500481149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Abstract
Neurological disease can involve the eye in many ways. Every structure--the conjunctiva, cornea, anterior chamber, iris, lens, vitreous humour, retina, choroid, and optic nerve--can be affected. In many cases, ocular involvement is the first manifestation of the underlying disease. In such cases, the ability of the physician to recognise the nature and significance of the ocular abnormality can lead to early diagnosis and successful treatment of the underlying condition. In other cases, recognition of the ocular abnormality can prevent permanent visual dysfunction.
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Affiliation(s)
- Neil R Miller
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
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Abstract
PURPOSE Several investigators have tried to assess the role of hyperhomocysteinemia and the 677C-T mutation in the methylenetetrahydrofolate reductase (MTHFR) gene as risk factors in retinal vein occlusion with contrasting results. Aim of the study is to investigate the correlation between increased homocysteine plasma level and the homozygosity for the 677C-T mutation in the gene MTHFR in patients aged under 50 years affected by central retinal vein occlusion (CRVO). METHODS Through a prospective, case-control study, 31 patients under 50 years of age and diagnosed with CRVO were compared with two control groups. The first control group (GROUP I) included 31 subjects matched for age, sex, laboratory tests and the main risk factors for atherosclerosis. The second control group (GROUP II) consisted of 31 volunteers matched only for age and sex. RESULTS The mean homocysteine plasma level was 10.60 micromol/l in patients, 10.39 micromol/l in GROUP I and 9.34 micromol/l in GROUP II. There was no statistically significant difference between mean homocysteine plasma level in cases and in GROUP I. Mean homocysteine plasma level was lower in GROUP II than in patients, and the difference was statistically significant. Homozygosity for the 677C-T mutation in the MTHFR was found in four patients (12.9%), in five controls in GROUP I (16.1%) and in four controls in GROUP II (12.9%). CONCLUSION Our results support first of all the hypothesis that the homocysteine plasma level is not a primary and independent risk factor for central retinal vein occlusion, but is more likely a marker of atherosclerosis and the consequence of other well-established risk factors. Second, the importance of the design of the study is highlighted, since the obtained results differed on the basis of the considered control group. This feature could contribute to explain the contradictory results previously reported in the literature.
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Narin F, Narin N, Halici C, Oner AO, Dogan H, Karakukcu M. Plasma homocysteine and retinal artery occlusive disease: a case-control study. Ann Saudi Med 2004; 24:186-8. [PMID: 15307456 PMCID: PMC6147935 DOI: 10.5144/0256-4947.2004.186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2004] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Previous studies have documented that elevated plasma homocysteine is a risk factor for cardiovascular, cerebrovascular and peripheral vascular disease. In a case-control study, we sought to determine whether elevated homocysteine (HCY) is a risk factor for retinal artery occlusive disease PATIENTS AND METHODS. Study subjects consisted of 20 patients (12 male, 8 female) (mean age, 55.8; range 42-70 years) with clinical and objective evidence of retinal vascular occlusive disease and 20 age-matched control subjects (9 males, 11 females) (mean age, 55.3 years; range 50-68 years). Hyperhomocysteinemia was defined as a plasma HCY level >15 micromol/L by HPLC. We also measured concentrations of triglycerides, and total cholesterol, LDL cholesterol, and HDL cholesterol. RESULTS The mean plasma HCY level in the patient group was 21.23+/-9.53 micromol/L (range, 8.00-43.99 micromol/L) compared with 12.59+/-4.97 micromol/L (range, 6.38 to 22.88 micromol/L) in the control group (P<0.008). There was no correlation between HCY and serum triglycerides or cholesterol levels within each group. We conclude that high plasma HCY level may be a risk factor for retinal artery occlusive disease.
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Affiliation(s)
- Figen Narin
- Department of Biochemistry, Erciyes University Medical Faculty, PK, Kayseri, Turkey.
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Abu El-Asrar AM, Al-Obeidan SA, Abdel Gader AGM. Retinal periphlebitis resembling frosted branch angiitis with nonperfused central retinal vein occlusion. Eur J Ophthalmol 2004; 13:807-12. [PMID: 14700106 DOI: 10.1177/1120672103013009-1015] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To report the unusual association between severe retinal periphlebitis resembling frosted branch angiitis and nonperfused central retinal vein occlusion (CRVO). METHODS Observational case reports. RESULTS Patient 1 was a 28-year-old man who presented with extensive sheathing involving all retinal veins in one eye followed by nonperfused CRVO. Twenty-seven months after initial presentation, he developed perfused CRVO in the other eye followed by periphlebitis that progressed into nonperfused CRVO. Patient 2 was a 47-year-old man who presented with unilateral severe retinal periphlebitis associated with nonperfused CRVO. Despite systemic administration of corticosteroid therapy, rubeosis iridis developed in both patients and neovascular glaucoma developed in Patient 1 despite full panretinal photocoagulation. Extensive systemic workup and coagulation studies were unremarkable except for the presence of antiphospholipid antibodies in both patients and elevated plasma homocysteine level in Patient 2. CONCLUSIONS Severe retinal periphlebitis complicated by nonperfused CRVO is associated with poor visual outcome despite appropriate medical and surgical treatment.
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Affiliation(s)
- A M Abu El-Asrar
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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Feki M, Houman H, Ghannouchi M, Smiti-Khanfir M, Hamzaoui K, El Matri L, Mebazaa A, Kaabachi N. Hyperhomocysteinaemia is associated with uveitis but not with deep venous thrombosis in Behçet's disease. Clin Chem Lab Med 2004; 42:1417-23. [PMID: 15576305 DOI: 10.1515/cclm.2004.263] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractPlasma homocysteine was assessed in Behçet's disease (BD) patients in order to determine the prevalence of hyperhomocysteinaemia in BD and to test its association with clinical manifestations of the disease. The study included 59 patients with BD and 118 age- and sex-matched healthy subjects. Plasma homocysteine, vitamin B
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Affiliation(s)
- Moncef Feki
- LAB-SM-01 Research Laboratory & Department of Biochemistry, Rabta University Hospital, 1007 Jebbari, Tunis, Tunisia.
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