Factores de riesgo vascular y enfermedad obstructiva microvascular de la retina

Position paper on retinal arterial occlusion. SEMI-SERV

The retina is an organ frequently affected by ischemic changes. Retinal arterial occlusion can be considered the equivalent of stroke, in terms of presentation, management and treatment. In addition to a specific ophthalmological treatment systemic management is essential with an appropriate study and control of cardiovascular risk factors considering these patients of a very high cardiovascular risk. In this consensus document we aim to provide an update on this relatively frequent pathology in our practices, considering the importance of an early and systematic action.

[Retinal venous occlusion and its association with atherosclerotic vascular disease]

Retinal venous occlusion (RVO) is the second most frequent cause of decreased visual acuity due to retinal vascular, after diabetic retinopathy. Its etiology is not completely clear. Current scientific evidence suggests that it is related to the atherosclerotic process given the high number of cardiovascular risk factors and the higher incidence of cardiovascular events in these patients. In fact, RVO implies a 45% higher risk of stroke, 26% of acute myocardial infarction and peripheral vascular disease, 53% of heart failure and 36% of overall mortality, compared to the general population adjusted for age, sex and the different cardiovascular risk factors. However, no increase in cardiovascular mortality has been detected. Therefore, a multidisciplinary clinical approach to this pathology is essential.

Evaluation of the ambulatory blood pressure monitoring in patients with retinal vein occlusion

BACKGROUND

Arterial hypertension (AHT) is the main risk factor for the development of retinal vein occlusion (RVO).

AIMS

To analyze the hypertensive profile with ambulatory blood pressure monitoring (ABPM) in patients with RVO.

PATIENTS AND METHODS

Retrospective and observational study of 66 patients with ABPM, 33 with retinal vein occlusion from a cohort of these disease and 33 controls without RVO, adjusted for age and sex.

RESULTS

Compared to controls, patients with RVO had elevated nocturnal values of SBP 130mmHg (21) vs. 119mmHg (11); P=.01 and DBP 73mmHg (11) vs. 65mmHg (9); P=.002. In addition, they presented a lower decrease in the Dipping ratio percentage 6.0% (10.4) vs. 12.3% (6.3); P=.005.

CONCLUSIONS

Patients with RVO have an unfavorable nocturnal hypertensive profile. Recognition of this fact can help optimize their treatment.

The role of coagulation disorders in patients with retinal vein occlusion

BACKGROUND

The role of a hypercoagulable state in the pathogenesis of retinal vein occlusion (RVO) has not been conclusively established.

AIM

To analyse the prevalence of thrombophilia in RVO.

DESIGN

Prospective case-control study.

METHODS

All the patients diagnosed with RVO were referred to an Internal Medicine clinic and compared with sex- and age-matched individuals from a population-based cohort. Demographic, clinical and laboratory variables (including a thrombophilia panel) were analysed.

RESULTS

One hundred and seventy patients (93 men and 77 women; 68 ± 11 years) and 170 controls (80 men and 90 women; 67 ± 10 years) were included. RVO was peripheral in 113 cases. Genetic thrombophilia was detected in 13% of patients. Acquired thrombophilia was observed in 10% of cases and 4.7 % of controls (P < 0.01). Sixty-three percent of cases and 24.6% of controls had serum hyperhomocysteinemia (odds ratio [OR] 5.2, IC 95% 2.7-10.1; P < 0.0001) : In RVO patients aged <50 years (n = 11), 36.4% had genetic thrombophilia (P = 0.04), as well as 50% of those without vascular risk factors (n = 18; P = 0.01). Forty-one (24%) patients with RVO received antiplatelet agents and 13 (7.6%) were on anticoagulants due to preexistent atrial fibrillation.

CONCLUSIONS

We suggest that, in patients with RVO, hyperhomocysteinemia and antiphospholipid syndrome should be ruled out. Moreover, a study of genetic thrombophilia should only be considered in those aged <50 years or without cardiovascular risk factors. Antiplatelet therapy with aspirin is probably the treatment of choice of RVO, to reduce the overall vascular risk. Anticoagulation should only be considered in patients with high-risk thrombophilia.