Prothrombotic states associated with retinal venous occlusion in young adults

Abstract

Background. The etiology of retinal venous occlusion in young patients is not well understood although thrombosis does occur histologically. A search for the risk factors that may lead to thrombosis is highly desirable may contribute to our understanding of the pathogenesis of this complication and may improve our therapeutic strategies. Methods. We studied 17 patients with retinal venous occlusion. All patients were under 45 years of age (mean 37.8 4-7.1). Antiphospholipid antibodies (APAs) and certain hemostatic factors were determined. The results obtained in these patients were compared to those of normal controls. Results. We found APAs in 8 out of 17 patients compared to 5 out of 60 controls (p = 0.0002). In patients with major trunk occlusion, there was a trend for the presence of APAs in those with poor visual acuity at presentation. Deficiencies of the coagulation inhibitor proteins C and S and antithrombin III activities were detected in 6 patients, and reduced levels of Factor XII were found in 4 patients. Levels of hematocrit, erythrocyte sedimentation rate, Fibrinogen, cq-globulin, and ct2-globulin were significantly higher in patients compared to the controls (p --0.019; 0.014; 0.0001; 0.011; 0.047), indicating increased blood viscosity in patients with retinal venous occlusion. Conclusion: Prothrombotic changes in the form of APAs and/or deficiencies of coagulation inhibitors and Factor XII may contribute to the etiology of retinal venous occlusion in young adults. Young patients with retinal venous occlusion should be evaluated for these prothrombotic states.

Central retinal vein occlusion and thrombophilia

“…These studies have shown a relatively consistent level of APS frequency in the control population of Ͻ5% but the Eye The two studies by Abu El-Asrar and colleagues (both of which showed a significant increased frequency of LA/ACA) stand out from virtually all other studies in that they also had a extremely high level of all thrombophilic abnormalities detected in their CRVO cohorts. 19,45 A total of 18 abnormalities in their earlier study of 17 patients and 46 abnormalities in 57 patients in their latter study were detected. In the study by Gleuk et al although a very high and significant difference in the incidence of LA was found, there was no difference at all in the incidence of ACA antibodies.…”

“…47 Branch retinal vein occlusion has also been studied with similar findings in terms of the role of APS to those found in the CRVO patients. 45,47 Thus in conclusion APS may play a role in CRVO but very disparate results have been obtained due to many studies probably lacking adequate statistical power.…”

Ischemic retinal vein occlusion: characterizing the more severe spectrum of retinal vein occlusion

“…Homocysteine level was significantly increased in patients with iCRVO when compared with that in non-iCRVO patients and control subjects (166) . Other reported potential associations include deficiencies of the coagulation inhibitor proteins C and S and antithrombin III, whereas the role of reduced levels of Factor XII remains controversial with some studies suggesting an association while others do not (8,23,160,278) .…”

Thrombophilia in Patients with Retinal Vein Occlusion: A Retrospective Analysis

“…In a multivariate analysis though there was no additive effect of elevated fibrinogen levels to the risk of RVO [28]. While several case-control studies did not find any significant differences between fibrinogen levels of RVO patients and controls [11,29,30,31,32], some smaller studies discovered significant differences [3,33,34,35]. High fibrinogen levels may create hypercoagulable states by increasing blood viscosity, red blood cell aggregation, velocity of platelet aggregation and platelet reactivity.…”