Thrombus and branch retinal vein occlusion

Baglivo, Edoardo; Dosso, A. A.; Pournaras, Constantin J.

doi:10.1007/bf01007831

Cited by 10 publications

(9 citation statements)

References 12 publications

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“…The pathomechanisms described above raise some questions that are listed below: If we assume the mechanical compression of the vein being important: Why is a BRVO sometimes reversible [19]?Why do BRVOs not always occur at A/V crossings [19]?Why is a distinct vein compression histologically not always visible [20]?Why do we only extremely rarely find a thrombus [4, 21, 22]? And if a thrombus is present why do we find it rather downstream of A/V crossings [23]?…”

Section: Open Questions Challenging the Present Conceptsmentioning

confidence: 99%

Retinal vein occlusions: The potential impact of a dysregulation of the retinal veins

2010

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A retinal vein occlusion (RVO) is a sight threatening disease. It can be divided into central vein occlusion and branch retinal vein occlusion. The pathogenesis of the condition remains to be solved. Mechanical compression of the vessel wall or thrombotic occlusion of the vessel lumen, sometimes combined with rheological disorders, are often assumed pathomechanisms. Accordingly, the therapy relies either on mechanical decompression, lyses of thrombi or improvement of rheology. A number of observations however, such as the relationship of RVO to atherosclerotic risk factors, spontaneous reversibility particularly in young patients, rest flow observed in angiography, occlusion despite anticoagulation or thrombocytopenia and finally the positive effect of anti-VEGF therapy are not explained by the present pathogenetic concept. As a new concept we propose a local venous constriction induced by vasoconstrictive molecules diffusing from neighbouring diseased arteries and/or from other neighbouring (hypoxic) tissues. Recognizing these postulated conditions might lead to an earlier identification of impending vein occlusions as well as to a treatment more tailored to the risk factor constellation of the particular patient.

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Section: Open Questions Challenging the Present Conceptsmentioning

confidence: 99%

Retinal vein occlusions: The potential impact of a dysregulation of the retinal veins

2010

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“…Retinal vascular occlusions may be due to a combination of various mechanisms such as degenerative changes of the vessel wall, abnormal hematological factors or an abnormal perivascular status. It is most likely that the majority of retinal vascular occlusions, particularly in elderly patients, are primarily secondary to underlying cardiovascular diseases [1,2,26,29,30]. Hence, it seems plausible that screening for thrombophilic disorders in patients with retinal vein or artery occlusion should be selective.…”

Section: Introductionmentioning

confidence: 98%

High prevalence of resistance to APC in young patients with retinal vein occlusion

Kuhli

Hattenbach

Scharrer

et al. 2002

Graefe's Arch Clin Exp Ophthalmol

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Resistance to activated protein C (APC) is among the coagulation disorders that have been implicated in retinal vein occlusion. However, since retinal vascular occlusions may be due to a combination of several mechanisms, the question of whether thrombophilic anomalies are pathogenic for this disorder remains controversial. In the current study, we investigated the prevalence of APC resistance in patients with retinal vein occlusion with reference to age and various cardiovascular risk factors. A cohort of 142 consecutive patients with retinal vein occlusion and a control group of 128 subjects matched for age, sex and several risk factors were screened for resistance to APC. Both cohorts were divided into two subgroups, according to the patient's age (< or =45 or >45 years) at the time of the retinal vein occlusion or a previous thromboembolic event. The proportion of individuals with resistance to APC was higher in the patient group (13 of 142; 9.1%) when compared to controls (6 of 128; 4.7%). Moreover, patient age < or =45 years by the time of the retinal vein occlusion or a previous thromboembolic event was significantly associated with a high prevalence of APC resistance (17%). By contrast, resistance to APC was present in 5 of 95 cases (5.3%) in the patient group >45 years and in 4 of 83 (4.8%) young controls. Our results indicate that APC resistance is highly prevalent in patients with retinal vein occlusion at age < or =45 years and/or with a history of thrombosis at this age. By contrast, the prevalence of APC resistance in patients who suffered a retinal vein occlusion when they were older than 45 years and had no history of thromboembolism appears to be similar to that seen in healthy control subjects or in the normal population. Selective screening may be helpful in identifying retinal vein occlusion patients with thrombophilic defects.

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“…BRVOs occur at an arteriovenous crossing, with strong evidence that an intravenous thrombus is the penultimate cause of the occlusion to venous outflow and that there is further active propagation of the thrombus downstream. [8][9][10] It is this occlusion that is responsible for the delay in retinal blood flow through the occluded segment and the subsequent VEGF upregulation and elevation in hydrostatic pressure that produce the retinal changes seen clinically. 32 Results from the BRAVO and subsequent extension studies have shown that the VEGF upregulation can be controlled with intraocular injections of ranibizumab with good initial effects on visual acuity; however, injections in many patients need to be continued for years.…”

Section: Discussionmentioning

confidence: 99%

“…It is thought that the thickened and rigid arteriosclerotic arterial wall compresses the vein, resulting in turbulence in blood flow and endothelial damage leading to the formation of a local thrombus. [8][9][10] The evidence that a thrombus is the cause of the obstruction to the venous outflow in BRVO is much stronger than in central retinal vein occlusion (CRVO), where both the cause and site of the venous obstruction still remain controversial. [11][12][13] The largest histopathological study of BRVOs showed evidence of a fresh or recanalized thrombus within the retinal vein at the site of the obstruction in all nine cases examined.…”

mentioning

confidence: 99%

Intravitreal Tenecteplase (Metalyse) for Acute Management of Retinal Vein Occlusions

McAllister

Vijayasekaran

2013

Invest. Ophthalmol. Vis. Sci.

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Thrombus and branch retinal vein occlusion

Cited by 10 publications

References 12 publications

Retinal vein occlusions: The potential impact of a dysregulation of the retinal veins

Retinal vein occlusions: The potential impact of a dysregulation of the retinal veins

High prevalence of resistance to APC in young patients with retinal vein occlusion

Intravitreal Tenecteplase (Metalyse) for Acute Management of Retinal Vein Occlusions

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