Thrombophilia and retinal vascular occlusion

Charles J Glueck,1 Robert K Hutchins,2,3 Joel Jurantee,1 Zia Khan,1 Ping Wang11Cholesterol Center, Jewish Hospital of Cincinnati, Cincinnati, OH, USA; 2Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, OH, USA; 3Cincinnati Eye Institute, Cincinnati, OH, USAPurpos...

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Autores principales:	Glueck CJ, Hutchins RK, Jurantee J, Khan Z, Wang P
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2012
Materias:	Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/d6f046a07a79486b91dfdab80c2cba50
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spelling	oai:doaj.org-article:d6f046a07a79486b91dfdab80c2cba502021-12-02T03:11:36ZThrombophilia and retinal vascular occlusion1177-54671177-5483https://doaj.org/article/d6f046a07a79486b91dfdab80c2cba502012-08-01T00:00:00Zhttp://www.dovepress.com/thrombophilia-and-retinal-vascular-occlusion-a10847https://doaj.org/toc/1177-5467https://doaj.org/toc/1177-5483Charles J Glueck,1 Robert K Hutchins,2,3 Joel Jurantee,1 Zia Khan,1 Ping Wang11Cholesterol Center, Jewish Hospital of Cincinnati, Cincinnati, OH, USA; 2Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, OH, USA; 3Cincinnati Eye Institute, Cincinnati, OH, USAPurpose: The purpose of this research was to assess associations of thrombophilia with central retinal vein occlusion (CRVO), central retinal artery occlusion (CRAO), and amaurosis fugax (AF); to evaluate outcomes of normalizing high homocysteine; and to study CRVO, CRAO, and AF developing in estrogens/estrogen agonists in women subsequently shown to have thrombophilia.Methods: Measures of thrombophilia&ndash;hypofibrinolysis were obtained in 132 CRVO cases, 15 CRAO cases, and 17 AF cases. Cases were compared to 105 healthy control subjects who did not differ by race or sex and were free of any ophthalmologic disorders. All cardiovascular disease (CVD) risk factors were compared to healthy general populations.Main outcome measures: The main outcome measure of this study was thrombophilia.Results: CRVO cases were more likely than controls to have high homocysteine (odds ratio [OR] 8.64, 95% confidence intervals [CI]: 1.96&ndash;38), high anticardiolipin immunoglobulin M (IgM; OR 6.26, 95% CI: 1.4&ndash;28.2), and high Factor VIII (OR 2.47, 95% CI: 1.31&ndash;7.9). CRAO-AF cases were more likely than controls to have high homocysteine (OR 14, 95% CI: 2.7&ndash;71.6) or the lupus anticoagulant (OR 4.1, 95% CI: 1.3&ndash;13.2). In four of 77 women with CRVO (two found to have high homocysteine, two with inherited high Factor XI), CRVO occurred after starting estrogen&ndash;progestins, estrogen&ndash;testosterone, or estrogen agonists. In one of eight women with CRAO found to have high anticardiolipin antibody IgG, CRAO occurred after starting conjugated estrogens, and AF occurred after starting conjugated estrogens in one of eleven women with AF (inherited protein S deficiency). Therapy for medians of 21 months (CRVO) and 6 months (CRAO-AF) was 5 mg folic acid, 100 mg B6, and 2000 mcg/day B12 normalized homocysteine in 13 of 16 (81%) CRVO cases and all five CRAO-AF cases with pretreatment hyperhomocysteinemia. The CRVO cases had an excess of hypertension; CRAO-AF cases had an excess of type 2 diabetes and hypertension.Conclusion: Treatable thrombophilia, hyperhomocysteinemia in particular, is more common in RVO cases than in normal controls. RVO occurs after estrogens or estrogen agonists were administered in women subsequently shown to have thrombophilia.Keywords: central retinal vein occlusion, central retinal artery occlusion, amaurosis fugax, retinal vascular occlusion, thrombophilia, estrogen, estrogen agonistGlueck CJHutchins RKJurantee JKhan ZWang PDove Medical PressarticleOphthalmologyRE1-994ENClinical Ophthalmology, Vol 2012, Iss default, Pp 1377-1384 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Ophthalmology RE1-994
spellingShingle	Ophthalmology RE1-994 Glueck CJ Hutchins RK Jurantee J Khan Z Wang P Thrombophilia and retinal vascular occlusion
description	Charles J Glueck,1 Robert K Hutchins,2,3 Joel Jurantee,1 Zia Khan,1 Ping Wang11Cholesterol Center, Jewish Hospital of Cincinnati, Cincinnati, OH, USA; 2Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, OH, USA; 3Cincinnati Eye Institute, Cincinnati, OH, USAPurpose: The purpose of this research was to assess associations of thrombophilia with central retinal vein occlusion (CRVO), central retinal artery occlusion (CRAO), and amaurosis fugax (AF); to evaluate outcomes of normalizing high homocysteine; and to study CRVO, CRAO, and AF developing in estrogens/estrogen agonists in women subsequently shown to have thrombophilia.Methods: Measures of thrombophilia&ndash;hypofibrinolysis were obtained in 132 CRVO cases, 15 CRAO cases, and 17 AF cases. Cases were compared to 105 healthy control subjects who did not differ by race or sex and were free of any ophthalmologic disorders. All cardiovascular disease (CVD) risk factors were compared to healthy general populations.Main outcome measures: The main outcome measure of this study was thrombophilia.Results: CRVO cases were more likely than controls to have high homocysteine (odds ratio [OR] 8.64, 95% confidence intervals [CI]: 1.96&ndash;38), high anticardiolipin immunoglobulin M (IgM; OR 6.26, 95% CI: 1.4&ndash;28.2), and high Factor VIII (OR 2.47, 95% CI: 1.31&ndash;7.9). CRAO-AF cases were more likely than controls to have high homocysteine (OR 14, 95% CI: 2.7&ndash;71.6) or the lupus anticoagulant (OR 4.1, 95% CI: 1.3&ndash;13.2). In four of 77 women with CRVO (two found to have high homocysteine, two with inherited high Factor XI), CRVO occurred after starting estrogen&ndash;progestins, estrogen&ndash;testosterone, or estrogen agonists. In one of eight women with CRAO found to have high anticardiolipin antibody IgG, CRAO occurred after starting conjugated estrogens, and AF occurred after starting conjugated estrogens in one of eleven women with AF (inherited protein S deficiency). Therapy for medians of 21 months (CRVO) and 6 months (CRAO-AF) was 5 mg folic acid, 100 mg B6, and 2000 mcg/day B12 normalized homocysteine in 13 of 16 (81%) CRVO cases and all five CRAO-AF cases with pretreatment hyperhomocysteinemia. The CRVO cases had an excess of hypertension; CRAO-AF cases had an excess of type 2 diabetes and hypertension.Conclusion: Treatable thrombophilia, hyperhomocysteinemia in particular, is more common in RVO cases than in normal controls. RVO occurs after estrogens or estrogen agonists were administered in women subsequently shown to have thrombophilia.Keywords: central retinal vein occlusion, central retinal artery occlusion, amaurosis fugax, retinal vascular occlusion, thrombophilia, estrogen, estrogen agonist
format	article
author	Glueck CJ Hutchins RK Jurantee J Khan Z Wang P
author_facet	Glueck CJ Hutchins RK Jurantee J Khan Z Wang P
author_sort	Glueck CJ
title	Thrombophilia and retinal vascular occlusion
title_short	Thrombophilia and retinal vascular occlusion
title_full	Thrombophilia and retinal vascular occlusion
title_fullStr	Thrombophilia and retinal vascular occlusion
title_full_unstemmed	Thrombophilia and retinal vascular occlusion
title_sort	thrombophilia and retinal vascular occlusion
publisher	Dove Medical Press
publishDate	2012
url	https://doaj.org/article/d6f046a07a79486b91dfdab80c2cba50
work_keys_str_mv	AT glueckcj thrombophiliaandretinalvascularocclusion AT hutchinsrk thrombophiliaandretinalvascularocclusion AT juranteej thrombophiliaandretinalvascularocclusion AT khanz thrombophiliaandretinalvascularocclusion AT wangp thrombophiliaandretinalvascularocclusion
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Thrombophilia and retinal vascular occlusion

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