A longitudinal analysis of risk factors associated with central retinal vein occlusion

Is there an association between retinal vein occlusion and cerebrovascular accident? A systematic review and meta-analysis

BACKGROUND

Retinal vein occlusion (RVO) is a significant retinal vascular disorder that has been hypothesized to increase the risk of cerebrovascular accidents (CVA). Given the shared vascular pathology between the retina and cerebral circulation, understanding the association between RVO and stroke incidence is critical for early intervention and risk management. This systematic review and meta-analysis aim to evaluate the risk of CVA, including ischemic and hemorrhagic subtypes, in patients with RVO.

METHODS

This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in PROSPERO (CRD42024557820). A systematic search of PubMed, Cochrane Library, Scopus, Web of Science, and Embase was conducted from inception to February 2025. Studies assessing the incidence of CVA post-RVO in adult patients (≥ 18 years) were included. Two independent reviewers performed study selection, data extraction, and quality assessment using the Cochrane Risk of Bias tool for Non-Randomized studies (ROBINS-I) was used for observational cohort studies. Meta-analysis was conducted using Comprehensive Meta-Analysis (CMA) software version 3.7, applying a fixed-effects model for low heterogeneity. Subgroup and sensitivity analyses were performed based on RVO type (BRVO vs. CRVO) and stroke subtype (ischemic vs. hemorrhagic CVA). Publication bias was evaluated using Egger's test and funnel plots.

RESULTS

A total of 14 studies (n = 97,812 patients) were included. The pooled event rate for CVA post-RVO was 37.5% (95% CI: 37.3%-37.8%), with no significant heterogeneity (I2 = 0%, p = 0.97). Subgroup analysis showed that both ischemic CVA (37.8%; 95% CI: 37.3%-38.3%) and hemorrhagic CVA (32.7%; 95% CI: 32.3%-33.1%) occurred at similar rates across branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO). The mortality rate post-CVA in RVO patients was 69.0% (95% CI: 68.4%-69.5%), highlighting the severity of stroke outcomes in this population. The incidence of ischemic cardiovascular events, including myocardial infarction, was 15.7% (95% CI: 15.4%-16.0%), reinforcing the need for cardiovascular monitoring in RVO patients. The incidence of deep vein thrombosis (DVT) was relatively low (0.05%) but still warrants clinical attention in high-risk populations. Publication bias was minimal, as confirmed by Egger's test (p > 0.24) and funnel plot symmetry. Sensitivity analyses confirmed the robustness of the pooled estimates.

CONCLUSION

This meta-analysis provides strong evidence linking RVO to an increased risk of CVA and mortality. Given the high incidence of stroke (37.5%) and mortality post-CVA (69%), early cardiovascular risk assessment and intervention are crucial. Patients with RVO should undergo comprehensive vascular risk evaluation, including blood pressure control, lipid regulation, and anticoagulation therapy when indicated. The findings support a multidisciplinary approach involving ophthalmologists, neurologists, and cardiologists for proactive stroke prevention strategies in RVO patients. Future research should explore genetic predispositions, inflammatory markers, and AI-based predictive models to improve early risk stratification and intervention.

Link Between Metabolic Syndrome, Inflammation, and Eye Diseases

Metabolic syndrome (MetS)-a cluster of conditions including obesity, hypertension, dyslipidemia, and insulin resistance-is increasingly recognized as a key risk factor for the development of various eye diseases. The metabolic dysfunctions associated with this syndrome contribute to vascular and neurodegenerative damage within the eye, influencing disease onset and progression. Understanding these links highlights the importance of early diagnosis and management of metabolic syndrome to prevent vision loss and improve ocular health outcomes. This review explores the intricate interplay between metabolic syndrome, chronic low-grade inflammation, and eye diseases such as diabetic retinopathy, age-related macular degeneration, glaucoma, and dry eye syndrome. It highlights how inflammatory mediators, oxidative damage, and metabolic dysregulation converge to compromise ocular structures, including the retina, optic nerve, and ocular surface. We discuss the molecular and cellular mechanisms underpinning these associations and examine evidence from clinical and experimental studies. Given the rising global prevalence of metabolic syndrome, addressing this connection is crucial for improving overall patient outcomes and quality of life. Future research should focus on delineating the precise mechanisms linking these diseases as well as exploring targeted interventions that address both metabolic and ocular health.

Disparities Between Clinical Trial Recruitment and Real-World Demographics in Macular Edema Secondary to Retinal Vein Occlusion

PURPOSE

Clinical trial cohorts frequently differ demographically from the overall population receiving treatment for the condition under study. Our study describes the racial, ethnic, and gender composition of the cohorts of retinal vein occlusion (RVO) macular edema (ME) clinical trials and compares this to the racial, ethnic, and gender composition of patients undergoing treatment for ME secondary to RVO from the (Intelligent Research in Sight) IRIS Registry.

DESIGN

Retrospective observational case series Subjects: Participants in RVO-ME clinical trials that met the following inclusion criteria: conducted in the United States of America, Phase III completed, data reported between January 1, 2000, and January 1, 2020, and demographic information reported with results.

METHODS

This study identified clinical trials by searching PubMed with the following search terms; "retinal vein occlusion" and "clinical trial" and by searching ClinicalTrials.gov with the search term "retinal vein occlusion."

MAIN OUTCOME MEASURES

The primary outcome was the enrollment fraction defined as the number of trial enrollees divided by the reference sample size of RVO patients undergoing treatment for ME from published IRIS Registry (Intelligent Research in Sight) data. Enrollment fraction was compared between different races, ethnicities, and genders.

RESULTS

Eight clinical trials met our inclusion criteria. Compared to the enrollment fraction of 7.69% among Whites, lower enrollment fractions were found in Black patients (4.32%, odds ratio [OR] 0.541, confidence interval [CI] 0.468-0.626, P < .001) and Hispanic patients (3.38%, OR 0.420, CI 0.351-0.503, P < .001), and higher enrollment fraction in Asian patients (10.68%, OR 1.436, CI 1.207-1.708, P < .001). Men were more likely to enroll in the clinical trials compared to women (enrollment fraction, 7.69% vs 5.77%, respectively, OR 1.364, CI 1.273-1.462, P < .001).

CONCLUSIONS

RVO-ME clinical trials have a higher relative proportion of Asian, White and male subjects when compared to the population undergoing treatment for ME secondary to RVO. Further efforts should encourage clinical trial recruitment that is reflective of the RVO population undergoing treatment for ME to ensure generalizability of clinical trial results.

Prediction of treatment outcome for branch retinal vein occlusion using convolutional neural network-based retinal fluorescein angiography

Deep learning techniques were used in ophthalmology to develop artificial intelligence (AI) models for predicting the short-term effectiveness of anti-VEGF therapy in patients with macular edema secondary to branch retinal vein occlusion (BRVO-ME). 180 BRVO-ME patients underwent pre-treatment FFA scans. After 3 months of ranibizumab injections, CMT measurements were taken at baseline and 1-month intervals. Patients were categorized into good and poor prognosis groups based on macular edema at the 4th month follow-up. FFA-Net, a VGG-based classification network, was trained using FFA images from both groups. Class activation heat maps highlighted important locations. Benchmark models (DesNet-201, MobileNet-V3, ResNet-152, MansNet-75) were compared for training results. Performance metrics included accuracy, sensitivity, specificity, F1 score, and ROC curves. FFA-Net predicted BRVO-ME treatment effect with an accuracy of 88.63% and an F1 score of 0.89, with a sensitivity and specificity of 79.40% and 71.34%, respectively.The AUC of the ROC curve for the FFA-Net model was 0.71. The use of FFA based on deep learning technology has feasibility in predicting the treatment effect of BRVO-ME. The FFA-Net model constructed with the VGG model as the main body has good results in predicting the treatment effect of BRVO-ME. The typing of BRVO in FFA may be an important factor affecting the prognosis.

Deciphering the interplay of gut microbiota and metabolomics in retinal vein occlusion

This study aims to explore the link between retinal vein occlusion (RVO), a blinding ocular condition, and alterations in gut microbiota composition, to offer insights into the pathogenesis of RVO. Fecal samples from 25 RVO patients and 11 non-RVO individuals were analyzed using 16S rRNA sequencing and liquid chromatography-mass spectrometry (LC-MS). Significant differences in the abundance of gut microbial species were noted between RVO and non-RVO groups. At the phylum level, the RVO group showed an elevation in the ratio of Firmicutes to Bacteroidetes. At the genus level, the RVO group showed higher abundance in Escherichia_Shigella (P < 0.05) and less abundance in Parabacteroides (P < 0.01) than the non-RVO group. Functional predictions indicated reduced folate synthesis, biotin metabolism, and oxidative phosphorylation, with an increase in butyric acid metabolism in the RVO group. LC-MS analysis showed significant differences in purine metabolism, ABC transporters, and naphthalene degradation pathways, especially purine metabolism. Pearson correlation analysis revealed significant associations between bacterial genera and fecal metabolites. Enrichment analysis highlighted connections between specific metabolites and bacterial genera. The findings showed that the dysregulation of gut microbiota was observed in RVO patients, suggesting the gut microbiota as a potential therapeutic target. Modulating the gut microbiota could be a novel strategy for managing RVO and improving patient outcomes. Furthermore, the study findings suggest the involvement of gut microbial dysbiosis in RVO development, underscoring the significance of understanding its pathogenesis for effective treatment development.

IMPORTANCE

Retinal vein occlusion (RVO) is a blinding ocular condition, and understanding its pathogenesis is crucial for developing effective treatments. This study demonstrates significant differences in gut microbiota composition between RVO patients and non-RVO individuals, implicating the involvement of gut microbial dysbiosis in RVO development. Functional predictions and metabolic profiling provide insights into the underlying mechanisms, highlighting potential pathways for therapeutic intervention. These findings suggest that modulating the gut microbiota might be a promising strategy for managing RVO and improving patient outcomes.

Disparities in Retinal Vein Occlusion Presentation and Initiation of Anti-VEGF Therapy: An Academy IRIS® Registry Analysis

OBJECTIVE

Investigate disparities in retinal vein occlusion (RVO) presentation and initiation of anti-VEGF treatment.

DESIGN

Retrospective cohort study.

SUBJECTS

Patients in the American Academy of Ophthalmology IRIS® (Intelligent Research in Sight) Registry database (2015-2021) with branch or central RVO and macular edema (ME).

METHODS

The association of demographic characteristics and presenting visual acuity (VA) with anti-VEGF treatment initiation were quantified using multivariable logistic regression.

MAIN OUTCOME MEASURES

Treatment with ≥ 1 anti-VEGF injection within 12 months after RVO diagnosis.

RESULTS

A total of 304 558 eligible patients with RVO and ME were identified. Age at presentation varied by race, ethnicity, sex, and RVO type (all P values < 0.001). Within the first year after RVO presentation, 192 602 (63.2%) patients received ≥ 1 anti-VEGF injection. In a multivariable regression model adjusting for relevant covariates, female (vs. male) patients had lower odds of receiving injections (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.93-0.96; P < 0.0001) as did Black/African American (vs. White) patients (OR, 0.90; 95% CI, 0.88-0.92; P < 0.0001) and Asian (vs. White) patients (OR, 0.95; 95% CI, 0.91-0.99; P = 0.02), whereas older patients (vs. patients aged < 51 years) had higher odds (61-70 years: OR, 1.20; 95% CI, 1.16-1.24; 71-80 years: OR, 1.20; 95% CI, 1.16-1.24; > 80 years: OR, 1.15; 95% CI, 1.11-1.18; all P values < 0.0001). Hispanic (vs. non-Hispanic) patients had a small increased odds of treatment initiation (OR, 1.08; 95% CI, 1.04-1.11; P < 0.0001). Results were similar in the subset of 226 143 patients with VA data. In this subset, patients with presenting VA < 20/40 to 20/200 were most frequently treated in the first year after diagnosis (∼ 70%) and patients with light perception/no light perception (LP-NLP) vision or VA of 20/20 or better were treated least frequently (36.9% and 41.9%, respectively).

CONCLUSIONS

In this large national clinical registry, 37% of RVO patients with ME had no anti-VEGF treatment documented in the first year after diagnosis. Black/African American, Asian, and female patients and patients with VA of LP-NLP were least likely to receive treatment. Awareness of this undertreatment and these disparities highlight the need for initiatives to ensure all RVO patients receive timely anti-VEGF injections for optimized visual outcomes.

FINANCIAL DISCLOSURES

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Systemic Risk Factors in Branch Retinal Vein Occlusion: a Comprehensive Review

BACKGROUND

Retinal vein occlusion (RVO) is a major cause of vision impairment globally. Obstruction in the retinal venous system is often due to thrombus formation at arteriovenous crossing points, leading to symptoms localized to the affected retinal area. Systemic conditions like hypertension, diabetes mellitus, dyslipidemia and heart disease are recognized risk factors for RVO, influencing the components of Virchow's triad.

OBJECTIVE

This work aims to provide an updated overview of systemic risk factors associated with branch retinal vein occlusion (BRVO) development and to explore management options for the prevention or modification of associated risks.

METHODS

Review of the literature concerning the pathogenesis and risk factors of BRVO, including diabetes mellitus, hyperlipidemia, hematologic conditions, hormonal factors, thyroid disease, and the impact of COVID-19 and related vaccines on BRVO incidence.

RESULTS

Diabetes mellitus contributes to BRVO through mechanisms like endothelial dysfunction and thrombogenesis. Hyperlipidemia - through lipid-mediated vascular changes - and hematologic conditions - by predisposing to hypercoagulability - significantly increase BRVO risk. Hormonal imbalances and thyroid diseases also influence BRVO development through their effects on vascular and hemostatic systems. Furthermore, COVID-19 has been identified as a potential risk factor for BRVO, possibly due to its pro- thrombotic effects.

CONCLUSION

Branch retinal vein occlusion represents a complex interplay of systemic and local vascular factors, necessitating comprehensive management strategies. Early detection and modification of risk factors is crucial for preventing vision impairment associated with BRVO. The ongoing pandemic and its systemic implications underscore the importance of continued review into the multifactorial etiology of BRVO and optimization of management strategies to improve patient outcomes.

Risk factors in developing retinal vein occlusion in subject with obstructive sleep apnea

BACKGROUND

Patients with obstructive sleep apnea (OSA) have a higher risk of developing vascular diseases. In this study, we evaluated the clinical profile of patients with OSA who develop retinal vein occlusion (RVO) compared with a population of OSA patients without RVO.

METHODS

We analyzed patients with OSA diagnosed with RVO (21 cases; mean of age 61 years. range 44-87 years. 67% men), belonging to a large cohort of people with long-term follow-up for RVO (up to 12 years). We compared them with 21 patients with OSA, without RVO, matched by age and gender, selected from the Sleep Unit Registry (control group).

RESULTS

There were no differences in the prevalence of arterial hypertension (AHT) or Diabetes mellitus (DM), but the RVO patients presented a higher diastolic blood pressure compared to controls (87.6±12.6 mmHg vs. 77.9±10.1 mmHg respectively). The polygraphic parameters were similar in both groups. The Apnea-Hypopnea Index (IHA) similar in both groups (30.4±20.9 RVO vs. 33.7±22.1 controls). In addition, RVO patients had a less favorable lipid profile, with higher total cholesterol (218±52 mg/dL vs. 179±41 mg/dL), higher LDL cholesterol (139±47 mg/dL vs. 107±32 mg/dL) and higher atherogenic indices: LDL/HDL (2.78±0.95 RVO vs. 2.03±0.67 controls) and total cholesterol/HDL (4.37±1.08 vs. 3.45±0.84). Among the cases, 81% had peripheral RVO (superior temporal branch in 20 out of 21 cases) and 19% had central RVO. A percentage of 62% of the cases received intravitreal antiangiogenic therapy and dexamethasone implants and 33% received argon laser photocoagulation.

CONCLUSIONS

Poor control of cardiovascular risk factors, particularly dyslipidemias, in patients with OSA may lead to the development of this ocular complication.

Proteome Analysis of Bevacizumab Intervention in Experimental Central Retinal Vein Occlusion

Bevacizumab is a frequently used inhibitor of vascular endothelial growth factor (VEGF) in the management of macular edema in central retinal vein occlusion (CRVO). Studying retinal protein changes in bevacizumab intervention may provide insights into mechanisms of action. In nine Danish Landrace pigs, experimental CRVO was induced in both eyes with argon laser. The right eyes received an intravitreal injection of 0.05 mL bevacizumab (n = 9), while the left control eyes received 0.05 mL saline water (NaCl). Retinal samples were collected 15 days after induced CRVO. Label-free quantification nano-liquid chromatography-tandem mass spectrometry identified 59 proteins that were regulated following bevacizumab treatment. Following bevacizumab intervention, altered levels of bevacizumab components, including the Ig gamma-1 chain C region and the Ig kappa chain C region, were observed. Changes in other significantly regulated proteins ranged between 0.58-1.73, including for the NADH-ubiquinone oxidoreductase chain (fold change = 1.73), protein-transport protein Sec24B (fold change = 1.71), glycerol kinase (fold change = 1.61), guanine-nucleotide-binding protein G(T) subunit-gamma-T1 (fold change = 0.67), and prefoldin subunit 6 (fold change = 0.58). A high retinal concentration of bevacizumab was achieved within 15 days. Changes in the additional proteins were limited, suggesting a narrow mechanism of action.

An artificial intelligence system for the whole process from diagnosis to treatment suggestion of ischemic retinal diseases

Ischemic retinal diseases (IRDs) are a series of common blinding diseases that depend on accurate fundus fluorescein angiography (FFA) image interpretation for diagnosis and treatment. An artificial intelligence system (Ai-Doctor) was developed to interpret FFA images. Ai-Doctor performed well in image phase identification (area under the curve [AUC], 0.991-0.999, range), diabetic retinopathy (DR) and branch retinal vein occlusion (BRVO) diagnosis (AUC, 0.979-0.992), and non-perfusion area segmentation (Dice similarity coefficient [DSC], 89.7%-90.1%) and quantification. The segmentation model was expanded to unencountered IRDs (central RVO and retinal vasculitis), with DSCs of 89.2% and 83.6%, respectively. A clinically applicable ischemia index (CAII) was proposed to evaluate ischemic degree; patients with CAII values exceeding 0.17 in BRVO and 0.08 in DR may be associated with increased possibility for laser therapy. Ai-Doctor is expected to achieve accurate FFA image interpretation for IRDs, potentially reducing the reliance on retinal specialists.

Prevalence and systemic associations of retinal vascular occlusions in Sub-Saharan Africa

Background

Retinal vascular occlusions are a common cause of visual impairment. Studies on retinal vascular occlusions in sub-Saharan Africa (SSA) have primarily been retrospective and on retinal vein occlusion (RVO) only. The aim of this study, therefore, was to determine the prevalence and pattern of retinal vascular occlusions and their systemic associations in SSA.

Materials and Methods

This was a hospital-based, cross-sectional study involving all new patients presenting at the general ophthalmic and specialty retina clinics in four hospitals in Nigeria over a 1 year period. All the patients underwent a comprehensive eye examination. The demographic and clinical data of patients with retinal vascular occlusions were entered into an excel sheet and analyzed using the Statistical Package for the Social Sciences (SPSS) software version 22.0. Statistical significance was indicated by P < 0.05.

Results

A total of 8614 new patients were seen, and a diagnosis of retinal vascular occlusion was made in 90 eyes of 81 patients giving a disease prevalence of 0.9%. Eighty-one eyes of 72 (88.9%) patients had RVO, while 9 eyes of 9 (11.1%) patients had retinal artery occlusion (RAO). The mean age of patients with RVO and RAO was 59.5 years and 52.4 years, respectively. Increasing age, hypertension, and diabetes were the significant associations with retinal vascular occlusion with P < 0.0001.

Conclusion

Retinal vascular occlusions are an increasing cause of retinal disease in SSA and tend to occur at an earlier age. They are associated with hypertension, diabetes, and increasing age. Further studies will, however, be required to establish the demographic and clinical profile of patients with RAO in the region.

Association between retinal vein occlusion and early-stage hypertension: A propensity score analysis using a large claims database

BACKGROUNDS/OBJECTIVES

The threshold of hypertension was lowered from systolic blood pressure (SBP)/diastolic blood pressure (DBP) 140/90 mmHg to 130/80 mmHg by the 2017 American College of Cardiology/American Heart Association blood pressure (BP) guideline. Thus, we investigated the association between retinal vein occlusion (RVO) occurrence and early-stage hypertension.

SUBJECTS/METHODS

This retrospective cohort study used the JMDC Claims Database (JMDC Inc., Tokyo, Japan) between 2005 and 2020. Individuals undergoing health checkups who had data on BP and did not take antihypertensive medications were included. They were classified into four BP groups: normal BP (SBP < 120 mmHg and DBP < 80 mmHg), elevated BP (SBP 120-129 mmHg and DBP < 80 mmHg), stage 1 hypertension (SBP 130-139 mmHg or DBP 80-89 mmHg), and stage 2 hypertension (SBP ≥ 140 mmHg or DBP ≥ 90 mmHg). Date of RVO occurrence was defined as the first date of diagnosis. We estimated adjusted hazard ratios for RVO and central RVO using weighted Cox regression to adjust for potential confounders.

RESULTS

A total of 2,703,264 individuals were eligible. During a mean follow-up of 1,091 days, 3,526 RVO and 828 central RVO events occurred. The adjusted hazard ratios (95% confidence intervals) were 1.37 (1.19-1.57), 1.95 (1.75-2.18), and 3.33 (2.95-3.76) for RVO and 1.44 (1.07-1.93), 2.17 (1.72-2.73), and 3.76 (2.91-4.86) for central RVO in the elevated BP, stage 1 hypertension, and stage 2 hypertension groups, respectively, compared with the normal BP group.

CONCLUSIONS

Even individuals with early-stage hypertension showed higher risks for RVO and central RVO than individuals with normal BP.

Nonvalvular atrial fibrillation and retinal vein occlusion: The Valdecilla Cohort

INTRODUCTION AND OBJECTIVES

Retinal vein occlusion (RVO) and nonvalvular atrial fibrillation (NVAF) are associated with vascular risk factors (VRF) and aging. The aim of this study is to analyze differences in the prevalence of VRF, vascular events, glaucoma, and anticoagulant treatment in patients with NVAF and RVO compared to a control group of the general population from the same geographic area.

METHODS

This is a prospective, single-center, case-control study. All patients diagnosed with RVO from December 2008 to March 2020 as well as a control group were included. Clinical, laboratory, electrocardiographic, and carotid ultrasound variables were analyzed.

RESULTS

A total of 386 patients with RVO and 343 controls were studied. Patients with RVO and NVAF were older and more of them had hypertension, a history of vascular events, and carotid atheromatosis than subjects with RVO without NVAF. In patients with NVAF who were on anticoagulants, those who had RVO differed from the controls with NVAF in that they had a higher prevalence of glaucoma (32 vs. 5.3%; p<0.034), with no significant differences regarding age, VRF, vascular events, or type of anticoagulant therapy (acenocumarol or direct-acting oral anticoagulants).

CONCLUSIONS

Patients with RVO and NVAF were older and had a higher prevalence of hypertension and carotid atheromatosis than subjects with RVO without NVAF. Patients with NVAF and RVO had higher prevalence of glaucoma than subjects with NVAF without RVO. In patients with NVAF, it is recommended to optimized VRF treatment and glaucoma control to prevent the development of RVO.

Racial differences in quantitative optical coherence tomography angiography findings between older non-diabetics with co-morbidities

This cross-sectional study compared optical coherence tomography angiography (OCTA) parameters between older Black and White adults with systemic comorbidities in an effort to further understand racial differences in the retinal microvasculature. We analyzed vessel density at the superficial (SCP), intermediate (ICP), and deep capillary plexuses (DCP), foveal avascular zone (FAZ) parameters, and blood flow area (BFA) at the choriocapillaris. We used a mixed-effects linear regression model, controlling for hypertension and two eyes from the same subject, to compare OCTA parameters. Black subjects had lower foveal vessel density at the SCP and ICP, while no differences were observed at the parafovea or 3x3 mm macular area of any capillary layer. Black subjects had greater FAZ area, perimeter, and FD-300, a measurement of vessel density in a 300 μm wide ring around the FAZ. Black subjects also had lower BFA at the choriocapillaris. Within a cohort of subjects without hypertension, these differences remained statistically significant, with the exception of foveal vessel density at the SCP and foveal BFA of the choriocapillaris. These findings suggest that normative databases of OCTA parameters must strive to be diverse in nature to adequately capture differences across patient populations. Further study is required to understand if baseline differences in OCTA parameters contribute to epidemiological disparities in ocular diseases.

A review of risk factors for retinal vein occlusions

INTRODUCTION

Risk factors for retinal vein occlusion have been extensively studied, with varying population sizes. Smaller populations result in less certain measures of associations. The present review included studies with a relevant population size to identify clinically relevant risk factors for retinal vein occlusion. Understanding the risk factors of retinal vein occlusion is important for the management of these patients.

AREAS COVERED

A comprehensive literature review was conducted through a systematic literature search in PubMed and Embase. Additional studies were selected from cross references in the assessed studies. Weighted effect measures were calculated for all included risk factors.Risk factors associated with retinal vein occlusion included cardiovascular diseases, eye diseases, systemic diseases, medical interventions, and sociodemographic factors.

EXPERT OPINION

This review provided an extensive overview of a wide variety of risk factors increasing the risk of developing retinal vein occlusion. The severity of the identified risk factors indicated that these patients have been in contact with the health care system before their retinal vein occlusion event. Therefore, the clinical course for patients with retinal vein occlusion may benefit from a multidisciplinary collaboration between ophthalmologists and especially cardiologists.

Association between Retinal Vein Occlusion and Life's Simple 7 Cardiovascular Health Metrics: A Large Claims Database Study

PURPOSE

Cardiovascular diseases and retinal vein occlusion (RVO) have many risk factors in common. We aimed to investigate the associations between RVO occurrence and each of the cardiovascular health (CVH) metrics known as Life's Simple 7, which are indicators of an unhealthy lifestyle.

DESIGN

Retrospective cohort study.

PARTICIPANTS

Individuals in the JMDC Claims Database (JMDC Inc) who underwent health checkups between 2005 and 2020.

METHODS

We set the following exposures: (1) each component of the CVH metrics (body mass index, blood pressure [BP], fasting blood glucose, total cholesterol, smoking, dietary habits, and physical activity) and (2) the number of nonideal CVH metrics (nonideal CVH score, ranging from 0 [healthiest] to 7 [unhealthiest]). The study outcomes were RVO and central RVO (CRVO) occurrence, which were identified on the first date of diagnosis. We performed Cox regression analyses, with covariates including age, sex, and glaucoma.

MAIN OUTCOME MEASURES

The hazard ratios for RVO and CRVO occurrence for (1) each component of the CVH metrics and (2) the nonideal CVH score.

RESULTS

We included 2 093 536 individuals. During a mean follow-up period of 1070 ± 884 days, there were 3265 RVO and 789 CRVO events. An increased risk of RVO occurrence was most strongly associated with a nonideal BP (hazard ratio [HR], 2.25; 95% confidence interval [CI], 2.06-2.46), followed by a nonideal body mass index (HR, 1.31; 95% CI, 1.21-1.41). Individuals with nonimprovement in BP within 1 year showed a higher risk of RVO occurrence than those with improvement (HR, 2.07; 95% CI, 1.70-2.52). The adjusted HRs of the groups with nonideal CVH scores of 6 to 7, 5, 4, 3, 2, and 1 were 3.76 (2.66-5.30), 2.87 (2.06-4.00), 2.57 (1.85-3.57), 2.22 (1.60-3.08), 1.79 (1.29-2.48), and 1.39 (0.99-1.95), respectively, compared with the group with a score of 0. Similar results were observed for CRVO.

CONCLUSIONS

The strongest risk factor for RVO was nonideal BP, followed by nonideal body mass index. There was a dose-dependent positive association between a nonideal CVH score and RVO occurrence. These findings are important with respect to the identification of individuals at higher risk of RVO.

Retinal vein occlusion in patients under 50 years. Analysis of vascular risk factors, thrombophilia, carotid ultrasound findings and uncommon aetiologies

INTRODUTION

Retinal vein occlusion (RVO) has been related to vascular risk factors and thrombophilia.

METHODS

This is a prospective cohort study of all patients diagnosed with RVO and referred to an Internal Medicine clinic of a tertiary teaching hospital during a 10-year period. Clinical, laboratory and supra-aortic trunks ultrasound variables were analysed and compared according to age.

RESULTS

Some 309 patients diagnosed with RVO were included, 25 of them younger than 50 years. The prevalence of high blood pressure, dyslipidaemia, diabetes mellitus, hyperhomocysteinemia, and carotid plaque was significantly higher in patients >50 years than in those below. However, the prevalence of inherited thrombophilia was higher in the younger group (32.0% vs 11.4%; p = 0.005). Uncommon diseases related to RVO such as hepatitis C, thalassemia minor, Lyme disease, vasculitis, and periphlebitis were observed in young patients without vascular risk factors.

CONCLUSION

We suggest performing a genetic thrombophilia study in RVO patients younger than 50 years, while an exhaustive control of vascular risk factors is always recommended in all RVO patients. Moreover, we suggest bearing in mind uncommon diseases related to RVO, especially in young patients without vascular risk factors.

COVID-19 AdenoviralVector Vaccine and Central Retinal Vein Occlusion

PURPOSE

The purpose of this article is to report a case of sudden onset ischemic retinal central vein occlusion after a second dose of COVID-19 adenoviral vector vaccine.

CASE REPORT/OBSERVATIONS

A 54-year-old woman with systemic arterial hypertension developed ischemic central retinal vein occlusion in her right eye on day 2 after the second dose of COVID-19 adenoviral vector vaccine ChAdOx1 nCoV-19/ AZD1222, Oxford-AstraZeneca.

CONCLUSION

Adenoviral vector vaccine promotes both cellular and humoral immune responses, increasing the level of inflammatory cytokines. These cytokines are the same implied in the possible pathogenesis of central retinal vein occlusion. Subsequently, we recommend informing patients at risk of possible ocular adverse events, which require urgent evaluation.

Association between proteinuria and retinal vein occlusion in individuals with preserved renal function: a retrospective cohort study

PURPOSE

To investigate the association between proteinuria and the incidence of retinal vein occlusion (RVO) in individuals with preserved renal function.

METHODS

We conducted a retrospective cohort study from 2005 to 2020 using the JMDC Claims Database, a large database of health check-ups and administrative claims in Japan. Individuals who underwent annual health check-ups were included. Participants were classified into three groups based on the protein concentration in their urine: negative (≤10 mg/dl), trace (10-30 mg/dl) and positive (≥30 mg/dl). We estimated hazard ratios (HRs) for the development of RVO using Cox regression analyses with adjustment for baseline characteristics by the matching weights calculated from the multiple propensity scores. The cumulative incidence of RVO between the weighted groups was calculated using the Kaplan-Meier estimator.

RESULTS

There were 1 635 212 eligible participants, among whom 2360 developed RVO. The mean follow-up period was 1036 ± 951 days. The adjusted HRs for RVO were 1.10 (95% confidence interval 0.92-1.33) and 1.46 (1.19-1.78) in the groups with trace and positive proteinuria compared with negative proteinuria respectively. The cumulative incidence rates of RVO at 7 years were 0.40%, 0.43% and 0.55% in the groups with negative, trace and positive proteinuria, respectively.

CONCLUSION

Positive proteinuria was independently associated with an increased incidence of RVO in individuals with preserved renal function. Proteinuria may be a novel risk factor for RVO development.

Comparison of each retinal layer thicknesses between eyes with CRVO and normal contralateral eyes

Purpose

To evaluate the difference in each retinal layer thickness in central retinal vein occlusion (CRVO) with resolved macular edema after intravitreal antivascular endothelial growth factor injection and normal contralateral eyes..

Methods

Patients with ischemic and nonischemic CRVO whose macular edema resolved after intravitreal antivascular endothelial growth factor injections and did not recur for at least 6 months, and a normal contralateral eye were enrolled. Each retinal layer thickness between CRVO and normal contralateral eyes was compared according to Early Treatment Diabetic Retinopathy Study subfields using spectral domain optical coherence tomography.

Results

The thicknesses of outer nuclear layer, photoreceptor layer, and retinal pigment epithelium in central ring, ganglion cell layer, inner plexiform layer, outer nuclear layer, and photoreceptor layer in the inner ring, and ganglion cell layer in the outer ring of CRVO eyes were significantly thinner than those of normal contralateral eyes (all p < 0.05). Whereas, inner nuclear layer and outer plexiform layer thicknesses in central ring of CRVO eyes were 23.86 ± 8.8 and 25.76 ± 7.6 μm, respectively, which was significantly thicker than those of normal contralateral eyes (19.52 ± 7.7 and 22.76 ± 6.5 μm; p = 0.019 and p = 0.043, respectively). Additionally, the mean best-corrected visual acuity of CRVO eyes were significantly correlated with photoreceptor layer thickness in central ring (p = 0.005).

Conclusions

In CRVO eyes with resolved macular edema, the outer retinal layers were thinner as well as inner retinal layers, whereas inner plexiform layer and outer nuclear layer were thicker than normal fellow eyes. Additionally, photoreceptor layer thickness in foveal area had a significant impact on visual acuity in CRVO.

Two-Week Central Macular Thickness Reduction Rate >37% Predicts the Long-Term Efficacy of Anti-vascular Endothelial Growth Factor Treatment for Macular Edema Secondary to Retinal Vein Occlusion

Objective

To determine if the early response assessments can predict the long-term efficacy of anti-vascular endothelial growth factor (VEGF) treatment for macular edema secondary to retinal vein occlusion (RVO-ME).

Methods

A retrospective study of patients with diagnosis of RVO-ME and intravitreal anti-VEGF treatment was conducted. Clinical characteristics including age, gender, disease subtype and disease duration were recorded at baseline. The best corrected visual acuity (BCVA and logMAR), intraocular pressure (IOP), and central macular thickness (CMT) were recorded at baseline, 2 weeks, and every month (months 1–6) after injection. Further, we compared the early response assessments between the cured group (6-month CMT ≤ 250 μm) and the uncured group (6-month CMT &gt; 250 μm).

Results

A total of 164 eyes in 164 patients (77 male and 87 female) were included. At each post-injection time point, both BCVA and CMT are significantly decreased from baseline (all P &lt; 0.001). Spearman’s test showed that 2-week CMT reduction rate after the first injection was negatively correlated with BCVA at 6 months (r = −0.359, P &lt; 0.001). Compared with the uncured group (47 cases), the cured group (117 cases) was younger (59.53 ± 11.68 vs. 65.19 ± 13.10 years old, P &lt; 0.01), had more BRVO patients (76.1% vs. 44.7%, P &lt; 0.01), a shorter disease duration (1.92 ± 2.43 vs. 5.05 ± 4.32 months, P &lt; 0.01), lower baseline CMT (527.09 ± 154.95 vs. 768.96 ± 287.75 μm, P &lt; 0.01), and lower baseline BCVA (0.86 ± 0.44 vs. 1.31 ± 0.51, P &lt; 0.01). At each post-injection time point, the cured group had lower CMT and BCVA values when compared to the uncured group (all P &lt; 0.01), and the 2-week CMT reduction rate was identified as the earliest response time to predict the long-term treatment efficacy. Moreover, ROC curve analysis indicated that a 2-week CMT reduction rate &gt;37% yielded the best cut-off point for predicting the long-term cure of anti-VEGF treatment at 6 months (P &lt; 0.001). Multivariable logistic regression confirmed that the 2-week CMT reduction rate &gt;37% was independently associated with the 6-month cured rate (OR = 9.639, 95% Cl = 1.030–90.227, P = 0.047).

Conclusion

Age, disease duration, baseline CMT, and baseline BCVA are associated with visual outcomes at 6-month of anti-VEGF treatment for RVO-ME. The “2-week CMT reduction rate &gt;37%” after the first injection is an independent factor to predict better long-term outcomes.

Novel Association between Opioid Use and Increased Risk of Retinal Vein Occlusion Using the National Institutes of Health All of Us Research Program

Purpose

To assess for risk factors for retinal vein occlusion (RVO) among participants in the National Institutes of Health All of Us database, particularly social risk factors that have not been well studied, including substance use.

Design

Retrospective, case-control study.

Participants

Data were extracted for 380 adult participants with branch retinal vein occlusion (BRVO), 311 adult participants with central retinal vein occlusion (CRVO), and 1520 controls sampled among 311 640 adult participants in the All of Us database.

Methods

Data were extracted regarding demographics, comorbidities, income, housing, insurance, and substance use. Opioid use was defined by relevant diagnosis and prescription codes, with prescription use > 30 days. Controls were sampled at a 4:1 control to case ratio from a pool of individuals aged > 18 years without a diagnosis of RVO and proportionally matched to the demographic distribution of the 2019 U.S. census. Multivariable logistic regression identified medical and social determinants significantly associated with BRVO or CRVO. Statistical significance was defined as P < 0.05.

Main Outcome Measure

Development of BRVO or CRVO based on diagnosis codes.

Results

Among patients with BRVO, the mean (standard deviation) age was 70.1 (10.5) years. The majority (53.7%) were female. Cases were diverse; 23.7% identified as Black, and 18.4% identified as Hispanic or Latino. Medical risk factors including glaucoma (odds ratio [OR], 3.29; 95% confidence interval [CI], 2.22-4.90; P < 0.001), hypertension (OR, 2.15; 95% CI, 1.49-3.11; P < 0.001), and diabetes mellitus (OR, 1.68; 95% CI, 1.18-2.38; P = 0.004) were re-demonstrated to be associated with BRVO. Black race (OR, 2.64; 95% CI, 1.22-6.05; P = 0.017) was found to be associated with increased risk of BRVO. Past marijuana use (OR, 0.68; 95% CI, 0.50-0.92; P = 0.013) was associated with decreased risk of BRVO; however, opioid use (OR, 1.98; 95% CI, 1.41-2.78; P < 0.001) was associated with a significantly increased risk of BRVO. Similar associations were found for CRVO.

Conclusions

Understanding RVO risk factors is important for primary prevention and improvement in visual outcomes. This study capitalizes on the diversity and scale of a novel nationwide database to elucidate a previously uncharacterized association between RVO and opioid use.

The Quantification and Impact of Persistent Retinal Fluid Compartments on Best-Corrected Visual Acuity of Patients With Retinal Vein Occlusion

BACKGROUND AND OBJECTIVES

To evaluate the impact of persistent intraretinal fluid (IRF) and subretinal fluid (SRF) on best visual acuity (BVA) of patients with retinal vein occlusions (RVOs).

PATIENTS AND METHODS

This retrospective cohort study observed 92 treatment-naïve patients with RVO during 12 months of treatment with anti-vascular endothelial growth factor agents. Deep learning was used to quantify IRF and SRF volumes, and linear mixed effects regression modeled the impact on BVA.

RESULTS

Average IRF volume declined -923.1 ± 2,382.5 nL from baseline to 12 months (P < .001). Average SRF volume declined -35.4 ± 223.4 nL from baseline to 12 months (P = .139). linear mixed effects regression modeling disclosed IRF≥ 1,616 nL at all time points predicted a -10.38 letter loss at 12 months (95% CI, -14.58 to -5.9 letters; P < .001). A similar relationship was not found for SRF.

CONCLUSION

Persistent IRF may be an important prognostic biomarker for BVA outcomes in real-world patients with RVO. [Ophthalmic Surg Lasers Imaging Retina. 2022;53:139-147.].

The effect of select systemic medications on outcomes in diabetics with central retinal vein occlusion

BACKGROUND

Diabetes mellitus is a risk factor for central retinal vein occlusion (CRVO); however, it is unclear whether certain commonly used medications among diabetics or glycemic control impact visual outcomes in diabetic eyes with CRVO.

PURPOSE

To evaluate the effect of select systemic medications and glycemic control on presenting features, treatment burden, and outcomes in patients with diabetes who develop a central retinal vein occlusion (CRVO).

METHODS

Retrospective longitudinal cohort study at a single tertiary academic referral center from 2009-2017 investigating eyes of patients being treated for diabetes mellitus at CRVO onset. Eyes with a prior history of anti-vascular endothelial growth factor (anti-VEGF) therapy or laser treatment within the year prior to CRVO onset were excluded. Main outcomes and measures were visual acuity (VA), central subfield thickness (CST), cystoid macular edema (CME), and number of intravitreal injections and laser treatment throughout follow-up.

RESULTS

We identified 138 eyes of 138 participants who were diabetic at CRVO onset. Of these, 49% had an ischemic CRVO. Median follow-up time was 25.5 months. Fifty-five eyes (40%) had a HbA1c within 6 months of CRVO presentation. HbA1c was positively correlated with both presenting CST (p = 0.04) and presence of CME (p < 0.01). In all 138 eyes, mean presenting VA was 20/246, and mean final VA was 20/364. Better-presenting VA was significantly associated with aspirin 325 mg use (p = 0.04). Lower CST at presentation was significantly associated with metformin use (p = 0.02). Sitagliptin use at CRVO onset was associated with a lower prevalence of CME at final follow-up (p < 0.01). Lower final CST was significantly associated with glipizide use at CRVO onset (p = 0.01). There were no significant associations between systemic medications or HbA1c and treatment burden or final VA (p > 0.05).

CONCLUSION

Although aspirin 325 mg, metformin, sitagliptin, and glipizide were associated with better-presenting VA, lower-presenting CST, lower prevalence of macular edema at final visit, and lower final CST, respectively, none of these systemic agents or glycemic control were associated with decreased treatment burden or improved visual outcomes in diabetics with CRVO.

Risk factors in central retinal vein occlusion: A multi-center case-control study conducted on the Italian population : Demographic, environmental, systemic, and ocular factors that increase the risk for major thrombotic events in the retinal venous system

PURPOSE

To explore the risk factors for central retinal vein occlusion (CRVO) by comparing a large sample of patients with healthy controls.

MATERIALS AND METHODS

Multi-center case-control study. The study group includes patients affected by central retinal vein occlusion, confirmed angiographically, aged 50 years old or above (Group A). The control group includes healthy subjects without an history of retinal vein occlusion (Group B). Outcome measures: age, gender, active smoking, presence of uncontrolled arterial hypertension (uHTN), presence of the following comorbidities: diabetes mellitus type II (DMII), chronic liver disease (CLD), chronic kidney disease (CKD), thyroid disease (TD), systemic lupus erythematosus (SLE), hyperhomocystenemia (HHcy), dyslipidemia (DLip), carotid artery disease (CAD), glaucoma, atrial fibrillation (AF), migraine headache (MH), chronic obstructive pulmonary disease (COPD), obstructive sleep apnea syndrome (OSAS), history of myocardial infarction (MI). Odds-ratios were calculated with logistic regression analysis.

RESULTS

A total of 203 patients (Group A) and 339 controls (Group B). Statistically-significant differences were found for the following variables: age (OR: 1.109 [1.081-1.138], p < .001), active smoking (OR: 2.048 [1.210- 3.466], p < .008), DMII (OR: 4.533 [2.097-9.803], p < .001), HHcy (OR: 4.507 [2.477-10.001 ], p < .001), DLip (OR: 2.255 [1.352-3.762], p  =  .002), CAD (OR: 6.632 [2.944- 14.942], p < .001), glaucoma (OR: 4.656 [2.031-10.673], < .001), OSAS (OR: 1.744 [1.023-2.975], < .041), uHTN (OR: 3.656 [2.247-5.949], < .001). No statistically-significant differences were found for the other variables.

CONCLUSIONS

Older age, active smoking, as well as presence of DMII, HHcy, DLip, CAD, glaucoma, OSAS, and uHTN, all increase the risk for CRVO. A comprehensive assessment of patients with CRVO is paramount. Adequate control of all the aforementioned risk factors is likely of great significance in reducing the incidence of CRVO among the general population, and it likely plays an important role in improving the prognosis following the occlusive event.

Hemi-central retinal vein occlusion as a rare manifestation of the hypercoagulable state in COVID-19

To date, COVID-19 has no definite effective targeted therapy, and management is primarily supportive. Central retinal vein occlusion (CRVO) is frequently caused by systemic risk factors posing hypercoagulable states. In April 2020, a female patient with a history of hypertension, diabetes mellitus and chronic kidney disease presented with 2 days of loose, watery stools, nasal congestion and severe lethargy. The patient denied dyspnoea or fever. A week after the initial symptoms, the patient reported decreased vision from the left eye. Dilated funduscopy and fluorescein angiography suggested hemi-CRVO. The patient refused intravitreal antivascular endothelial growth factor agents because of non-severe visual loss. Testing was positive for COVID-19 IgG antibodies; reverse transcription PCR was not available. Vision improved within 3 weeks of presentation. We recommend that clinicians keep a high suspicion for acute onset of thrombotic events in patients with COVID-19 and thrombotic predisposing risk factors.

Characteristics of Branch Retinal Vein Occlusion in African American Patients

BACKGROUND AND OBJECTIVES

To describe the presentation, management, and clinical outcomes of branch retinal vein occlusion (BRVO) in African American patients compared to patients of other racial or ethnic backgrounds.

PATIENTS AND METHODS

This retrospective cohort study included eyes diagnosed with BRVO and macular edema at a tertiary referral center. Presenting features, treatment, and outcomes were compared based on racial or ethnic backgrounds.

RESULTS

The study included 285 eyes: 21.8% African American, 78.2% other. African American patients were more likely to have comorbid diabetes (P = .012), open-angle glaucoma (P < .001), and to present with subretinal fluid (P = .049); multivariate analysis showed race and ethnicity alone may not fully explain presenting subretinal fluid (odds ratio = 2.807; 95% CI, 0.997 to 7.903; P = .051). There was no difference in other comparisons of clinical outcomes or treatment burden, including visual acuity, duration, or treatment method.

CONCLUSIONS

Despite significant differences at presentation, the management and outcomes of BRVO did not differ significantly between African American patients and patients of other racial and ethnic backgrounds. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:492-497.].

Cataract Surgery Is Not Associated with Decreased Risk of Retinal Vein Occlusion

Purpose

Design

Participants

Methods

Main Outcome Measure

Results

Conclusions

Lipid profile and serum folate, vitamin B12 and homocysteine levels in patients with retinal vein occlusion

BACKGROUND

Retinal vein occlusion (RVO) is mainly related with vascular risk factors (VRF).

OBJECTIVES

To analyze the lipid profile and serum folate, vitamin B₁₂ and homocysteine levels, in patients with RVO and a population-based control group.

PATIENTS AND METHODS

Case-control study. Patients with RVO were assessed during an 11-year period.

RESULTS

We included 368 patients and 325 controls of similar age and sex. HDL cholesterol and folate levels were lower (52 [43-63] mg/dL vs. 55 [46-66]; p = 0.016 and 7 [5-10] ng/mL vs. 9 [7-13]; p < 0.0001, respectively) and non-HDL cholesterol and homocysteine levels higher (148.9 ± 37.3 mg/dL vs. 142.9 ± 34.5; p = 0.03 and 13.4 [11.2-18.2] μmol/L vs. 11.1 [9.0-14.4]; p < 0.001) in patients with RVO than controls. Although total cholesterol, LDL-C, and triglyceride levels were higher and serum vitamin B₁₂ levels were lower in RVO patients, these differences did not reach statistical significance.

CONCLUSIONS

RVO-patients have lower serum HDL-C and folate levels and higher non-HDL-C and serum homocysteine levels than population-based controls of similar age and sex. In patients with RVO, apart from the lipid profile, determination of serum homocysteine, folate and vitamin B₁₂ levels might be useful, as well as the treatment of their alterations.

Clinical significance of subclinical atherosclerosis in retinal vein occlusion

Retinal vein occlusion (RVO) is associated with atherosclerotic cardiovascular risk factors; however, its association with the specific markers of subclinical atherosclerosis has not yet been established. To investigate this association, we compared 70 patients with RVO to 70 age- and sex-matched patients without RVO. Low-density lipoprotein cholesterol (LDL-C) levels and brachial-ankle pulse wave velocity (baPWV) were significantly higher in the RVO group than in the control group. Carotid plaques (54.3% vs. 28.6%, p = 0.004) were more frequent in the RVO group. Multivariate logistic regression analysis showed that the presence of carotid plaques (odds ratio [OR]: 3.15, 95% confidence interval [CI] 1.38–7.16, p = 0.006), as well as smoking, LDL-C level, and baPWV were associated with RVO. Additionally, a multinomial logistic regression model showed that the presence of carotid plaques (OR: 3.94, 95% CI 1.65–9.41, p = 0.002) and LDL-C level were associated with branch RVO, whereas smoking and baPWV were associated with central RVO. In conclusion, RVO was associated with subclinical atherosclerosis markers, including carotid plaques and baPWV. These results support the hypothesis that atherosclerosis contributes to the etiology of RVO and suggest the evaluation of subclinical atherosclerosis in patients with RVO.

Differential Effect of the Metabolic Syndrome on the Incidence of Retinal Vein Occlusion in the Korean Population: A Nationwide Cohort Study

Purpose

To investigate the impact of the metabolic syndrome (METS) on the incidence of retinal vein occlusion (RVO).

Methods

This is a retrospective cohort study using Korean National Health Insurance System data. 23,153,600 subjects without previous history of RVO underwent a National Health Screening Program examination between 2009 and 2012. They were monitored for RVO development (registration of diagnostic code for RVO) until 2015. Presence of METS was defined using the data from the National Health Screening Program examination according to the revised criteria of the National Cholesterol Education Program Adult Treatment Panel III. A multivariate adjusted Cox regression analysis was used to reveal hazard ratios and 95% confidence interval for RVO development in the presence of METS.

Results

The age of the subjects was 47.64 ± 13.51 years. In this cohort, 11,747,439 (50.7%) were male, 11,406,161 (49.3%) were female, and 6,398,071 subjects (27.6%) were diagnosed with METS. The overall incidence of RVO was 0.947 per 1000 person-years. The adjusted hazard ratio of RVO in the presence of METS was 1.458 (95% confidence interval, 1.440–1.475; P < 0.001) after adjusting for age, sex, smoking status, alcohol consumption, physical activity, and income. Among all of the criteria for METS diagnosis, elevated blood pressure was the greatest risk for RVO development (adjusted hazard ratio, 1.610; 95% confidence interval, 1.589–1.631; P < 0.001).

Conclusions

METS and each of diagnostic criteria was associated with an increased risk of RVO development. Elevated blood pressure seems to be especially important factors for RVO development.

Translational Relevance

Our results provide information about the link between METS and RVO.

Papillitis with retinal venous congestion and intraocular inflammation

Purpose

Observations

Conclusions

Importance

Risk factors for central retinal vein occlusion in young adults

Purpose:

Several risk factors have been identified for central retinal vein occlusion (CRVO) in older population. CRVO in young is uncommon, and the risk factors for this group are unclear. This large retrospective, cross-sectional study used the National Inpatient Sample (NIS) database to evaluate the risk factors for CRVO in patients 18 to 40 years of age.

Methods:

The 2002 to 2014 NIS database was used. All patients 18 to 40 years of age with a primary diagnosis of CRVO were identified. Age- and gender-matched non-CRVO controls were randomly selected. The primary outcome was identification of risk factors for CRVO. Chi-square analysis and Firth logistic regression were performed with IBM SPSS 23 and R packages versions 3.4.3, respectively. p < 0.05 was considered significant.

Results:

A total of 95 weighted young CRVO patients were identified. The average age was 31.44 ± 6.41 years with no gender predilection. Systemic and ocular conditions found to have statistically significant associations with CRVO included primary open-angle glaucoma (POAG) (OR 836.72, p < 0.001), retinal vasculitis (OR 705.82, p < 0.001), pseudotumor cerebri (OR 35.94, p < 0.001), hypercoagulable state (OR 25.25, p < 0.001), history of deep vein thrombosis/pulmonary embolism (DVT/PE) (OR 21.88, p < 0.001), and hyperlipidemia (OR 3.60, p = 0.003).

Conclusion:

The most significant risk factors for CRVO in young adults were POAG, retinal vasculitis, and pseudotumor cerebri. Hypercoagulable states and DVT/PE were also associated with CRVO in this population. Systemic inflammatory conditions were not associated with CRVO. Traditional risk factors such as hypertension and diabetes did not pose significant risks, whereas hyperlipidemia was deemed a significant risk factor.

Agreement on Grading Retinal Findings of Patients with Diabetes Using Fundus Photographs by Allied Medical Personnel when Compared to an Ophthalmologist at a Diabetic Retinopathy Screening Program in Nepal

Introduction

Diabetic retinopathy (DR) is the emerging cause of blindness in developing countries. This study aimed to assess the accuracy of grading retinal findings of patients with diabetes using fundus photographs by allied medical personnel (AMP) when compared to an ophthalmologist.

Materials and Methods

Six AMPs were enrolled for grading fundus photographs of patients with diabetes after three and six months of training twice at two weeks interval. The total number of fundus photographs graded were 1,344. Grading by a retina specialist was used as the gold standard. Intra-rater and inter-rater agreement was assessed using the kappa coefficient (k).

Results

The intra-rater agreement of half of the AMPs in both three months and six months was almost perfect for grading of any retinal abnormalities, and substantial for retinal hemorrhages. In three months, the overall inter-rater agreement at the second rating was moderate for any retinal abnormalities (k=0.60) and retinal hemorrhage (k=0.48) and was fair for macular exudates (k=0.35). The overall inter-rater agreement of AMPs in six months at the second rating was substantial for any retinal abnormalities (k=0.61), fair for retinal hemorrhage (k=0.30), and moderate for macular exudates (k=0.49). The overall inter-rater agreement at first rating was almost similar to the second rating in both three months and six months.

Conclusion

Intra-rater agreement of AMPs was almost perfect for any retinal abnormalities and substantial for retinal hemorrhage. The inter-rater agreement of AMP was substantial for any retinal abnormalities and moderate for retinal hemorrhages and macular exudates. The agreement results were almost similar at three months and six months. AMPs could be utilized in screening of DR and other retinal pathologies for timely referral to reduce the blindness in low-resource settings.

Impending central retinal vein occlusion in patient with idiopathic cutaneous leukocytoclastic vasculitis

Purpose

To report a case of impending central retinal vein occlusion (CRVO) associated with idiopathic cutaneous leukocytoclastic vasculitis (LCV) that demonstrated significant resolution following treatment with intravenous (IV) methylprednisolone.

Observations

A 27-year-old man presented to a tertiary Uveitis Clinic with a five-day history of blurry vision in the right eye (OD). He had a history of a purpuric rash and arthralgias five years ago and a biopsy-confirmed diagnosis of LCV controlled with colchicine two years ago in India. Recently, he presented with a recurrent rash and severe abdominal pain. After being evaluated by rheumatology and gastroenterology, he was placed on Helicobacter pylori treatment and high dose oral prednisone, which improved his skin and gastrointestinal symptoms. At the first ophthalmic exam, his systemic findings included lower extremity purpura. His best-corrected visual acuity (BCVA) was 20/20 in both eyes (OU). Slit-lamp examination revealed no cells or flare in OU. Dilated fundus exam showed mild enlarged, tortuous veins, optic nerve hemorrhage, and intraretinal hemorrhages temporal to the macula in OD. Spectral-domain optical coherence tomography (SD-OCT) demonstrated multiple hyper-reflective, plaque-like lesions involving the inner nuclear layer, consistent with paracentral acute middle maculopathy (PAMM). The patient was diagnosed with impending central retinal vein occlusion (CRVO) in OD. Laboratory evaluations were unremarkable. Aspirin was initially started for the patient but was later held due to the worsening of retinal hemorrhage and retinal vein tortuosity at the one-week follow-up. The patient then received three doses of intravenous methylprednisolone, followed by systemic oral prednisone and mycophenolate mofetil. One month later, retinal hemorrhages, venous stasis, and skin manifestations resolved.

Conclusion and importance

Ocular involvement in LCV is rare and may present with different manifestations. The index case is the first report of impending CRVO in a patient with idiopathic LCV and without any other known risk factors for CRVO. Our report not only describes the unique course of LCV-related ocular involvement, but also introduces and underscores a potentially effective therapeutic plan.

Characteristics of Central Retinal Vein Occlusion in African Americans

Purpose:

This article studies whether the characteristics and clinical course of African American patients with central retinal vein occlusion (CRVO) differ from other racial groups.

Methods:

This retrospective cohort study included consecutive patients diagnosed with CRVO at Duke Eye Center, Durham, North Carolina. Presenting characteristics, examination findings, treatment course, and functional and structural outcomes were compared based on patient-reported race.

Results:

A total of 479 patients with CRVO were included (64.7% white, 22.2% African American, 1.7% mixed race, and 11.4% other races). African American patients were older (68.1 vs 64.3 years, P = .049), more likely to be hypertensive ( P = .001) and diabetic ( P = .000), and had higher rates of open-angle glaucoma ( P < .000). Presenting visual acuity (VA) was worse in African Americans (logarithm of the minimum angle of resolution 1.25 vs 0.96, P = .010). There were no significant differences in the proportion of patients requiring panretinal photocoagulation, intravitreal antivascular endothelial growth factor (anti-VEGF), or intravitreal corticosteroid; however, analysis of treatment-naive individuals showed a higher number of anti-VEGF injections in the first year in African Americans. Final VA was not significantly different between groups, but African Americans had higher rates of neovascular sequelae (25.0% vs 11.8%, P = .019; odds ratio, 2.295, P = .088).

Conclusions:

African Americans with CRVO presented with more severe visual impairment and more systemic and ocular risk factors for CRVO. Treatment-naive African Americans had a greater treatment burden during the first year of follow-up.

Screening for obstructive sleep apnea amongst patients with retinal vein occlusion

OBJECTIVE

To evaluate the prevalence and varying severity of obstructive sleep apnea (OSA) amongst those newly diagnosed with retinal vein occlusion (RVO), and screen patients with the use of 2 in-office-administered questionnaires validated against polysomnography.

DESIGN

Prospective cross-sectional study.

PARTICIPANTS

Consecutive adult patients (≥18 years of age) with a new diagnosis of RVO confirmed with intravenous fluorescein angiography were enrolled.

METHODS

The study was conducted at a tertiary academic centre between March 22, 2017, and April 7, 2018. Patients completed the Berlin and STOP-BANG questionnaires screening for OSA at presentation. Diagnostic test properties of the 2 questionnaires compared with polysomnography at a certified sleep laboratory centre as the gold standard for detection of OSA were calculated.

RESULTS

A total of 27 patients (37% females) with a mean (standard deviation) age of 69.6 (11.5) years completed the study. The diagnosis of OSA based on polysomnography was made in 96% (41% severe OSA) of patients with RVO. The Berlin questionnaire had a sensitivity of 43% (confidence interval [CI]: 22%-66%) and specificity of 67% (CI: 22%-96%). The STOP-BANG questionnaire had a sensitivity of 86% (CI: 64%-97%) and specificity of 50% (CI: 12%-88%).

CONCLUSIONS

Given the high prevalence of severe OSA amongst those with a new diagnosis of RVO, all patients should be strongly considered for polysomnography. The use of in-office questionnaires may aid in triaging urgency of referrals.

Molecular Analysis of Prothrombotic Gene Variants in Venous Thrombosis: A Potential Role for Sex and Thrombotic Localization

Background: Requests to test for thrombophilia in the clinical context are often not evidence-based. Aim: To define the role of a series of prothrombotic gene variants in a large population of patients with different venous thromboembolic diseases. Methods: We studied Factor V Leiden (FVL), FVR2, FII G20210A, Methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C, beta-fibrinogen -455 G>A, FXIII V34L, and HPA-1 L33P variants and PAI-1 4G/5G alleles in 343 male and female patients with deep vein thrombosis (DVT), 164 with pulmonary embolism (PE), 126 with superficial vein thrombosis (SVT), 118 with portal vein thrombosis (PVT), 75 with cerebral vein thrombosis (CVT) and 119 with retinal vein thrombosis (RVT), and compared them with the corresponding variants and alleles in 430 subjects from the general population. Results: About 40% of patients with DVT, PE and SVT had at least one prothrombotic gene variant, such as FVL, FVR2 and FII G20210A, and a statistically significant association with the event was found in males with a history of PE. In patients with a history of PVT or CVT, the FII G20210A variant was more frequent, particularly in females. In contrast, a poor association was found between RVT and prothrombotic risk factors, confirming that local vascular factors have a key role in this thrombotic event. Conclusions: Only FVL, FVR2 and FII G20210A are related to vein thrombotic disease. Other gene variants, often requested for testing in the clinical context, do not differ significantly between cases and controls. Evidence of a sex difference for some variants, once confirmed in larger populations, may help to promote sex-specific prevention of such diseases.

Diabetes mellitus as a risk factor for retinal vein occlusion: A meta-analysis

Retinal vein occlusion (RVO) is the second most common etiology for vision loss. There is contrasting evidence on the association between diabetes mellitus (DM) and the risk of RVO. We performed a meta-analysis of published articles before October 31, 2019, to estimate a pooled odds ratio for the association between DM and RVO, including central and branch RVO by a fixed or random effects model. We identified 37 publications from 38 studies (1 publication was from 2 studies), published between 1985 and 2019. In total, 148,654 cases and 23,768,820 controls were included in this meta-analysis. The results of pooled analysis for all 37 publications (or 38 studies) showed a significant association between DM and the risk of RVO (OR = 1.68, 95% CI: 1.43-1.99). Subgroup analysis indicated that DM was significantly associated with CRVO (OR = 1.98, 95% CI: 1.29-3.03, I = 67.9%), but not significantly associated with BRVO (OR = 1.22, 95% CI: 0.95-1.56, I = 64.1%). In conclusion, the result of present meta-analysis suggested that DM is a risk factor for RVO. More well-designed studies on the relationship between RVO and DM should be undertaken in the future.

Spectrum of Eye Disease in Diabetes (SPEED) in India: A prospective facility-based study. Report # 3. Retinal vascular occlusion in patients with type 2 diabetes mellitus

Purpose

To determine the proportion of people with type 2 diabetes mellitus (T2DM) attending large eye care facilities across India who have retinal vascular occlusion (RVO).

Methods

A 6-month descriptive, multicenter, observational hospital-based study of people was being presented to the 14 eye care facilities in India. The retina-specific component of comprehensive eye examination included stereoscopic biomicroscopy, binocular indirect ophthalmoscopy, and fundus fluorescein angiography, and optical coherence tomography was also available when needed. Data recording of the duration of diabetes, hypertension (HTN), stroke, and other variables was obtained from the medical history. The statistical analysis included frequencies, mean, and standard deviations for continuous variables. Odds ratio (OR) and multivariate analysis were undertaken to assess the associations between risk factors and RVO.

Results

The study recruited 11,182 consecutive patients (22,364 eyes) with T2DM. About 59.0% (n = 6697) were male. The mean age was 58.2 ± 10.6 years. In this cohort, RVO was detected in 3.4% (n = 380) of patients; 67.6% (n = 257) of them had branch retinal vein occlusion (BRVO) and the remaining 32.4% (n = 123) had central retinal vein occlusion (CRVO). The frequency of unilateral BRVO (n = 220, 85.6%) and unilateral CRVO (n = 106, 86.18%) was much common. Unilateral RVO was more frequent (n = 326, 85.8%) than bilateral diseases (n = 54, 14.2%) (χ2 = 126.95, P < 0.001). Ischemic CRVO was more common (n = 103, 73.6%) than nonischemic CRVO (n = 37, 26.4%). Macula-involving BRVO was found in 58.5% (n = 172) of cases, suggesting more than 50% of cases in RVO carries a risk of severe vision loss. The duration of diabetes apparently had no influence on the occurrence of RVO. On the multivariate analysis, a history of HTN [OR: 1.7; 95% confidence interval (CI): 1.3-2.1; P = 0.001) and stroke (OR: 5.1; 95% CI: 2.1-12.4; P < 0.001) was associated with RVO.

Conclusion

RVO is a frequent finding in people with T2DM. History of stroke carries the highest risk followed by HTN. The management of people with T2DM and RVO must also include comanagement of all associated systemic conditions.

[Hypertension and Framingham general vascular risk score in retinal vein occlusion]

OBJECTIVES

To determine the prevalence of arterial hypertension (AHT), systolic blood pressure (SBP), the diastolic blood pressure (DPB), and the Framingham vascular risk score (FRS), in subjects with retinal vein occlusion (RVO), as well as in a control group.

PATIENTS AND METHOD

A prospective, cross-sectional case and control study was conducted on all patients with a diagnosis of RVO referred to the General Medicine Clinic, and comparing them with a control group. An analysis was performed on the clinical and laboratory variables.

RESULTS

A total of 253 patients with RVO were studied (132 males and 121 females) and 244 controls (112 males and 132 females) of similar age (67.9±12.3 vs. 68.1±9.2 años). The prevalence of AHT, and the SBP and DPB values in the clinic after the RVO were significantly higher in patients with RVO than in the controls (71.5% vs. 51.2%), SBP mmHg (148±22 vs. 138±18mmHg), DBP mmHg (83±10 vs. 77±10mmHg). The de novo diagnosis of AHT was made from the RVO in 23.8% of the cases. Significant differences were found in the FRS between the patients with RVO and the controls (11±8.3 vs. 8.25±6.3. There were no differences in any of the parameters studied between patients with peripheral or central RVO.

CONCLUSIONS

Hypertension is very prevalent as significantly more common in patients with RVO than in controls. Its diagnosis and treatment is often established from the RVO. The FRS is greater in patients with RVO. There were no differences in any of the parameters studied between patients with peripheral or central RVO. It is suggested that RVO should be considered a vascular event when defining therapeutic objectives.

Different Factors Associated with 2-Year Outcomes in Patients with Branch versus Central Retinal Vein Occlusion Treated with Ranibizumab

PURPOSE

To investigate characteristics associated with visual and anatomic outcomes in branch and central retinal vein occlusion (BRVO and CRVO) patients treated with ranibizumab.

DESIGN

Post hoc analysis of patients with BRVO and CRVO from 2 multicenter clinical trials who completed month 12 of the HORIZON extension trial.

PARTICIPANTS

205 patients with BRVO and 181 patients with CRVO who completed month 12 of the extension trial.

METHODS

With the use of logistic regression, covariates with a P value < 0.20 from univariate analysis were included in multivariate models to identify independent factors associated with a given outcome (at P < 0.05), with preset variables of disease duration and original treatment assignment.

MAIN OUTCOME MEASURES

Best-corrected visual acuity (BCVA) ≥20/40 (≥70 letters), gain ≥15 letters, and central subfield thickness (CST) ≤250 μm at HORIZON month 12.

RESULTS

In patients with BRVO, good baseline BCVA (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.30-1.79), male sex (OR, 2.48; 95% CI, 1.20-5.13), and normal hematocrit (low vs. normal, OR, 0.26; 95% CI, 0.12-0.59) predicted BCVA ≥20/40; high central foveal thickness (OR, 1.03; 95% CI, 1.01-1.04) and normal hematocrit (low vs. normal, OR, 0.31; 95% CI, 0.15-0.66) predicted BCVA improvement ≥15 letters; and extensive baseline subretinal fluid modestly predicted CST ≤250 μm (OR, 1.08; 95% CI, 1.00-1.16). In patients with CRVO, good baseline BCVA (OR, 1.59; 95% CI, 1.35-1.89), never smoking (OR, 2.80; 95% CI, 1.27-6.17), and young age (OR, 0.58; 95% CI, 0.41-0.82) predicted BCVA ≥20/40; never smoking (OR, 2.13; 95% CI, 1.03-4.39), young age (OR, 0.41; 95% CI, 0.28-0.59), poor baseline BCVA (OR, 0.82; 95% CI, 0.73-0.93), hypertension (OR, 4.47; 95% CI, 1.70-11.75), and low diastolic ocular perfusion pressure (OPP) throughout the study (OR, 0.39; 95% CI, 0.21-0.72) predicted BCVA improvement ≥15 letters; and young age (OR, 0.65; 95% CI, 0.47-0.90), lower mean hematocrit (low vs. normal, OR, 2.81; 95% CI, 1.06-7.49), high systolic OPP throughout the study (OR, 1.61; 95% CI, 1.14-2.27), large areas of central hemorrhage (OR, 1.44; 95% CI, 1.04-2.00), and no subretinal fluid (OR, 2.15; 95% CI, 1.06-4.40) predicted CST ≤250 μm.

CONCLUSIONS

There are substantial differences in good outcome factors in CRVO versus BRVO, suggesting differences in pathophysiology. Young age, never smoking, hemodilution, and hypertension/high systolic perfusion pressure are more beneficial in CRVO, suggesting that avoidance of sluggish blood flow and maintenance of perfusion may be particularly important in CRVO.

Altered spontaneous brain activity patterns in patients with retinal vein occlusion indicated by the amplitude of low-frequency fluctuation: A functional magnetic resonance imaging study

The aim of the present study was to explore the amplitude of low-frequency fluctuations (ALFF; a measurement of spontaneous brain activity) in different brain regions of patients with retinal vein occlusion (RVO) and its association with vision changes measurements. A total of 24 RVO patients (12 males and 12 females) and 24 healthy controls (HCs, 12 males and 12 females) were recruited, and they were closely matched regarding age, gender and education level (classified according to nine-year compulsory education in China and higher education, all including primary school, junior school, high school and university). ALFF values of different brain regions were gathered and analyzed, and statistical analysis software was used to explore the correlations between the average ALFF signals and clinical features. The ability of ALFF values to distinguish between subjects with RVO and HCs was analyzed by receiver operating characteristic (ROC) curves. The results indicated that the subjects from the RVO group had higher ALFF values than the HCs in the posterior lobe of the left cerebellum, inferior temporal gyrus, cerebellar anterior lobe, right cerebellum posterior/anterior lobe, and lower ALFF values in the medial frontal gyrus, right precuneus, left middle frontal gyrus, right angular gyrus and right superior frontal gyrus. The ROC curve analysis of each brain region indicated that the accuracy of the area under the ROC curves regarding the prediction of RVO was excellent. The best-corrected visual acuity (VA) in the left eye was positively correlated with the ALFF value of the right precuneus (r=0.767, P=0.004) and the best-corrected VA in the right eye was positively correlated with the ALFF value of the left middle frontal gyrus (r=0.935, P<0.001). The central subfield retinal thickness in the left eye was negatively correlated with the ALFF value of the right precuneus (r=−0.895; P<0.001). The duration of RVO in the right eye was positively correlated with the ALFF value of the left middle frontal gyrus (r=0.868; P<0.001). In conclusion, the present results indicate that RVO is associated with dysfunction of diverse brain regions, including language- and movement-associated areas, which may reflect the underlying pathogenic mechanisms of RVO (trial registry no. CDYFY-LL-2017025).

Epidemiological profile of health consultations during the Mozambique 9th National Cultural Festival, August 2016

Introduction

The use of mass gatherings as spaces to practice health surveillance has been growing in recent years. In Mozambique, the 9th National Festival of Culture in 2016 was selected for this practice. A specific public health surveillance system to facilitate rapid detection of outbreaks and other health-related events was implemented for this event with real time data collection and analysis

Methods

A descriptive epidemiological evaluation of all the health consultations that occurred in fixed posts prepared for the event was conducted. The data were collected through electronic mobile system (tablets) in real time, with the aid of a form designed for this purpose and sent directly to the incident command system (ICS)

Results

During the event, a total of 355 patients were assisted, 52.3% were female, 87.0% were from Beira city and the artists were the group that most frequently sought health care at 59.4%. The largest number of visits took place on the third day (36.4%). People over 45 years of age were the age group that most frequently sought health care (30.8%). The main provisional diagnoses of those who were attended to during the festival was arterial hypertension (20.3%), followed by febrile syndrome (19.0%), with falls being the most frequent causes of trauma during the festival (60.0%).

Conclusion

The system of monitoring in real time using mobile technologies proved to be efficient for the monitoring of the main health events during the mass gatherings. This profile of health consultations encourages the health sector to plan strategies and actions geared to the reality of care for this type of event.

Management of the open angle glaucoma in patients with central/hemicentral retinal vein occlusions

AIM

To prospectively assess the cumulative prevalence and management of open angle glaucoma (OAG), including primary open angle glaucoma (POAG) with high and normal-pressure, as well as pseudoexfoliative glaucoma (PEXG), in patients with central/hemicentral retinal vein occlusions (RVOs) over a 3-year follow-up period.

METHODS

The study encompassed 57 patients with unilateral acute central/hemicentral RVOs. A complete ophthalmic examination of both eyes was undertaken for all patients. Patients with OAGs associated with central/hemicentral RVOs were treated with the current ocular hypotensive medications used worldwide and/or surgery and aimed to reduce the intraocular pressure (IOP) by 30% from baseline values for the 3 OAG forms existing in our series. The cumulative prevalence of OAG and the efficacy of treatment were evaluated.

RESULTS

OAG was observed in 3 clinical forms, namely, POAG with increased IOP in 4 patients, POAG with normal IOP in 3 patients, and PEXG in 3 patients. The cumulative prevalence of OAG was 19.6% (95%CI: 8.7-30.5). Using available ocular hypotensive medications (8 patients) and trabeculectomy (2 patients), the IOP decreased significantly from 24.3±4.36 mm Hg to 16.55±2.85 mm Hg, a reduction of 31.89% compared with baseline values. Glaucoma progression was not detected in any of the cases.

CONCLUSION

The high value of the cumulative prevalence of OAG is a risk factor for the development of venous occlusion. The treatment of glaucoma prevented its progression over a follow-up period of 3y.

Central retinal vein occlusion in a patient with breast carcinoma

Purpose: Systemic malignancies may have ocular manifestations in the form of metastatic tumors, carcinoma associated retinopathy or central retinal vein occlusion (CRVO). Although CRVO has been mentioned in association with renal, lung, prostatic and ovarian malignancies, the association of CRVO with breast carcinoma is unreported. We report a patient with one such rare association.

Methods: We describe a patient with breast carcinoma who was diagnosed to have CRVO. The history, ocular examination, retinal optical coherence tomography scan, ocular ultrasound scan, hematological profile, mammogram details and aspiration cytology description of the malignant breast lesion are reported in this article.

Results: The retina showed extensive hemorrhages and dilated retinal veins. Complete hematologic evaluation revealed the presence of microcytic hypochromic anemia and increased hematocrit. These changes are possibly related to the malignant disease and might contribute to the pathogenesis of CRVO.

Coclusion: This case report demonstrates the rare association between breast malignancy and CRVO.