Abstract
Purpose To investigate whether the risk of subsequent stroke, ischemic stroke, hemorrhagic stroke, and all-cause mortality is increased among retinal vein occlusion (RVO) patients compared to non-RVO patients. Methods From the entire population of the Taiwan National Health Insurance Research Database (NHIRD) from 2001 to 2013, a total of 22919 subjects with RVO were enrolled in the RVO group, and 114595 propensity score (PS)-matched non-RVOs were enrolled in the comparison group. PS matching was based on age, gender, obesity, diabetes, hypertension, hyperlipidemia, coronary artery disease, atrial fibrillation, hyperviscosity syndrome, Charlson comorbidity index, glaucoma, and the use of antithrombotic drugs. A multivariate Cox regression analysis was used to estimate the adjusted hazard ratios (HRs) with a 95% confidence interval (CI) for each of the clinical outcomes, including stroke, ischemic stroke, hemorrhagic stroke, and all-cause mortality. Furthermore, we divided the RVO group into the branch retinal vein occlusion (BRVO) group and the central retinal vein occlusion (CRVO) group and separately compared their subsequent risks of the clinical outcomes with those of the comparison group. Results After adjusting for PS, the RVO group had a significantly higher risk of stroke (adjusted HR = 1.36; 95% CI: 1.32–1.40), ischemic stroke (adjusted HR = 1.36; 95% CI: 1.32–1.40), and hemorrhagic stroke (adjusted HR = 1.34; 95% CI: 1.24–1.44). However, the all-cause mortality did not exhibit significant differences. Furthermore, both the BRVOs and CRVOs had a significantly higher risk of subsequent stroke, ischemic stroke, and hemorrhagic stroke than did the comparisons, whereas all-cause mortality was similar among the groups. Conclusions People with RVO are at a significantly greater risk of developing stroke, ischemic stroke, and hemorrhagic stroke. However, RVO does not significantly increase the risk of all-cause mortality.
Highlights
Retinal vein occlusion (RVO) is the second most common retinal vascular disease
Depending on the site of occlusion, RVO can be classified as either branch RVO (BRVO) or central RVO (CRVO). e risk factors for RVO include hypertension, diabetes, hyperlipidemia, arteriosclerosis, and older age [3,4,5,6,7,8,9]. ese are risk factors for stroke or mortality
In the Beijing Eye Study, the RVO was significantly associated with an increased mortality rate [19]. ese conflicting results should be explored. erefore, in our study, we further investigated the association between RVO and all-cause mortality
Summary
Retinal vein occlusion (RVO) is the second most common retinal vascular disease. It results from thrombosis of the retinal vein due to external compression by an atherosclerotic artery or increased blood viscosity [1, 2]. Erefore, it is important to investigate the Journal of Ophthalmology relationship between RVO and the subsequent risk of stroke or mortality. Previous population-based studies on the association between RVO and stroke revealed conflicting findings. Studies in the USA, Denmark, and Korea revealed a significantly higher risk of stroke among RVO patients [3,12,13,14]. Erefore, in our study, we used the NHIRD with the entire population in Taiwan to include a sufficient number of RVO patients. We evaluated ischemic stroke and hemorrhagic stroke separately Another outcome variable that we wanted to explore was all-cause mortality. In the Beijing Eye Study, the RVO was significantly associated with an increased mortality rate [19]. Erefore, in our study, we further investigated the association between RVO and all-cause mortality In the Beijing Eye Study, the RVO was significantly associated with an increased mortality rate [19]. ese conflicting results should be explored. erefore, in our study, we further investigated the association between RVO and all-cause mortality
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