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Elleuch IE, Sayadi S, Rahali N, Dridi T, Zbiba W. [Retinal artery occlusion and anterior ischemic optic neuropathy associated with factor V Leiden mutation: A case report]. J Fr Ophtalmol 2020; 43:294-297. [PMID: 32107025 DOI: 10.1016/j.jfo.2019.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 11/17/2022]
Abstract
Factor V is a pro-coagulant cofactor required for the transformation of prothrombin into thrombin. Thrombin activates factor V, which is then deactivated by protein C. A mutation in factor V is responsible for the formation of factor V Leiden, resistant to activated protein C. The association of this mutation with venous thromboses has been established. Its association with arterial occlusions is still controversial. We report the case of a central retinal artery occlusion associated with a non-arteritic anterior optic neuropathy associated with a Leiden mutation of factor V (FVL). The presence of FVL has been associated with lack of reperfusion and rapid progression to neovascularization. It seems that FVL intervenes mainly during the reperfusion phase after the occurrence of arterial thrombosis.
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Affiliation(s)
- I E Elleuch
- Service d'ophtalmologie, hôpital Mohamed Taher Maamouri, Mrazka, 8000 Nabeul, Tunisie.
| | - S Sayadi
- Service d'ophtalmologie, hôpital Mohamed Taher Maamouri, Mrazka, 8000 Nabeul, Tunisie
| | - N Rahali
- Service d'ophtalmologie, hôpital Mohamed Taher Maamouri, Mrazka, 8000 Nabeul, Tunisie
| | - T Dridi
- Service d'ophtalmologie, hôpital Mohamed Taher Maamouri, Mrazka, 8000 Nabeul, Tunisie
| | - W Zbiba
- Service d'ophtalmologie, hôpital Mohamed Taher Maamouri, Mrazka, 8000 Nabeul, Tunisie
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Zou Y, Zhang X, Zhang J, Ji X, Liu Y. Factor V G1691A is associated with an increased risk of retinal vein occlusion: a meta-analysis. Oncotarget 2017; 8:75467-75477. [PMID: 29088882 PMCID: PMC5650437 DOI: 10.18632/oncotarget.20636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 08/17/2017] [Indexed: 01/03/2023] Open
Abstract
We performed a meta-analysis to investigate the association between the Factor V G1691A polymorphism and the risk of retinal vein occlusion (RVO). This analysis included 37 studies involving 2,510 cases and 3,466 controls. Factor V G1691A was associated with an increased risk of RVO in the allele, heterozygote, dominant, and carrier models (PA < 0.001, odds ratios >1), but not the homozygote or recessive models (PA > 0.05). Similar results were observed in a meta-analysis of central retinal vein occlusion (CRVO) and when comparing Caucasian subgroups to population-based controls. These data demonstrate that the G/A genotype of Factor V G1691A is associated with an increased risk of RVO/CRVO in a Caucasian population.
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Affiliation(s)
- Yuanyuan Zou
- The Second Department of Ophthalmology, Cangzhou Central Hospital, 061001, Cangzhou, PR China
| | - Xi Zhang
- The Second Department of Ophthalmology, Cangzhou Central Hospital, 061001, Cangzhou, PR China
| | - Jingyi Zhang
- The Second Department of Ophthalmology, Cangzhou Central Hospital, 061001, Cangzhou, PR China
| | - Xiangning Ji
- The Second Department of Ophthalmology, Cangzhou Central Hospital, 061001, Cangzhou, PR China
| | - Yuqing Liu
- The Second Department of Ophthalmology, Cangzhou Central Hospital, 061001, Cangzhou, PR China
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Koylu MT, Kucukevcilioglu M, Erdurman FC, Durukan AH, Sobacı G, Torun D, Tunca Y, Ayyildiz O. Association of retinal vein occlusion, homocysteine, and the thrombophilic mutations in a Turkish population: A case-control study. Ophthalmic Genet 2017; 38:352-356. [PMID: 28085519 DOI: 10.1080/13816810.2016.1235716] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To compare homocysteine and thrombophilic mutations for the methylenetetrahydrofolate reductase (MTHFR) C677T, factor V Leiden, and prothrombin G20210A between retinal vein occlusion (RVO) and healthy controls in a Turkish population. MATERIALS AND METHODS Forty-nine subjects with RVO were compared for homocysteine status and the MTHFR C677T, prothrombin G20210A, and factor V Leiden mutations with those of 68 healthy controls. Then, the groups were subdivided into two subgroups according to age (less than 50 years old, equal to or more than 50 years old) and were further compared. RESULTS Mean plasma level of homocysteine was similar, but the frequency of hyperhomocysteinemia was significantly higher in the RVO group when compared with the control group (22.5% and 8.8%, respectively, p = 0.037). The frequency of all thrombophilic mutations was similar between the groups (p > 0.05). The frequency of all thrombophilic mutations and homocysteine levels was also similar between age subgroups (p > 0.05). Only hyperhomocysteinemia was significantly different between subgroups (p = 0.037); the frequency of hyperhomocysteinemia was significantly different in RVO patients less than 50 years old (22.7%) from that in healthy controls less than 50 years old (11.1%). Two RVO patients (4.1%) with bilateral involvement had MTHFR C677T mutation. CONCLUSIONS Screening for thrombophilic mutations such as MTHFR C677T, factor V Leiden, and prothrombin G20210A in RVO patients at all ages seems to be unnecessary and not cost-effective. However, thrombophilic disorders should be screened selectively, focusing on young individuals, especially with bilateral involvement, without additional cardiovascular risk factors, or a family history of thrombosis.
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Affiliation(s)
- Mehmet Talay Koylu
- a Department of Ophthalmology , Gulhane Military Medicine Academy , Ankara , Turkey
| | | | | | - Ali Hakan Durukan
- a Department of Ophthalmology , Gulhane Military Medicine Academy , Ankara , Turkey
| | - Gungor Sobacı
- a Department of Ophthalmology , Gulhane Military Medicine Academy , Ankara , Turkey
| | - Deniz Torun
- b Department of Genetics , Gulhane Military Medicine Academy , Ankara , Turkey
| | - Yusuf Tunca
- b Department of Genetics , Gulhane Military Medicine Academy , Ankara , Turkey
| | - Onder Ayyildiz
- a Department of Ophthalmology , Gulhane Military Medicine Academy , Ankara , Turkey
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Dixon SG, Bruce CT, Glueck CJ, Sisk RA, Hutchins RK, Jetty V, Wang P. Retinal vascular occlusion: a window to diagnosis of familial and acquired thrombophilia and hypofibrinolysis, with important ramifications for pregnancy outcomes. Clin Ophthalmol 2016; 10:1479-86. [PMID: 27563233 PMCID: PMC4984829 DOI: 10.2147/opth.s106969] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Aim Our specific aim was to document the pathoetiologic importance of thrombophilia among females presenting with severe ischemic retinal vein (RVO) or retinal artery (RAO) occlusion, without typical risk factors, and to emphasize that the ophthalmologists’ diagnosis of thrombophilia has important diagnostic and therapeutic downstream ramifications for nonocular thrombosis, including reproductive outcomes. Methods We evaluated familial and acquired thrombophilia in 60 females with RVO (central RVO, n=52; branch RVO, n=8) and 16 with RAO (central RAO, n=11; branch RAO, n=5). They were referred by retinologists, without typical risk factors for RVO/RAO and/or severe ocular ischemic presentation. We focused on extraocular thrombotic events, particularly pregnancy complications, including unexplained spontaneous abortion, pre-eclampsia–eclampsia. Thrombophilia measurements in the 76 females were compared with 62 healthy normal females without ocular vascular occlusions (OVOs). Results The 76 females with OVO were more likely than 62 normal female controls to have high homocysteine (24% vs 0%, P<0.0001), high anticardiolipin antibody (immunoglobulin M, 17% vs 3%, P=0.012), high (>150%) factor VIII (42% vs 11%, P<0.0001), and high (>150%) factor XI (22% vs 4%, P=0.004). Of the 76 females, 26 (34%) had ≥1 spontaneous abortion; 17 (22%) had ≥2 spontaneous abortions and/or pre-eclampsia–eclampsia. Compared to 62 healthy female controls, these 17 females with pregnancy complications had high homocysteine (29% vs 0%, P=0.0003), high anticardiolipin antibody immunoglobulin M (24% vs 3%, P=0.02), high factor VIII (38% vs 11%, P=0.02), and were marginally more likely to be heterozygous for the factor V Leiden mutation (19% vs 3%, P=0.058). Conclusion In females lacking typical risk factors for retinal vascular occlusion or severely ischemic presentation, by diagnosing thrombophilia as an etiology for OVO, the ophthalmologist opens a window to family screening and preventive therapy, with particular relevance to pregnancy outcomes and venous thromboembolism.
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Affiliation(s)
- Stephan G Dixon
- Cholesterol, Metabolism, and Thrombosis Center, Jewish Hospital of Cincinnati
| | - Carl T Bruce
- Cholesterol, Metabolism, and Thrombosis Center, Jewish Hospital of Cincinnati
| | - Charles J Glueck
- Cholesterol, Metabolism, and Thrombosis Center, Jewish Hospital of Cincinnati
| | - Robert A Sisk
- Cincinnati Eye Institute; Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Robert K Hutchins
- Cincinnati Eye Institute; Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Vybhav Jetty
- Cholesterol, Metabolism, and Thrombosis Center, Jewish Hospital of Cincinnati
| | - Ping Wang
- Cholesterol, Metabolism, and Thrombosis Center, Jewish Hospital of Cincinnati
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Zöller B, Li X, Sundquist J, Sundquist K. Venous thromboembolism does not share familial susceptibility with retinal vascular occlusion or glaucoma: a nationwide family study. J Thromb Thrombolysis 2016; 42:505-12. [DOI: 10.1007/s11239-016-1387-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lindsell LB, Lai MM, Fine HF. Current concepts in managing retinal vein occlusion in young patients. Ophthalmic Surg Lasers Imaging Retina 2015; 46:695-701. [DOI: 10.3928/23258160-20150730-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Schockman S, Glueck CJ, Hutchins RK, Patel J, Shah P, Wang P. Diagnostic ramifications of ocular vascular occlusion as a first thrombotic event associated with factor V Leiden and prothrombin gene heterozygosity. Clin Ophthalmol 2015; 9:591-600. [PMID: 25897198 PMCID: PMC4396423 DOI: 10.2147/opth.s80714] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
AIM This study aimed to assess the diagnostic ramifications of vascular occlusion of the ocular vein and artery as a first thrombotic event associated with factor V Leiden (FVL) and/or prothrombin gene (PTG) heterozygosity. METHODS Patients with ocular vein (n=191) and artery (n=74) occlusion, free of cardioembolic etiologies, were sequentially referred from vitreoretinal specialists for measurement of thrombophilia-hypofibrinolysis and compared to 110 healthy normal controls. RESULTS Of the 265 patients, 29 (11%; 17 women, 12 men) of all referred ocular vascular occlusion (OVO) cases were found to be heterozygous for FVL and/or PTG, including 16 with FVL, 12 with PTG, and 1 with both. Of the 29 cases, 16 had central retinal vein occlusion (CRVO), 2 branch retinal vein occlusion (BRVO), 5 nonarteritic anterior ischemic optic neuropathy (NA-AION), 3 retinal artery occlusion (RAO), 2 amaurosis fugax (AF), and 1 had both CRVO and RAO. Of the 16 FVL cases, 15 (94%) had OVO as a first thrombotic event without prior deep venous thrombosis (DVT) or pulmonary embolism (PE); 6 (38%) also had other thrombotic events, including recurrent miscarriage, osteonecrosis, ischemic stroke, and/or ischemic colitis; and 5 (31%) had immediate family members with previous venous thromboembolism (VTE). Of the 12 PTG cases, 9 (75%) had OVO as a first thrombotic event, 5 (42%) experienced VTE other than DVT or PE, and 6 (50%) had immediate family members with VTE. In one patient with both FVL and PTG, DVT occurred before BRVO. Of the 17 women with FVL and/or PTG mutations, 7 (41%) experienced ≥1 miscarriage, 6 (35%) were on estrogen therapy, and 1 (6%) was on clomiphene. CONCLUSION Of the 265 patients with OVO, 29 (11%) had FVL and/or PTG, and 83% of these 29 cases presented with OVO as their first thrombotic event. By diagnosing thrombophilia as an etiology for OVO, the ophthalmologist opens a window to family screening and preventive therapy.
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Affiliation(s)
- Samantha Schockman
- Internal Medicine Residency Program, The Jewish Hospital-Mercy Health, Cincinnati, Ohio, USA
| | - Charles J Glueck
- Cholesterol, Metabolism, and Thrombosis Center, The Jewish Hospital-Mercy Health, Cincinnati, Ohio, USA ; Mercy Health Physicians, Mercy Health, Cincinnati, Ohio, USA
| | - Robert K Hutchins
- Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA ; Cincinnati Eye Institute, Cincinnati, Ohio, USA
| | - Jaykumar Patel
- Cholesterol, Metabolism, and Thrombosis Center, The Jewish Hospital-Mercy Health, Cincinnati, Ohio, USA
| | - Parth Shah
- Cholesterol, Metabolism, and Thrombosis Center, The Jewish Hospital-Mercy Health, Cincinnati, Ohio, USA
| | - Ping Wang
- Cholesterol, Metabolism, and Thrombosis Center, The Jewish Hospital-Mercy Health, Cincinnati, Ohio, USA
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Mrad M, Fekih-Mrissa N, Wathek C, Rannen R, Gabsi S, Gritli N. Thrombophilic risk factors in different types of retinal vein occlusion in Tunisian patients. J Stroke Cerebrovasc Dis 2014; 23:1592-8. [PMID: 24630828 DOI: 10.1016/j.jstrokecerebrovasdis.2013.12.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 10/30/2013] [Accepted: 12/29/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Retinal vein occlusion (RVO) is the second most common cause of vision loss because of retinal vascular disease. There are 2 types of RVO: branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO). The pathogenesis of RVO is multifactorial. The role of factor V Leiden (FVL) and prothrombin mutations was examined in patients with CRVO and BRVO. METHODS FVL and prothrombin were investigated by extracting DNA of 88 patients with RVO. Sixteen of the patients were diagnosed with CRVO, 4 with hemispheric retinal vein occlusion, and 68 with BRVO. The genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism. RESULTS Significant differences were found in the frequencies of the genotypes for both the FVL (G1691A) (P<10(-3), odds ratio [OR]=17.4, confidence interval [CI]=6.20-59) and prothrombin (G20210A) (P=.007, OR=5.11, CI=1.30-29) polymorphisms between RVO patients and healthy controls. Additionally, the frequency of the GA genotype for the G1691A polymorphism was significantly higher among the patients in a subset of BRVO compared with controls (P<10(-3), OR=21.4, CI=7.34-74.2). However, no statistically significant differences were found in the frequencies of the prothrombin G20210A polymorphism between the BRVO group and healthy controls (P=.09, OR=3.13, CI=64-19.9). The frequency of both G1691A and G20210A genotypes among the patients of a CRVO subgroup was significantly higher compared with controls (P<10(-3), OR=11.4, CI=2.94-44.2; P=.007, OR=10.8, CI=2.15-54.1, respectively), suggesting an association between these polymorphisms and CRVO. CONCLUSIONS Large study would be required to understand completely the contribution of these markers in the risk of all types of RVO.
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Affiliation(s)
- Meriem Mrad
- Faculté des Science de Tunis, Université Tunis el Manar, El Manar, Tunisie; Laboratoire de Biologie Moléculaire, Service d'Hématologie, Hôpital Militaire Principal d'Instruction de Tunis, Montfleury, Tunisie
| | - Najiba Fekih-Mrissa
- Laboratoire de Biologie Moléculaire, Service d'Hématologie, Hôpital Militaire Principal d'Instruction de Tunis, Montfleury, Tunisie; Académie Militaire Fondouk Jédid, Nabeul, Tunisie.
| | - Cheima Wathek
- Faculté de Médecine de Tunis, Université Tunis el Manar, Tunis, Tunisie; Service d'Ophtalmologie, Hôpital Militaire Principal d'Instruction de Tunis, Montfleury, Tunisie
| | - Riadh Rannen
- Faculté de Médecine de Tunis, Université Tunis el Manar, Tunis, Tunisie; Service d'Ophtalmologie, Hôpital Militaire Principal d'Instruction de Tunis, Montfleury, Tunisie
| | - Salem Gabsi
- Faculté de Médecine de Tunis, Université Tunis el Manar, Tunis, Tunisie; Service d'Ophtalmologie, Hôpital Militaire Principal d'Instruction de Tunis, Montfleury, Tunisie
| | - Nasreddine Gritli
- Laboratoire de Biologie Moléculaire, Service d'Hématologie, Hôpital Militaire Principal d'Instruction de Tunis, Montfleury, Tunisie; Faculté de Pharmacie, Université de Monastir, Monastir, Tunisie
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Jaulim A, Ahmed B, Khanam T, Chatziralli IP. BRANCH RETINAL VEIN OCCLUSION: Epidemiology, Pathogenesis, Risk Factors, Clinical Features, Diagnosis, and Complications. An Update of the Literature. Retina 2013; 33:901-10. [PMID: 23609064 DOI: 10.1097/iae.0b013e3182870c15] [Citation(s) in RCA: 210] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Yioti GG, Panagiotou OA, Vartholomatos GA, Kolaitis NI, Pappa CN, Evangelou E, Stefaniotou MI. Genetic polymorphisms associated with retinal vein occlusion: a Greek case-control study and meta-analysis. Ophthalmic Genet 2013; 34:130-9. [PMID: 23289804 DOI: 10.3109/13816810.2012.746376] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The genetic background of retinal vein occlusion (RVO) remains unclear. In the current study, we aimed to replicate polymorphisms related to thrombophilia/hypofibrinolysis in a Greek population and also systematically summarize current evidence available on the topic. MATERIALS AND METHODS A total of 48 RVO patients and 53 controls were genotyped for factor V H1299R and V Leiden, β-fibrinogen G455A, PAI-1 4G/5G, ACE I/D, HPA1, prothrombin G20210A, factor XIII Val34Leu, MTHFR A1298C and C677T polymorphisms. We examined the association between RVO and the above polymorphisms under a per-allele genetic model in a Greek unrelated case/control population. Additionally, searching PubMed up to January 2012, we identified existing evidence on these polymorphisms and performed meta-analyses. RESULTS A total of three polymorphisms had nominally significant associations with RVO. These associations pertained to ACE D allele (odds ratio, OR, 2.08 [95% CI, 1.12-3.85], p = 0.02); factor XIII 34Leu allele (OR = 0.41 [95% CI, 0.18-0.95], p = 0.037] and MTHFR 677T variant (OR = 2.20 [95% CI 1.10-4.40], p = 0.026). We performed a meta-analysis on the associations between RVO and PAI-1 (n = 5), factor V Leiden (n = 21), MTHFR C677T (n = 19) and prothrombin G20210A (n = 21). We observed nominally significant associations only for PAI-1 (OR = 1.27 [95% CI, 1.02-1.60, p = 0.036]) (I(2) = 44.7%), and factor V Leiden (OR = 1.40 [95% CI, 1.07-1.84, p = 0.015]) (I(2) = 3.6%) using random effects model. CONCLUSIONS Our results suggest that there may be an association between increased risk for RVO and ACE I/D, MTHFR C677T, PAI-1 4G/5G and factor V Leiden polymorphisms, whereas the Val34Leu variant may exert a protective effect.
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Affiliation(s)
- Georgia G Yioti
- Department of Ophthalmology, University of Ioannina School of Medicine, Ioannina, Greece
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12
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Abstract
In branch retinal vein occlusion (BRVO), abnormal arteriovenous crossing with vein compression, degenerative changes of the vessel wall and abnormal hematological factors constitute the primary mechanism of vessel occlusion. In general, BRVO has a good prognosis: 50-60% of eyes are reported to have a final visual acuity (VA) of 20/40 or better even without treatment. One important prognostic factor for final VA appears to be the initial VA. Grid laser photocoagulation is an established treatment for macular edema in a particular group of patients with BRVO, while promising results for this condition are shown by intravitreal application of steroids or new vascular endothelial growth factor inhibitors. Vitrectomy with or without arteriovenous sheathotomy combined with removal of the internal limiting membrane may improve vision in eyes with macular edema which are unresponsive to or ineligible for laser treatment.
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Affiliation(s)
- Jiri Rehak
- Department of Ophthalmology, University Hospital, Palacky University, Olomouc, Czech Republic.
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Weger M, Renner W, Steinbrugger I, Cichocki L, Temmel W, Stanger O, El-Shabrawi Y, Lechner H, Schmut O, Haas A. Role of thrombophilic gene polymorphisms in branch retinal vein occlusion. Ophthalmology 2005; 112:1910-5. [PMID: 16157382 DOI: 10.1016/j.ophtha.2005.05.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2005] [Accepted: 05/29/2005] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE Branch retinal vein occlusion (BRVO) is a common cause of severe visual loss. Numerous risk factors, including arterial hypertension, diabetes mellitus, and arteriosclerosis, have been identified. Gene polymorphisms affecting hemostasis may also play a role in the pathogenesis of BRVO. The present study was therefore done to determine the prevalence of genetic polymorphisms in factors implicated in hypercoagulability among patients with BRVO. DESIGN Retrospective case-control study. PARTICIPANTS The study cohort consisted of 294 patients with BRVO and 294 control subjects, matched for age and gender. METHODS Determination of genotypes was done by allele-specific digestion of polymerase chain reaction products, or by 5' exonuclease assay (TaqMan). MAIN OUTCOME PARAMETERS Genotypes of factor V R506Q (factor V Leiden), prothrombin 20210G>A, fibrinogen beta -455G> A, factor XII (FXII) 46C>T, and ITGA2 807C>T (platelet glycoprotein Ia [GPIa] 807C>T) and ITGB3 L59P (platelet GPIIIa PlA1/PlA2) polymorphisms. RESULTS Genotype distributions of the investigated gene polymorphisms did not differ significantly between patients and control subjects. In contrast, significantly increased prevalences of arterial hypertension and hypercholesterolemia were found among patients with BRVO. In a logistic regression analysis, the presence of arterial hypertension was associated with an odds ratio (OR) of 2.32 (95% confidence interval [CI], 1.62-3.32), whereas hypercholesterolemia yielded an OR of 2.54 (95% CI, 1.74-3.70) for BRVO. CONCLUSION Our data indicate that the prevalences of the investigated gene polymorphisms do not differ significantly in patients with BRVO and control subjects. This suggests that these polymorphisms are not major risk factors for BRVO.
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Affiliation(s)
- Martin Weger
- Department of Ophthalmology, Medical University Graz, Graz, Austria.
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15
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Abstract
Central retinal vein occlusion is a common cause of permanent visual loss. Work up and laboratory evaluation of patients requires the clinician to rule out hypertension, diabetes, hyperlipidemia, and glaucoma. Patients without an identifiable risk factor are often subject to extensive testing for primary and secondary thrombophilias. The purpose this paper is to review the literature to determine which of these tests is associated with central retinal vein occlusion. Antiphospholipid antibodies and elevated plasma homocysteine levels appear to be the tests associated most commonly in patients with central retinal vein occlusion in most controlled studies. Primary thrombophilias are found rarely when screening patients with central retinal vein occlusion. Extensive testing for thrombophilias is not warranted in the vast majority of patients with central retinal vein occlusion. Older patients with any of the common vascular risk factors do not require thrombophilic screening. By carefully selecting the patients who are evaluated for thrombophilias, the likelihood of finding true-positive tests is increased.
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Affiliation(s)
- J Michael Lahey
- Permanente Medical Group, Hayward, California, Department of Ophthalmology, Retinal Division, Union City, CA 94587, USA.
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Abstract
Central retinal vein occlusion is one of the commonest vascular diseases of the eye. The pathogenesis is multifactorial with both local factors and systemic diseases being aetiologically important. Many thrombophilic conditions have recently been identified and studies looking at their potential role in CRVO have been undertaken. The aim of this review is to critically appraise these studies as to date many have given conflicting results, making it far from clear what role thrombophilic conditions play in CRVO. It appears that hyperhomocysteinaemia and antiphospholipid syndrome are causes of CRVO and there is evidence that disorders causing hypofibrinolysis may also be important. The common hereditary thrombophilic conditions however do not appear to be strong risk factors but larger studies are needed for a definitive answer.
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Affiliation(s)
- C D Fegan
- Department of Haematology, Birmingham Heartlands Hospital, UK.
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Abstract
Occlusions of the retinal arterial and venous circulations are common causes of severe visual decline and can affect all age groups. Acute retinal arterial obstruction is often associated with critical cerebrovascular and cardiovascular disease that may require systemic treatment. Retinal venous obstruction may be the presentation of significant systemic hypertension, diabetes mellitus, and a greater risk for cardiovascular morbidity. Additional metabolic and hematologic abnormalities have been identified in patients with retinal occlusive disease. The authors review recent advances in the study of systemic conditions associated with retinal vascular occlusions and offer guidelines for appropriate medical evaluation of patients with retinal occlusive disease.
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Affiliation(s)
- F M Recchia
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
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