Risk of stroke in retinal vein occlusion

Construction and validation of risk prediction models for different subtypes of retinal vein occlusion

Purpose

While prognostic models for retinal vein occlusion (RVO) exist, subtype-specific risk prediction tools for central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO) remain limited. This study aimed to construct and validate distinct CRVO and BRVO risk stratification nomograms.

Methods

We retrospectively analyzed electronic medical records from a tertiary hospital in Guangzhou (January 2010-November 2024). Non-RVO controls were matched 1:4 (CRVO) and 1:2 (BRVO) by sex and year of admission. The final cohorts included 630 patients (126 CRVO cases and 504 controls) and 813 patients (271 BRVO cases and 542 controls). Predictors encompassed clinical histories and laboratory indices. Multivariate regression identified independent risk factors, and model performance was evaluated using the area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis (DCA).

Results

The CRVO-nom and BRVO-nom highlighted significant predictors, including the neutrophil-to-lymphocyte ratio (NLR). Additional risk factors for CRVO included high-density lipoprotein cholesterol (HDL-C), platelet distribution width (PDW), history of diabetes, cerebral infarction, and coronary artery disease (CAD). For BRVO, significant predictors included a history of hypertension, age, and body mass index (BMI). The AUC for CRVO-nom was 0.80 (95% CI: 0.73-0.87) in the training set and 0.77 (95% CI: 0.65-0.86) in the validation set, while BRVO-nom yielded an AUC of 0.95 (95 ​%CI: 0.91-0.97) in the training set and 0.95 (95% CI: 0.89-0.98) in the validation set.

Conclusions

CRVO and BRVO exhibit distinct risk profiles. The developed nomograms-CRVO-nom and BRVO-nom-provide subtype-specific risk stratification with robust discrimination and clinical applicability. An online Shiny calculator facilitates real-time risk estimation, enabling targeted prevention for high-risk populations.

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.

[Retinal Vein Occlusions]

As retinal vein occlusion is such a complex systemic disease, its underlying risk profile should be narrowed down individually. Ophthalmologists should always rule out glaucoma or ocular hypertension while also screening the patient for systemic vascular diseases or risk factors in particular. Intravitreally applied medication (VEGF inhibitors or steroids) and laser coagulation (focal or panretinal) or a combination thereof can be considered to treat such retinal anomalies.

Risk of stroke development following retinal vein occlusion: A systematic review and meta-analysis

Retinal vein occlusion (RVO) and cerebrovascular disease share common risk factors and may be independently associated; however, the strength and nature of this association remain unclear. We conducted a systematic review and meta-analysis, informed by studies from PubMed, Scopus, EMBASE, Web of Science, and Google Scholar until January 6, 2024, aimed to clarify this relationship. Eligible studies included cohorts observing stroke incidence in RVO patients for over a year. Pooled effect estimates were calculated using random-effects models, with subgroup analyses evaluating associations between RVO types (central and branch) and stroke subtypes (ischemic and hemorrhagic). Ten cohort studies with a total of 428,650 participants (86,299 RVO patients) were included. Compared to controls, RVO patients exhibited a significantly increased risk of stroke (pooled risk ratio [RR]=1.38, 95 % confidence interval (95 %CI)=1.34-1.41). Subgroup analyses indicated elevated risk for both ischemic (RR=1.37, 95 %CI=1.32-1.42) and hemorrhagic (RR=1.55, 95 %CI=1.08-2.22) strokes in RVO patients. Additionally, both central (RR=1.50, 95 %CI=1.27-1.78) and branch (RR=1.41, 95 %CI=1.32-1.50) RVO were associated with stroke risk. Sensitivity analyses confirmed consistent results across various criteria, and funnel plots indicated no publication bias. RVO significantly increases the risk of both ischemic and hemorrhagic stroke, regardless of RVO type, suggesting a strong independent association between these conditions.

Retinal Vein Occlusion-Background Knowledge and Foreground Knowledge Prospects-A Review

Thrombosis of retinal veins is one of the most common retinal vascular diseases that may lead to vascular blindness. The latest epidemiological data leave no illusions that the burden on the healthcare system, as impacted by patients with this diagnosis, will increase worldwide. This obliges scientists to search for new therapeutic and diagnostic options. In the 21st century, there has been tremendous progress in retinal imaging techniques, which has facilitated a better understanding of the mechanisms related to the development of retinal vein occlusion (RVO) and its complications, and consequently has enabled the introduction of new treatment methods. Moreover, artificial intelligence (AI) is likely to assist in selecting the best treatment option for patients in the near future. The aim of this comprehensive review is to re-evaluate the old but still relevant data on the RVO and confront them with new studies. The paper will provide a detailed overview of diagnosis, current treatment, prevention, and future therapeutic possibilities regarding RVO, as well as clarifying the mechanism of macular edema in this disease entity.

Individual trigger factors for hemorrhagic stroke: Evidence from case-crossover and self-controlled case series studies

BACKGROUND

Hemorrhagic stroke (HS) is a sudden-onset disease with high mortality and disability rates, and it is crucial to explore the triggers of HS. In this study, we analyzed individual triggers for HS to provide a basis for HS prevention and intervention.

METHODS

A systematic search of five databases was conducted until December 2022. Studies on HS-related individual triggers conducted using a case-crossover study or self-controlled case series design were included in the descriptive summary and comprehensive evidence synthesis of each trigger.

RESULTS

A total of 39 studies were included after the screening, and 32 trigger factor categories were explored for associations. Potential trigger factors for HS were as follows: Antiplatelet (odd ratio (OR), 1.10; 95% confidence interval (CI), 1.00-1.21) and anticoagulant (OR, 5.43; 95% CI, 2.04-14.46) medications, mood stabilizers/antipsychotics (OR, 1.33; 95% CI, 1.07-1.65), infections (OR, 2.15; 95% CI, 1.73-2.67), vaccinations (relative risk, 1.11; 95% CI, 1.02-1.21), physical exertion (OR, 2.08; 95% CI, 1.58-2.74), cola consumption (OR, 5.45; 95% CI, 2.76-10.76), sexual activity (OR, 7.49; 95% CI, 2.23-25.22), nose blowing (OR range, 2.40-56.40), defecation (OR, 16.94; 95% CI, 3.40-84.37), and anger (OR, 3.59; 95% CI, 1.56-8.26). No associations were observed with illicit drug use (OR, 2.05; 95% CI, 0.52-8.06) or cigarette smoking (OR, 0.81; 95% CI, 0.52-1.24) and HS.

CONCLUSIONS

Individual triggers, including several medications, infections, vaccinations, and behaviors, may trigger HS onset. Direct control measures for behavioral triggers can play a crucial role in preventing HS. High-risk populations should receive personalized therapies and monitoring measures during the medication treatment to balance the risk of acute HS and the basic diseases.

Retinal vein occlusion is associated with stroke independent of underlying cardiovascular disease

BACKGROUND

Stroke is a leading cause of mortality and morbidity. Thus, identifying associated risk factors may lead to earlier interventions aimed at reducing the risk of stroke development. Since cardiovascular disease simultaneously increases the risk of stroke and retinal vein occlusion (RVO), we sought to determine whether RVO is associated with the risk of stroke independent of underlying cardiovascular co-morbidities.

METHODS

In this cross-sectional study, we reviewed the records of 80,754 individuals who were evaluated by an ophthalmologist over a 6-year period. We identified individuals with RVO, stroke and cardiovascular diseases including hypertension, diabetes mellitus, carotid disease, coronary artery disease and atrial fibrillation. Multivariable logistic regression models were used to analyze odds ratios for RVO and stroke.

RESULTS

After adjusting for age, sex, cardiovascular disease and other risk factors, we found that the presence of RVO was associated with an odds ratio for stroke of 1.73 (CI, 1.40-2.12, p < 0.001). The association between RVO and stroke, after adjusting for sex and cardiovascular co-morbidities, was significantly stronger in individuals younger than 50 years of age, with an odds ratio of having a stroke of 3.06 (1.34-6.25, p < 0.001), while the presence of RVO in individuals older than 85 years was not significantly associated with stroke 1.19 (0.77-1.79, p = 0.41).

CONCLUSIONS

Our findings demonstrate that RVO is significantly associated with stroke, even after adjusting for underlying cardiovascular co-morbidities. This association was highly significant in younger subjects, while not significant in older individuals.

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.

Oral Health and Risk of Retinal Vascular Occlusions: A Nationwide Cohort Study

Retinal vascular occlusions are a common cause of visual loss. The association between oral health and the risk of retinal vascular occlusions remains unknown. We investigated whether oral health was associated with the risk of retinal vascular occlusions. We conducted a retrospective cohort study including 138,484 participants who completed a national health screening program with an oral health examination from the National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS) 2002-2015. Oral health markers, such as the presence of periodontitis, tooth loss, and dental caries, and the frequency of daily tooth brushing, were evaluated. The primary outcome was the occurrence of retinal vascular occlusions up to December 2015. In total, 2533 participants developed retinal vascular occlusions (215 with retinal artery occlusion, 1686 with retinal vein occlusion, 632 with unspecified retinal vascular occlusion). In the multivariable Cox regression analysis, periodontitis was an independent risk factor for retinal vascular occlusions (adjusted hazard ratio: 1.18; 95% confidence interval: 1.02-1.36; p = 0.024). Frequent tooth brushing was negatively associated with the risk of retinal vascular occlusions (adjusted hazard ratio: 0.89; 95% confidence interval: 0.80-0.98; p = 0.022). Improving oral hygiene may contribute to the attenuation of the risk of retinal vascular occlusions.

Altered synchronous neural activities in retinal vein occlusion patients: A resting-state fMRI study

Objective

Retinal vein occlusion (RVO) is the second most common retinal vascular disorder after diabetic retinopathy, which is the main cause of vision loss. Retinal vein occlusion might lead to macular edema, causing severe vision loss. Previous neuroimaging studies of patients with RVO demonstrated that RVO was accompanied by cerebral changes, and was related to stroke. The purpose of the study is to investigate synchronous neural activity changes in patients with RVO.

Methods

A total of 50 patients with RVO and 48 healthy subjects with matched sex, age, and education were enrolled in the study. The ReHo method was applied to investigate synchronous neural activity changes in patients with RVO.

Results

Compared with HC, patients with RVO showed increased ReHo values in the bilateral cerebellum_4_5. On the contrary, patients with RVO had decreased ReHo values in the bilateral middle occipital gyrus, right cerebelum_crus1, and right inferior temporal gyrus.

Conclusion

Our study demonstrated that patients with RVO were associated with abnormal synchronous neural activities in the cerebellum, middle occipital gyrus, and inferior temporal gyrus. These findings shed new insight into neural mechanisms of vision loss in patients with 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.

Review: The Development of Risk Factors and Cytokines in Retinal Vein Occlusion

Retinal vein occlusion (RVO) is the second most prevalent retinal disease. Despite this, the pathogenic mechanisms and risk factors are not entirely clear. In this article, we review recent publications on the classification, pathogenesis, risk factors, ischemic changes, cytokines, and vital complications of RVO. Risk factors and cytokines are important for exploring the mechanisms and new treatment targets. Furthermore, risk factors are interrelated, making RVO mechanisms more complex. Cytokines act as powerful mediators of pathological conditions, such as inflammation, neovascularization, and macular edema. This review aims to summarize the updated knowledge on risk factors, cytokines of RVO and signaling in order to provide valuable insight on managing the disease.

Risk of Stroke or Acute Myocardial Infarction in Subconjunctival Hemorrhage: A Nationwide Cohort Study

PURPOSE

To investigate whether subconjunctival hemorrhage (SCH) raises the risk of subsequent stroke or acute myocardial infarction (AMI) in the general population.

METHODS

Using the National Health Insurance Service-National Sample Cohort database records from 2002 to 2013. Of 1,025,340 individuals in the database, we included 703,090 aged ≥ 20 years old without any history of SCH, cerebrovascular diseases, and ischemic heart diseases in the analyses. Of these, we identified 46,251 cases of incident SCH and regarded it as a time-varying covariate. We performed sensitivity analyses using 1:4 propensity score (PS)-based matched controls. To adjust for potential confounders, we investigated Cox regression models using defined demographic information, comorbidities, co-medications, and the Charlson Comorbidity Index score.

RESULTS

The SCH group showed higher incidence probability of stroke or AMI than the general population (3.17% versus 2.71%, respectively; p < .001); however, when compared to the PS-based matched controls, there was no difference (3.17% versus 3.03%, respectively; p = .76). Time-varying covariate Cox regression analyses without adjusting for confounders showed that SCH was associated with increased risk of subsequent stroke or AMI; however, after adjusting for confounders, SCH did not increase the risk of stroke or AMI.

CONCLUSION

This population-based cohort study showed that SCH itself is not a risk factor for stroke or AMI. Clinicians could reassure patients with SCH that it would not increase the risk for stroke or AMI. We recommend attentive evaluation of underlying diseases for patients with SCH for identifying risk factors of stroke or AMI.

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.

Relationship between Retinal Vascular Occlusions and Cognitive Dementia in a Large Cross-Sectional Cohort

PURPOSE

To examine the association between cognitive dementia and retinal vascular occlusions.

DESIGN

A retrospective, cross-sectional study.

METHODS

Single-institution study population: we reviewed the electronic medical records of 37,208 individuals older than 65 years of age who were evaluated by an ophthalmologist or an optometrist and who also had a medical visit to our institution over a 6-year period. Individuals with and without retinal vascular occlusions were identified by International Classification of Diseases, version 10 (ICD-10) diagnostic codes.

MAIN OUTCOME

we analyzed the association between dementia and retinal vascular occlusions after adjusting for covariates which included age, sex, stroke, diabetes mellitus, and hypertension using multiple logistic regression analyses.

RESULTS

Compared to subjects without retinal vascular occlusions, those with retinal vascular occlusions had a higher prevalence of dementia (6.7% vs. 9.3%, respectively; P < .001). After adjusting for either age or stroke, there were no significant associations between retinal vascular occlusions and dementia.

CONCLUSIONS

Individuals with retinal vascular occlusions have a higher prevalence of dementia. However, this association is secondary to shared underlying risk factors in this population, such as older age and stroke.

Risk and mortality of aspiration pneumonia in Parkinson's disease: a nationwide database study

This retrospective cohort study investigated the risk and mortality rate due to aspiration pneumonia in patients with Parkinson's disease (PD) using a nationwide database. We identified 10,159 newly diagnosed PD patients between 2004 and 2006, and four age- and sex-matched controls for each PD patient from the National Health Insurance Service database in Korea. We analyzed the relative risk of aspiration pneumonia and mortality after the first occurrence of aspiration pneumonia until 2017. Throughout the study period, PD patients showed a higher incidence of aspiration pneumonia than their matched controls (3.01 vs. 0.59 events per 1,000 person-years), and they were at an increased risk of aspiration pneumonia (hazard ratio = 4.21; 95% confidence interval, 3.87-4.58). After the first occurrence of aspiration pneumonia, the mortality rate of PD patients was 23.9% after one month, 65.2% after 1 year, and 91.8% after 5 years, while that of controls was 30.9%, 67.4%, and 88.9%, respectively. Patients with PD are at an increased risk of aspiration pneumonia, and approximately two-thirds of the patients die within a year after experiencing aspiration pneumonia. Further studies are warranted to prevent aspiration pneumonia and implement proper treatments to prevent death after aspiration pneumonia in patients with PD.

Increased risk of cancer in patients with retinal vein occlusion: a 12-year nationwide cohort study

Aims

To investigate the association between incident retinal vein occlusion (RVO) and the subsequent development of cancer.

Methods

In this nationwide population-based retrospective study using 2002–2013 National Health Insurance Service database which covers the entire South Korean population, 186 701 incident RVO patients and their 1:1 propensity-score matched controls were included. We defined the fixed cohort from January 1st, 2004 to December 31st, 2013; the cohort included patients who suffered incident RVO after entering the cohort and their matched controls, and excluded patients having any cancer history before entering the cohort. The association of RVO and cancer was assessed by time-varying covariate Cox regression models; Model 1 included RVO as a time-varying covariate, Model 2 included Model 1 plus demographic information and Model 3 included Model 2 and comorbidities.

Results

RVO was associated with an increased risk of subsequent cancer (HR=1.29; 95% CI, 1.26–1.31 in Model 1), which was consistent in Models 2 and 3. The incidence rate of overall cancer during the study period was 25.55 (95% CI, 25.19–25.91) per 1000 person-years in the RVO group and 18.62 (95% CI, 18.46–18.79) per 1000 person-years in the control group. In the subgroup analysis, haematological malignancies showed the highest association with RVO (HR=1.65; 95% CI, 1.49–1.83).

Conclusion

Patients with RVO have an increased risk of subsequent cancer development even after adjusting for demographic factors and comorbidities. Further study is warranted to elucidate these associations to provide proper recommendations for RVO patients regarding the cancer screening.

Spinal cord infarction associated to retinal vein occlusion in a patient with chronic kidney disease

A 70-year-old man presented to the emergency department with blood hypotension associated to a sudden paraplegia and thermalgesic analgesia. He had an history of colic and prostatic adenocarcinoma, hypertension and non-dialyzed Chronic Kidney Disease (CKD) related to an idiopathic membranous glomerulonephritis type 1 discovered 9 years ago. Magnetic resonance imaging confirmed a diagnosis of Spinal Cord Infarction (SCI). Few months later, he presented a blurred vision due to central Retinal Vein Occlusion (RVO), which was improved by Anti-VEGF therapy. This is the first reported case of a concomitance of retinal vascular event and SCI highlights the links between the central nervous system and retinal vascularization despite separate involvement of the two events in the arterial and venous systems. Additionally, CKD worsened the risk of cardiovascular incidents by induced oxidative stress, thrombophilia, chronic inflammation, and endothelial dysfunction. SCI occurrence indicates severe vascular dysfunction and elevates the risk of additional vascular disorders.

ASSOCIATION OF RETINAL VEIN OCCLUSION WITH CARDIOVASCULAR EVENTS AND MORTALITY: A Systematic Review and Meta-analysis

PURPOSE

Previous studies examining the association of retinal vein occlusion (RVO) and cardiovascular events have been inconsistent and have mostly focused on stroke and myocardial infarction. The goal of this study is to use meta-analysis to examine the available evidence examining the association of RVO with incident cardiovascular events and mortality.

METHODS

Systematic review and meta-analysis of all longitudinal cohort studies published in PubMed, Embase, and the Cochrane Library from inception to April 7, 2018, that evaluated the association of baseline RVO and incident cardiovascular events and/or mortality, that provided multivariate-adjusted risk estimates with 95% confidence intervals (95% CIs), and that had average follow-up ≥1 year. The Newcastle-Ottawa scale was used to assess study quality. Multivariate-adjusted risk estimates with 95% CI along with study characteristics were extracted from each study, and pooled risk ratios (RRs) with 95% CI were generated using a random-effects model with inverse-variance weighting to account for heterogeneity. Main outcomes were incident stroke (fatal or nonfatal), myocardial infarction, heart failure, peripheral arterial disease, all-cause mortality, and cardiovascular mortality.

RESULTS

Fifteen cohort studies with a total of 474,466 patients (60,069 with RVO and 414,397 without RVO) were included. Each study had Newcastle-Ottawa scale score ≥6, indicating moderate-to-high quality. Retinal vein occlusion was associated with increased risk of stroke (RR = 1.45; 95% CI, 1.31-1.60), myocardial infarction (RR = 1.26; 95% CI, 1.17-1.37), heart failure (RR = 1.53; 95% CI, 1.22-1.92), peripheral arterial disease (RR = 1.26; 95% CI, 1.09-1.46), and all-cause mortality (RR = 1.36; 95% CI, 1.02-1.81), but was not associated with increased risk of cardiovascular mortality (RR = 1.78; 95% CI, 0.70-4.48).

CONCLUSION

This review suggests patients with RVO have an increased risk of cardiovascular events and all-cause mortality. More studies are needed to determine the highest risk periods for cardiovascular events and mortality after RVO and whether immediate cardiovascular evaluation and intervention will improve outcomes.

Hypertension and multiple cardiovascular risk factors increase the risk for retinal vein occlusions: results from the Gutenberg Retinal Vein Occlusion Study

OBJECTIVE

Although several risk factors for retinal vein occlusion (RVO) are known, what triggers RVO is unclear in many cases. We aimed to evaluate the relevance of multiple risk factors in patients with RVO.

METHODS

The Gutenberg RVO Study is an observational case-control study that assessed thrombophilic, cardiovascular, ophthalmic, and drug-related risk factors in participants with RVO and the same number of matched controls. Conditional logistic regression analysis was chosen to estimate the risk of RVO due to several risk factors.

RESULTS

Of 92 patients with RVO, 46 (50%) had central RVO, 31 (33.7%) had branch RVO, and 15 (16.3) had hemi-RVO. Systemic hypertension was associated with RVO [any RVO: odds ratio (OR): 1.81; 95% confidence interval (CI): 1.14-2.88; branch RVO: OR: 2.56; 95% CI: 1.08-6.10]. The most frequent combinations of risk factors were hypertension with dyslipidemia (33 of 92, 35.9%) and hyperhomocysteinemia and high levels of factor VIII (10 of 92, 10.9%). An increase in the risk sum score by one additional risk factor corresponded to ORs of 1.74 (95% CI: 1.31-2.32) for cardiovascular risk factors, 1.38 (95% CI: 1.04-1.82) for thrombophilic risk factors, and 1.43 (95% CI: 1.20-1.70) for the total number of risk factors for RVO.

CONCLUSION

Cardiovascular risk factors are more important than other risk factors for the presence of RVO. The risk of RVO increased by approximately 40% with any additional risk factor and by 70% with any additional cardiovascular risk factor.

Primary Open-angle Glaucoma and Increased Risk of Chronic Kidney Disease

PRECIS

The association between primary open-angle glaucoma (POAG) and subsequent development of chronic kidney disease (CKD) was investigated using a nationwide, population-based, retrospective cohort in South Korea. POAG increases the risk of subsequent CKD development.

PURPOSE

The purpose of this study was to investigate the risk of subsequent CKD development in patients with POAG.

METHODS

In this nationwide, population-based longitudinal cohort, 1,025,340 beneficiaries in the 2002-2013 Korean National Health Insurance database were included. We identified patients with incident POAG and evaluated the risk of subsequent CKD development using diagnostic codes from the database after 2-year wash-out periods. We applied time-varying covariate Cox regression analyses to determine the effect of POAG on the development of CKD: Model 1 included only POAG as a time-varying covariate; Model 2 included Model 1 and demographic information; and Model 3 included Model 2, comorbidity, comedication, and the Charlson Comorbidity Index score.

RESULTS

The fixed cohort included 478,303 eligible subjects, and of these subjects, 1749 suffered incident POAG, and 3157 developed CKD. POAG was associated with an increased risk of CKD development [hazard ratio (HR)=7.63; 95% confidence interval (CI), 5.89-9.87] in Model 1; HR=3.54 (95% CI, 2.73-4.58) in Model 2; and HR=2.90 (95% CI, 2.24-3.76) in Model 3].

CONCLUSION

POAG increased the risk of subsequent CKD in the general population, suggesting that POAG and CKD might share a common pathogenic mechanism.

Assessment of cerebral low-frequency oscillations in patients with retinal vein occlusion: a preliminary functional MRI study

BACKGROUND

There is increasing evidence that patients with retinal vein occlusion exhibit cerebral vascular changes and are at an increased risk of stroke. However, it remains unknown whether patients with retinal vein occlusion exhibit changes in intrinsic brain activity.

PURPOSE

This study investigated intrinsic brain activity changes in patients with retinal vein occlusion by assessing the amplitude of low-frequency fluctuations.

MATERIAL AND METHODS

Forty-five patients with retinal vein occlusion (22 men, 23 women, mean age 56.55 ± 6.97 years) and 43 healthy controls (13 men, 30 women; mean age 53.53 ± 8.19 years) closely matched in age, sex, and education level underwent resting-state MRI scans. The amplitude of low-frequency fluctuation method was used to compare intrinsic brain activity between the two groups.

RESULTS

Compared with healthy controls, patients with retinal vein occlusion exhibited significantly lower amplitude of low-frequency fluctuation values in the left middle occipital gyrus, right middle occipital gyrus, and right calcarine. However, patients with retinal vein occlusion showed significantly higher amplitude of low-frequency fluctuations in the bilateral cerebellum 6, right hippocampus, left insula, and left fusiform (voxel-level P < 0.01, Gaussian random field correction, cluster-level P < 0.05).

CONCLUSION

Our results demonstrated that patients with retinal vein occlusion showed abnormal spontaneous neural activities in the visual cortices, cerebellum, and Papez circuit, which might indicate impaired vision, cognition, and emotional function in patients with retinal vein occlusion. These findings offer important insights into the neural mechanism of retinal vein occlusion.

The Association with rhegmatogenous retinal detachment and paediatric atopic dermatitis: a 12-year Nationwide Cohort Study

PURPOSE

Historically, atopic dermatitis (AD) is associated with an increased risk of rhegmatogenous retinal detachment (RRD). However, uncertainty remained regarding the effect of AD itself and comorbidities (e.g., allergic diseases, cataract surgery) on RRD occurrence in a large, population-based paediatric population.

PATIENTS AND METHODS

We analysed the 12-year National Health Insurance Service database (2002-2013) covering the entire Korean population to estimate the association between AD and RRD in people aged under 20 years.

RESULTS

We identified 3142 RRD patients, and matched 18,852 controls (six controls to each RRD patient); therefore, we included 21,994 peoples under aged 20 years in the analyses. AD was more prevalent in the RRD group (329 patients, 10.47%) than the control group (1043 patients, 5.53%; P < 0.001), and so were severe AD (153 patients [4.87%] and 223 patients [1.18%], respectively; P < 0.001). In conditional logistic regression analysis, AD was associated with RRD (OR, 1.61; 95% CI, 1.93-1.87) even after adjusting for allergic conditions, connective tissue disease, uveitis, and cataract surgery. In addition, severity of AD was associated with an increased risk of RRD (OR for non-severe AD and severe AD, 1.26 [95% CI, 1.05-1.51] and 2.88 [95% CI, 2.25-3.68]).

CONCLUSION

This study suggests that AD itself is a risk factor of RRD in children by showing the association between AD and RRD occurrence and the biologic gradient even after adjustment for known confounders including allergic conditions, uveitis, and cataract surgery.

Association of Chronic Rhinosinusitis With Depression and Anxiety in a Nationwide Insurance Population

Importance

Chronic rhinosinusitis (CRS) is associated with a decreased quality of life, affecting physical and emotional aspects of daily function, the latter of which could manifest as depression and anxiety.

Objective

To evaluate the risk of depression and anxiety in CRS, depending on the CRS phenotype (CRS without nasal polyps [CRSsNP] and CRS with nasal polyps [CRSwNP]).

Design, Setting, and Participants

This retrospective nationwide cohort study used population-based insurance data (consisting of data from approximately 1 million patients). The study population included 16 224 patients with CRS and 32 448 individuals without CRS, with propensity score matching between groups according to sociodemographic factors and enrollment year. Data were collected from January 1, 2002, through December 31, 2013, and analyzed from July 1 through November 15, 2018.

Main Outcomes and Measures

Survival analysis, the log-rank test, and Cox proportional hazards regression models were used to calculate the incidence, survival rate, and hazard ratio (HR) of depression and anxiety for each group.

Results

Among the 48 672 individuals included in the study population (58.8% female), the overall incidence of depression during the 11-year follow-up was 1.51-fold higher in the CRS group than in the non-CRS group (24.2 vs 16.0 per 1000 person-years; adjusted HR, 1.54; 95% CI, 1.48-1.61). The incidence of anxiety was also higher in the CRS group than in the comparison group (42.2 vs 27.8 per 1000 person-years; adjusted HR, 1.57; 95% CI, 1.52-1.62). Moreover, the adjusted HRs of developing depression (CRSsNP, 1.61 [95% CI, 1.54-1.69]; CRSwNP, 1.41 [95% CI, 1.32-1.50]) and anxiety (CRSsNP, 1.63 [95% CI, 1.57-1.69]; CRSwNP, 1.45 [95% CI, 1.38-1.52]) were greater in patients with CRSsNP than in those with CRSwNP.

Conclusions and Relevance

This observational study suggests that CRS is associated with an increased incidence of depression and anxiety. Specifically, findings from this study found that patients without nasal polyps showed a higher risk of developing depression and anxiety than those with nasal polyps.

Association of Obstructive Sleep Apnea With the Risk of Affective Disorders

Importance

Obstructive sleep apnea (OSA) is a common subtype of sleep breathing disorder; however, the association between OSA and the psychological health of affected individuals has not been fully evaluated.

Objective

To investigate the association between OSA and development of affective disorders.

Design, Setting, and Participants

This study used a nationwide representative cohort sample from the Korea National Health Insurance Service-National Sample Cohort database comprising data from 1 025 340 patients. The study included 197 patients with OSA diagnosed between January 2004 and December 2006 and 780 individuals without OSA who were matched using propensity score matching. Data were analyzed from September 28, 2018, to March 30, 2019.

Main Outcomes and Measures

Affective disorder events over a 9-year follow-up period. Kaplan-Meier survival curves with log-rank tests and Cox proportional hazards regression models were used to calculate cumulative incidence and hazard ratios (HRs) of affective disorders for each group.

Results

Of the total population of 985 (860 male [87.3%], 540 [54.8%] were aged <45 years), the incidences per 1000 person-years of affective disorders were 49.57 and 27.18 in the OSA and comparison groups, respectively. A total of 1371.7 person-years in the OSA group and 6328.6 person-years in the comparison group were evaluated for affective disorder events. After adjustment for sociodemographic factors (age, residential area, and household income), disability, and comorbidities, the adjusted HRs for patients with OSA developing affective disorders in patients with OSA during the 9-year follow-up period was 2.04 (95% CI, 1.53-2.70). In a subgroup analysis, the adjusted HRs for patients with OSA who developed depressive and anxiety disorders were 2.90 (95% CI, 1.98-4.24) and 1.75 (95% CI, 1.26-2.44), respectively. Moreover, female patients with OSA had a significant likelihood of prospective development of depression and anxiety (adjusted HR for depression, 3.97 [95% CI, 1.54-10.19]; adjusted HR for anxiety, 2.42 [95% CI, 1.17-5.02]) compared with male patients with OSA (adjusted HR for depression, 2.74 [95% CI, 1.80-4.17]; adjusted HR for anxiety, 1.64 [95% CI, 1.13-2.39]).

Conclusions and Relevance

This observational study using nationwide data suggests that OSA is associated with an increased incidence of affective disorder, such as depression and anxiety. Further studies appear to be needed to confirm our findings and, if validated, then studies are needed to explore the nature of the observed association, including potential causality, between OSA and affective symptoms.

Risk of Nonarteritic Anterior Ischemic Optic Neuropathy After Cataract Surgery

PURPOSE

To determine whether the development of nonarteritic anterior ischemic optic neuropathy (NAION) is increased after receiving cataract surgery in a large general population.

DESIGN

Nationwide, population-based, retrospective cohort study.

METHODS

Setting: A 12-year nationwide, population-based, retrospective cohort study including 1,025,340 beneficiaries in the 2002-2013 Korean National Health Insurance Service database.

PATIENTS

We identified 40,356 patients who had undergone cataract surgery and matched non-cataract surgery controls (1:2) using estimated propensity scores in reference to age, sex, demographics, comorbidities, and co-medications.

OBSERVATIONS

Kaplan-Meier curves and Cox proportional hazard models were generated to determine the risk of developing NAION in the cataract surgery group compared to the non-cataract surgery group.

MAIN OUTCOME MEASURES

Effect (hazard ratio [HR]) of cataract surgery on NAION development.

RESULTS

The 10-year incidence probability of NAION was 0.70% (95% confidence interval [CI], 0.55%-0.86%) in the cataract surgery group and 0.27% (95% CI, 0.25%-0.29%) in the non-cataract surgery group (P < .0001, log-rank test). The cataract surgery group had an increased risk of developing NAION compared to the non-cataract surgery group (HR = 1.80; 95% CIs, 1.46-2.21) even after adjusting for demographics, comorbidities, Charlson comorbidity index, and co-medications.

CONCLUSION

Our results suggest that patients undergoing cataract surgery have an increased risk of NAION.

Association of Pediatric Atopic Dermatitis and Cataract Development and Surgery

Importance

There is a paucity of data addressing the risk of cataract development in pediatric patients with atopic dermatitis (AD).

Objective

To investigate the association of AD with subsequent cataract development and cataract surgery in a Korean pediatric population.

Design, Setting, and Participants

This population-based retrospective longitudinal cohort study used nationally representative data from the Korean National Health Insurance Service database from 2002 to 2013. Incident AD cases, consisting of patients younger than 20 years with AD and severe AD and were matched to 4 controls each using propensity score derived from age, sex, residential area, and household income.

Main Outcomes and Measures

Incidence probabilities of cataract development and cataract surgery between the AD group and controls were compared using Kaplan-Meier methods and log-rank tests. Cox proportional hazard models were fitted for cataract and cataract surgery to determine the risk factors in the matched cohort.

Results

Of 34 375 patients with incident AD (16 159 girls [47%]; mean [SD] age, 3.47 [4.96] years), there were 3734 severe AD cases (10.9%) with 137 500 matched controls. Development of cataracts was not different between the AD and control groups, (0.216% vs 0.227%; 95% CI, -0.041% to 0.063%; P = .32) or between the severe AD cohort and their controls (0.520% vs 0.276%; 95% CI, -0.073% to 0.561%; P = .06). Cataract surgery was performed more frequently in the AD cohort than in the control group (0.075% vs 0.041%; 95% CI, 0.017%-0.050%; P = .02) and in the severe AD cohort compared with their controls (0.221% vs 0.070%; 95% CI, 0.021%-0.279%; P = .03). Severe AD was associated with both development of cataract (adjusted hazard ratio, 1.94; 95% CI, 1.06-3.58, P = .03) and requirement for cataract surgery (adjusted hazard ratio, 5.48; 95% CI, 1.90-15.79, P = .002).

Conclusions and Relevance

Absolute risk of cataract was rare, with or without AD, even after 10 years of observation. However, our results suggest that pediatric patients with AD have an increased risk for cataracts requiring surgery and that disease severity may increase the risk for cataract development and cataract surgery.

[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.

Relationship of Chronic Rhinosinusitis with Asthma, Myocardial Infarction, Stroke, Anxiety, and Depression

BACKGROUND

Chronic rhinosinusitis (CRS) is a common chronic inflammatory disease of the nose and paranasal sinuses. It often has a high burden and is difficult to treat because of comorbidities. However, no population-based, long-term longitudinal study has investigated the relationship between CRS and its comorbidities.

OBJECTIVE

To investigate the potential relationship between CRS and its comorbidities-asthma, acute myocardial infarction (AMI), stroke, anxiety disorder, and depression-using a representative sample.

METHODS

Data for a total of 1,025,340 patients from the Korean National Health Insurance Service database from 2002 to 2013, including 14,762 patients with CRS and 29,524 patients without CRS, were used for this study. A 1:2 propensity score matching was performed using the nearest-neighbor matching method and sociodemographic factors and enrollment year. Cox proportional hazards model was used to analyze the hazard ratio (HR) of CRS for asthma, AMI, stroke, anxiety disorder, and depression.

RESULTS

The incidence rates of asthma, AMI, and stroke were 71.1, 3.1, and 7.7 per 1000 person-years in patients with CRS, respectively. The adjusted HRs of asthma, AMI, and stroke were 2.06 (95% CI, 2.00-2.13), 1.29 (95% CI, 1.15-1.44), and 1.16 (95% CI, 1.08-1.24), respectively, in patients with CRS versus patients without CRS. The incidence rates of anxiety disorder and depression in patients with CRS were 42.1 and 24.2 per 1000 person-years, respectively. The adjusted HRs of anxiety disorder (HR, 1.54; 95% CI, 1.49-1.60) and depression (HR, 1.50; 95% CI, 1.44-1.57) were significantly greater in patients with CRS versus patients without CRS.

CONCLUSIONS

CRS is associated with an increased incidence of asthma, AMI, stroke, anxiety disorder, and depression. Therefore, we suggest that clinicians should monitor patients with CRS carefully, and optimize management as a means to potentially decrease these other associated comorbid conditions.

Risk of ischemic stroke after third, fourth, and sixth cranial nerve palsies in type 2 diabetes

BACKGROUND

The aim of this study was to define the risk of ischemic stroke among newly diagnosed type 2 diabetes (T2D) patients who developed ocular motor cranial nerve (CN) palsies.

METHODS

From the National Health Insurance Service - National Sample Cohort database (2002-2013) of a random sample of 1 025 340 Koreans, patients with newly diagnosed T2D aged ≥20 years were included in the study. The incidence of ocular motor CN palsies was identified using diagnostic codes for third, fourth, and sixth CN palsies. To determine the effect of incident ocular motor CN palsy on subsequent ischemic stroke, covariate Cox regression was used (Model 1 included only ocular motor CN palsy as a time-varying covariate; Model 2 included ocular motor CN palsy and demographic information; Model 3 included all variables in Model 2 as well as comorbidity, concomitant medication, and the Charlson comorbidity index score).

RESULTS

Of 45 820 T2D patients, 75 developed ocular motor CN palsy and 1411 had ischemic stroke. Four patients experienced ischemic stroke after the development of ocular motor CN palsy. Incident ocular motor CN palsy was associated with the subsequent risk of ischemic stroke in Models 1, 2 and 3 (hazard ratios [95% confidence intervals] 3.74 [1.40-9.98], 3.33 [1.25-8.89], and 2.96 [1.11-7.92], respectively). Male sex, older age, and lower income were associated with an increased risk of ischemic stroke. Among confounders, hypertension, atrial fibrillation, and congestive heart failure were associated with the risk of ischemic stroke.

CONCLUSIONS

Physicians should pay more attention to manageable risk factors of ischemic stroke when diabetic patients suffer from ocular motor CN palsies.

Risk of Stroke After Nonarteritic Anterior Ischemic Optic Neuropathy

PURPOSE

To determine whether nonarteritic ischemic optic neuropathy (NAION) raises the risk of subsequent stroke in the general population.

DESIGN

Population-based, retrospective cohort study.

METHODS

Setting: Nationwide, population-based, retrospective cohort study.

PATIENTS

Of 1 025 340 beneficiaries in the National Health Insurance Service-National Sample Cohort database (2002-2013), we included 400 952 eligible individuals in the analysis.

OBSERVATIONS

To determine the effect of incident NAION on the occurrence of subsequent stroke, we used time-varying covariate Cox regression models. Model 1 included only incident NAION as a time-varying covariate. Model 2 included Model 1 and defined demographics. Model 3 included Model 2, comorbidity, co-medication, and Charlson index score.

MAIN OUTCOME MEASURES

Effect (hazard ratio [HR]) of NAION on stroke development.

RESULTS

Of 400 952 eligible individuals, 1125 patients developed NAION and 16 998 patients suffered from stroke. NAION was not associated with an increased risk of subsequent stroke in Model 1, with HR of 1.31 (95% confidence interval [CI], 0.89-1.92). This was consistent, after adjusting for demographics and/or confounding factors, in Model 2 (HR = 1.19, 95% CI, 0.81-1.75) and Model 3 (HR = 1.10, 95% CI, 0.75-1.62).

CONCLUSIONS

Our results suggest that NAION per se is not associated with a subsequent risk of stroke in the general population.

Obstructive sleep apnoea and increased risk of non-arteritic anterior ischaemic optic neuropathy

BACKGROUND/AIMS

To determine whether the development of non-arteritic anterior ischaemic optic neuropathy (NAION) is increased among patients newly diagnosed with obstructive sleep apnoea (OSA) in a large general population.

METHODS

A 12-year nationwide, population-based, retrospective cohort study including 1 025 340 beneficiaries in the 2002-2013 Korean National Health Insurance Service database was performed. We identified 919 patients newly diagnosed with OSA aged ≥40 years and matched 9190 non-OSA controls using estimated propensity scores in reference to age, sex, demographics, comorbidities and co-medications. We applied Kaplan-Meier curves and Cox proportional hazard models to determine the risk of developing NAION in the OSA group compared with the non-OSA group.

RESULTS

The 10-year incidence probability of NAION was higher in the OSA group (0.92%; 95% CI 0.88 to 0.97) than the non-OSA group (0.42%; 95% CI 0.41 to 0.44, p=0.002, log-rank test). The OSA group was at increased risk of developing NAION compared with the non-OSA group (HR 3.80; 95% CI 1.46 to 9.90) after adjusting for demographics, comorbidities and co-medications.

CONCLUSIONS

Our results suggest that patients with newly diagnosed OSA have an increased risk of NAION, although the absolute risk of NAION is low.

Ocular motor cranial nerve palsy and increased risk of stroke in the general population

Purpose

To determine whether ocular motor cranial nerve (CN) palsy raises the risk of subsequent stroke in the general population.

Methods

We investigated the association between ocular motor CN palsy and occurrence of stroke using the National Health Insurance Service-National Sample Cohort database from 2002 to 2013. We included individuals aged ≥ 20 years on January 1^st, 2004, and excluded those having any paralytic strabismus, disorders in binocular movement, diplopia and any cerebrovascular diseases before entering the cohort. Incident ocular motor CN palsy was identified by diagnostic codes for third, fourth, and sixth nerve palsies. To determine the effect of incident ocular motor CN palsy on the occurrence of subsequent stroke, we used time-varying covariate Cox regression models. Model 1 included only incident third, fourth, and sixth nerve palsies as a time-varying covariate. Model 2 included Model 1 and defined demographic information. Model 3 included Model 2, comorbidity, co-medication, and the Charlson index score.

Results

Among 727,689 individuals in the cohort, 1,633 patients developed ocular motor CN palsy and 17,657 patients suffered stroke. Cox regression models showed that development of ocular motor CN palsy was associated with an increased risk of subsequent stroke (hazard ratio [HR] = 4.65; 95% confidence intervals [CIs], 3.74–5.80 in Model 1), and the results were consistent even after adjusting for demographic factors and confounders in Model 2 and 3. Men, older age, and individuals not living in Seoul/Incheon area were associated with an increased risk of stroke, while individuals with higher income were associated with decreased risk of stroke in both Model 2 and 3. Sensitivity analyses using propensity score-based matching produced similar results in all three Models (HR = 1.95; 95% CI, 1.55–2.46 in Model 1, HR = 1.91; 95% CI, 1.52–2.41 in Model 2, and HR = 1.63; 95% CI, 1.29–2.06 in Model 3).

Conclusions

The occurrence of ocular motor CN palsy is a significant risk factor of subsequent stroke even after adjusting for demographic factors and confounders in the general population. Physicians may need to educate patients with ocular motor CN palsy regarding the higher risk of future stroke.

Beneficial effect of statins in patients receiving chronic hemodialysis following percutaneous coronary intervention: A nationwide retrospective cohort study

The cardiovascular diseases are the leading cause of mortality in end-stage renal disease (ESRD) patients. However, roles of statins are still controversial in dialysis-dependent ESRD patients regardless of having proven coronary artery occlusive disease. The aim of this study was to examine the benefit of statin following percutaneous coronary intervention (PCI) in ESRD patients who have proven coronary artery occlusive disease. This study was based on the National Health Insurance Service-National Sample Cohort in South Korea. We included 150 ESRD patients on chronic hemodialysis who underwent PCI with stenting between 2002 and 2013. The primary outcome was a composite of myocardial infarction, stroke, and all-cause mortality. Multivariate time-dependent Cox regression analysis were performed, and statin therapy after PCI was treated as a time-dependent variable. During 3.15 ± 2.71 (mean ± standard deviation) years of follow-up, there were 82 patients with primary outcome. The adjusted hazard ratio for statin use was 0.54 [0.33-0.90] compared to no statin use. This study showed that statin has significant benefit on reducing adverse events risk in dialysis-dependent ESRD patients after PCI.

Sex-specific age threshold for increased risk of retinal vein occlusion in Koreans

PURPOSE

Retinal vein occlusion (RVO) is one of most common retinal vascular disorders. It can lead to visual impairment and subsequent socioeconomic loss among the working population. RVO peak incidence is known to occur in the fifth and sixth decades of life, and is more predominant in males. To date, there has been no consensus regarding the optimal screening age for individuals at high risk for RVO, or whether sex-dependent cut-offs may be appropriate. Therefore, the purpose of this study was to predict the sex-specific age threshold for increased risk of RVO in Koreans.

METHODS

The analysis was based on data from the Korean National Health Insurance Database from 2013. Patients diagnosed with new cases of RVO from January 2013 to December 2013 were included. Individuals younger than 20 years of age and those with other retinal diseases were excluded. Multivariate logistic regression analysis and odds ratios with 95% confidence intervals were conducted to identify the age-related risk factors for RVO. A receiver operating characteristic (ROC) curve for RVO incidence was constructed.

RESULTS

Among the 754,749 individuals included in the study, 623 (0.08%) developed RVO. The optimal cut-off age for increased risk of RVO was 54 years overall, (sensitivity 0.78, specificity 0.70), 48 years in males (sensitivity 0.90, specificity 0.58), and 54 years in females (sensitivity 0.80, specificity 0.68). The incidence of RVO in females over 50 years of age was 3 times higher than that in females under the age of 50 after adjusting for confounding factors, and these differences tended to increase with age. The area under the ROC curve was 0.80 (95% CI; 0.79-0.82) overall, 0.81 (95% CI; 0.79-0.83) in males, and 0.79 (95% CI; 0.78-0.81) in females.

CONCLUSION

RVO incidence was higher in females, and increased more rapidly with age. The incidence of RVO more than doubled after 50 years of age for both sexes after adjusting for confounding factors. Females had an older age cut-off for RVO than males. However, the clinical impact of the use of sex-specific age cut-offs for RVO would benefit from additional validation from further studies.

Atrial fibrillation in retinal vascular occlusion disease and non-arteritic anterior ischemic optic neuropathy

Background

Patients with retinal vascular occlusion disease have an increased risk for ischemic stroke and share some risk factors with cerebrovascular disease. The purpose of this study was to analyze the prevalence of atrial fibrillation (AF) in subjects with retinal vascular occlusive disease and anterior ischemic optic neuropathy and to compare these data to an ischemic stroke group.

Methods

Prospective, observational single-center trial. Subjects with retinal artery occlusion (RAO), retinal vein occlusion (RVO) and anterior ischemic optic neuropathy (AION) were included. Patients with ischemic stroke (IS) from a previous observational trial were used as control. Investigation included 7-day Holter ECG, echocardiography, duplex ultrasonography of the carotid arteries, and 24-hour blood pressure monitoring. Further vascular risk factors were documented.

Results

During the 1-year study period, 101 patients were recruited. The control group with ischemic stroke consisted of 272 subjects. At inclusion, the prevalence of AF was 12% (RAO), 10.2% (RVO), 11.1% (NAION) and 15.8% (IS). The final prevalence after Holter ECG rose to 16% (RAO), 18.4% (RVO), 14.8% (NAION) and 26.5% (IS). No significant difference was measured between groups.

Conclusions

We detected a similar prevalence of AF in all groups. RVO patients tended to exhibit a higher AF detection rate and lower number needed to screen than RAO and NAION. The detection of AF rose considerably via Holter ECG. As a consequence, we recommend prolonged ECG monitoring in patients with acute ophthalmic vascular diseases.

AMBULATORY BLOOD PRESSURE PATTERNS IN PATIENTS WITH RETINAL VEIN OCCLUSION

PURPOSE

Failure of blood pressure (BP) to dip during sleep (nondipper pattern) is associated with cardiovascular disease and stroke. The prevalence and degree of nondipping and masked hypertension in patients with retinal vein occlusion (RVO), which is associated with stroke, has not been previously examined.

METHODS

We measured clinic and 24-hour ambulatory BPs in 22 patients with RVO and 20 control participants without known eye disease matched by age and sex. Mean BP dipping, defined as the ratio of difference in mean awake and sleep systolic BPs to mean awake systolic BP, and masked and nocturnal hypertension were compared between groups.

RESULTS

Mean 24-hour ambulatory BP was 144/79 mmHg among those with RVO and 136/77 mmHg among controls. Patients with RVO had an almost 2-fold higher prevalence of nondipping pattern (80.8% [95% confidence interval, 52.8-94.1] vs. 50.4% [95% confidence interval, 26.1-74.5]; P = 0.008). Average sleep systolic BP dip in patients with RVO was 6.1% versus 11.9% in controls (P = 0.004). More patients with RVO had masked hypertension by ambulatory BPs than controls (71% vs. 50%), but this difference was not statistically significant.

CONCLUSION

Our data suggest an association between RVO and nondipper BP pattern. Ambulatory BP monitoring may be useful in the evaluation of patients with RVO by identifying those who may benefit from more aggressive BP control.

Cardiovascular risk factors, nonvalvular atrial fibrillation and retinal vein occlusion

OBJECTIVES

To analyse the importance of cardiovascular risk factors, ultrasound findings in the supra-aortic trunk and the presence of anticoagulated nonvalvular atrial fibrillation (NVAF) in patients with retinal vein occlusion (RVO) and in a control group.

PATIENTS AND METHODS

A cross-sectional study was conducted of all patients with RVO consecutively referred to the office of internal medicine, comparing them with a control group. We analysed clinical, electrocardiographic and ultrasound variables.

RESULTS

We studied 212 patients (114 men and 98 women) with RVO and 212 controls (95 men and 117 women) of similar ages. Arterial hypertension, dyslipidaemia and diabetes mellitus were significantly more prevalent in the patients with RVO than in the controls (73.6 vs. 50%, 64.6 vs. 48.6% and 27.8 vs. 12.3%, respectively). We observed arteriosclerotic lesions in the supra-aortic trunk in 55% of the patients with RVO. The patients with RVO and NVAF had a greater burden of cardiovascular risk factors than the controls with NVAF. There were no differences in terms of the international normalised ratio or in the use of direct anticoagulants between the cases and controls with NVAF.

CONCLUSIONS

Cardiovascular risk factors (especially arterial hypertension) and arteriosclerotic involvement of the supra-aortic trunk are highly prevalent in RVO. Anticoagulation does not appear to be effective in preventing RVO.

Prevalence and associated factors of retinal vein occlusion in the Korean National Health and Nutritional Examination Survey, 2008-2012: A cross-sectional observational study

Retinal vein occlusion (RVO) is the second most common retinal vascular diseases and there are only a few Asian population-based studies with small samples. Hypertension is one of a modifiable risk factor of RVO, but no recent studies have shown the relationship between RVO and hypertension control status. We aimed to investigate the prevalence of RVO and its associated factors in an adult Korean population.A nationwide population-based, cross-sectional study. We enrolled 37,982 participants from the Korea National Health and Nutrition Examination Survey who were 19 years or older and who had undergone ophthalmologic exams from 2008 through 2012. All participants underwent a comprehensive ophthalmic examination, standardized ophthalmic and health interviews, and laboratory investigations. Digital fundus photographs were interpreted by retinal specialists who investigated for the presence of RVO. The prevalence of RVO was then estimated. RVO-associated factors were determined using step-wise logistic regression analyses. We also performed a subgroup analysis to evaluate the association between hypertension and RVO according to hypertension control status and antihypertensive medication use.Of those enrolled participants, 25,765 participants met our study criteria and were included in the analyses. The overall RVO prevalence (n = 205) was 0.6 ± 0.1% (0.6 ± 0.1% for branch RVO and <0.1% for central RVO), and no sex differences were observed. In multivariate logistic regression analyses after adjusting for all potential risk factors, we found the following factors to be significantly associated with RVO: old age (odds ratio (OR) = 1.72, 95% CI: 1.27-2.34), hypertension (OR = 2.56, 95% CI: 1.31-5.08), history of stroke (OR = 2.08, 95% CI: 1.01-4.45), and hypercholesterolemia (OR = 1.84, 95% CI: 1.01-3.35). In a subset of participants with hypertension, participants with uncontrolled hypertension (OR = 3.46, 95% CI: 1.72-6.94) and unmedicated hypertension (OR = 4.12, 95% CI: 2.01-8.46) were more significantly associated with RVO than participants without hypertension.RVO prevalence in Korea was moderate relative to that in the rest of the world, and RVO-associated factors were similar to those identified in other population-based studies. Well-controlled hypertension and antihypertensive medication showed inverse association with RVO.

Relationship between retinal vascular occlusions and incident cerebrovascular diseases: A systematic review and meta-analysis

Several studies investigating the role of retinal vascular occlusions, on cerebrovascular diseases (CVD) have been reported, but the results are still inconsistent. We therefore sought to evaluate the relationship between retinal vascular occlusions and CVD.We systematically searched the Cochrane Library, PubMed, and ScienceDirect databases through January 31, 2016 for studies evaluating the effect of retinal vascular occlusions on the risk of CVD. Data were abstracted using predefined criteria, and then pooled by RevMan 5.3 software.A total of 9 retrospective studies were included in this meta-analysis. When compared with individuals without retinal vascular occlusions, both individuals with retinal artery occlusion (RAO) (odds ratio [OR] = 2.01, 95% confidence interval [CI]: 1.21-3.34; P = 0.005) and individuals with retinal vein occlusion (RVO) (OR = 1.37, 95% CI: 1.24-1.50; P < 0.00001) had higher risks of developing CVD. Additionally, both individuals with central retinal artery occlusion (CRAO) (OR = 2.00, 95% CI: 1.12-3.56; P = 0.02) and branch retinal artery occlusion (BRAO) (OR = 1.60, 95% CI: 1.03-1.48; P = 0.04) were significantly associated with increased risk of CVD.Published literatures support both RVO and RAO are associated with increased risks of CVD. Further prospective studies are needed to confirm these findings.