Risk factors for central retinal vein occlusion in young adults

Abstract

Purpose: Several risk factors have been identified for central retinal vein occlusion (CRVO) in older population. CRVO in young is uncommon, and the risk factors for this group are unclear. This large retrospective, cross-sectional study used the National Inpatient Sample (NIS) database to evaluate the risk factors for CRVO in patients 18 to 40 years of age. Methods: The 2002 to 2014 NIS database was used. All patients 18 to 40 years of age with a primary diagnosis of CRVO were identified. Age- and gender-matched non-CRVO controls were randomly selected. The primary outcome was identification of risk factors for CRVO. Chi-square analysis and Firth logistic regression were performed with IBM SPSS 23 and R packages versions 3.4.3, respectively. p < 0.05 was considered significant. Results: A total of 95 weighted young CRVO patients were identified. The average age was 31.44 ± 6.41 years with no gender predilection. Systemic and ocular conditions found to have statistically significant associations with CRVO included primary open-angle glaucoma (POAG) (OR 836.72, p < 0.001), retinal vasculitis (OR 705.82, p < 0.001), pseudotumor cerebri (OR 35.94, p < 0.001), hypercoagulable state (OR 25.25, p < 0.001), history of deep vein thrombosis/pulmonary embolism (DVT/PE) (OR 21.88, p < 0.001), and hyperlipidemia (OR 3.60, p = 0.003). Conclusion: The most significant risk factors for CRVO in young adults were POAG, retinal vasculitis, and pseudotumor cerebri. Hypercoagulable states and DVT/PE were also associated with CRVO in this population. Systemic inflammatory conditions were not associated with CRVO. Traditional risk factors such as hypertension and diabetes did not pose significant risks, whereas hyperlipidemia was deemed a significant risk factor.

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

“…Instead of glaucoma, there are other diseases which might be risk factors of RVO. Retinal vasculitis may be a more relevant risk factor in young CRVO patients ( 124 ). Central Serous Chorioretinopathy (CSCR) is idiopathic and often recurs.…”

Central Retinal Vein Occlusion in patients with COVID-19 infection: A systematic review

“…Thus, CRVO is generally considered a disease of the elderly. In younger patients, hypercoagulable state has been found to be significantly associated with CRVO; however, diabetes mellitus and hypertension were not significant [ 12 ]. Individuals with SARS-CoV-2 infection may have a number of coagulation abnormalities suggesting a hypercoagulable state, which has been called COVID-19 associated coagulopathy [ 13 ].…”

Hemi- and Central Retinal Vein Occlusion Associated with COVID-19 Infection in Young Patients without Known Risk Factors

“…In a series of 95 patients diagnosed with CRVO between 18 and 40 years of age, Chen et al identified that statistically significant (p<0.001) risk factors for CRVO in young adults included primary open angle glaucoma, retinal vasculitis, pseudotumor cerebri, hypercoagulable state, hyperlipidemia, and a prior history of venous thromboembolic disease. 54 , 55 Other studies have identified that CRVO in young adults may be linked to smoking, migraine headaches, collagen vascular disease, medications (oral contraceptives, diuretics, sympathomimetics), and thrombophilia. 49 , 55 , 56 , 57 , 58 , 59 , 60 Young adults presenting with RVO may need a hypercoagulability workup to exclude systemic coagulopathies requiring anticoagulation, such as protein C and S deficiency, Factor V Leiden mutation, hyperhomocysteinemia, antiphospholipid antibody syndrome, prothrombin gene mutation, antithrombin deficiency, hyperviscosity syndrome, amongst others.…”

“… 54 , 55 Other studies have identified that CRVO in young adults may be linked to smoking, migraine headaches, collagen vascular disease, medications (oral contraceptives, diuretics, sympathomimetics), and thrombophilia. 49 , 55 , 56 , 57 , 58 , 59 , 60 Young adults presenting with RVO may need a hypercoagulability workup to exclude systemic coagulopathies requiring anticoagulation, such as protein C and S deficiency, Factor V Leiden mutation, hyperhomocysteinemia, antiphospholipid antibody syndrome, prothrombin gene mutation, antithrombin deficiency, hyperviscosity syndrome, amongst others. 59 , 61 The patients included in the present series were negative for thrombophilia according to extensive laboratory evaluations done by the contributing ophthalmologists and the appropriate medical providers.…”