Abstract
BackgroundRetinal vein thrombosis has in case reports been reported a clinical sign of cancer, especially hematological cancer. However, it is unclear whether retinal vein thrombosis is a marker of underlying cancer, as is the case for deep venous thrombosis and pulmonary embolism. We investigated the risk of occult cancer in patients with retinal vein thrombosis.MethodsA nationwide population‐based cohort study in Denmark on all patients diagnosed with a retinal vein thrombosis during 1994 and 2013. The main outcome measures were any cancer and site‐specific cancers <6 months, 6‐12 months, and 5 years following a retinal vein thrombosis diagnosis, as registered in the Danish Cancer Registry and the National Pathology Registry. We calculated the absolute cancer risk and computed standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) for cancer within <6 months, 6‐12 months, and 5 years following a retinal vein thrombosis diagnosis.ResultsAmong 9589 patients with retinal vein thrombosis, we observed 1514 cancer cases. The risk of any cancer was 1.2% <6 months and 28.8% after 5 years. The <6 months SIR was 1.20 (95% CI 0.99‐1.44), 6‐12 months SIR was 1.15 (95% CI 0.94‐1.39), and the 5 years’ SIR was 1.08 (95% CI 1.03‐1.14). Stratification by age, gender, calendar year, and Charlson Comorbidity Index score did not change overall cancer risk estimates.ConclusionRetinal vein thrombosis was not an important clinical marker for occult cancer. An extensive diagnostic cancer workup does not appear warranted for retinal vein thrombosis patients.
Highlights
Retinal vein thrombosis is the second most common cause of vision loss after diabetic retinopathy.[1]
The relative cancer risk beyond the first year following retinal vein thromboses was comparable with the cancer risk reported for deep venous thrombosis.[8]
Previous case reports suggesting an association between retinal vein thrombosis and hematological cancers could not be confirmed.[2,3,10,14,15,16,17]
Summary
Retinal vein thrombosis is the second most common cause of vision loss after diabetic retinopathy.[1] Risk factors include atherosclerosis, advanced age, hypertension, diabetes, and hyperlipidemia,[1,2,3,4] which increase the propensity for deep venous thromboembolism and pulmonary embolism. Cancer induces a systemic pro‐coagulant state, which increases the risk of venous thromboembolism.[5,6] venous thromboembolism in the lower extremities and the lungs are markers of cancer.[7,8,9,10,11,12,13] Several case reports have suggested that retinal vein thrombosis may be a clinical sign of cancer, especially hematological cancers,[2,3,10,14,15,16,17] but firm epidemiological evidence is lacking. | 5790 involve direct neoplastic infiltration leading to impaired drainage and obstruction of the retinal veins, as well as dehydration and hyperviscosity caused by the cancer.[1,2,3,16,18] To investigate these suppositions, we examined the risk of cancer following a retinal vein thrombosis compared with cancer risk in the general population
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