Évaluation du bilan étiologique des occlusions veineuses rétiniennes du sujet âgé de moins de 60 ans

Abstract

To assess the biologic factors contributing to the risk for cardiovascular and coagulation problems in patients under 60 years of age with retinal vein occlusions (RVOs) in order to determine the advantages of an exhaustive etiologic search.Observational and retrospective study on 43 patients under the age of 60, 30 of whom presented central or hemicentral retinal vein occlusions; 13 were affected with branch retinal vein occlusions. All patients received a systematic check-up including blood pressure measurement, blood cholesterol level, carotid Doppler imaging, intraocular pressure measurement and glaucoma history, presence of thrombophilic factors (protein C/S, activated protein C resistance, antiphospholipid antibodies), and presence of disturbed homocysteine metabolism. A systemic medical history was also taken.The most frequent factors associated with central retinal vein occlusion (CRVO) were hyperhomocysteinemia (33%), arterial hypertension (23%), hypercholesterolemia (20%), open-angle glaucoma or intraocular hypertension (13%), and diabetes (10%). As for branch retinal vein occlusion, the only notable risk factors were arterial hypertension and hypercholesterolemia (46.2% and 38.5%, respectively).and conclusion: Our results are consistent with etiologic data of RVO already reported in the literature. They further underline that there is little advantage to an exhaustive etiologic investigation to detect thrombophilia in the absence of a suggestive medical history. Finally, our data suggest the benefit of checking for hyperhomocysteinemia, frequently found in patients with CRVO, and easily correctable with a vitamin supplement.