Younger patients had better baseline and final acuities, a lower incidence of cystoid macular edema at presentation, and received fewer intravitreal injections than older patients. Workup for etiology of CRVO in younger patients may reveal nontraditional risk factors for CRVO.

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Purpose: The purpose of this article is to evaluate the effect of systemic medications and glycemic control on the visual outcome and treatment burden in patients with diabetes and branch retinal vein occlusion (BRVO). Methods: A retrospective review was performed for patients with diabetes diagnosed with a BRVO at an academic eye center from 2009 to 2017. The use of select antihypertensives, antiplatelet agents, anticoagulants, and hypoglycemics was reviewed. Data on visual acuity (VA), central subfield thickness (CST), treatment course, and hemoglobin (Hb)A1c were obtained throughout follow-up. Results: A total of 121 eyes met criteria with a median follow-up duration of 19.4 months. The mean baseline logarithm of the minimum angle of resolution (logMAR) VA was 0.56 (Snellen equivalent, 20/72) and mean final logMAR VA was 0.5 (20/63). At final follow-up, aspirin 325 mg was associated with 4.8 fewer injections (n = 13, P = .04), insulin was associated with 3.6 more injections (n = 26, P = .04), warfarin was associated with a 79 µm increase in CST ( P = .02), and a 1% increase in HbA1c was associated with 0.86 more injections ( P < .01). Conclusions: The VA outcome of BRVO in diabetics may be worse than that of BRVO in nondiabetics. Worse diabetic control was associated with a higher treatment burden. High-dose aspirin was associated with fewer injections.

ADP-forming acetyl-CoA synthetase (ACD) catalyzes the interconversion of acetyl-CoA and acetate. The related succinyl-CoA synthetase follows a three-step mechanism involving a single phosphoenzyme, but a novel four-step mechanism with two phosphoenzyme intermediates was proposed for Pyrococcus ACD. Characterization of enzyme variants of Entamoeba ACD in which the two proposed phosphorylated His residues were individually altered revealed that only His252 is essential for enzymatic activity. Analysis of variants altered at two residues proposed to interact with the phosphohistidine loop that swings between distinct parts of the active site are consistent with a mechanism involving a single phosphoenzyme intermediate. Our results suggest ACDs with different subunit structures may employ slightly different mechanisms to bridge the span between active sites I and II.

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