History Of Retinal Vein Occlusion Research Articles

Cumulative effect of metabolic syndrome on the risk of retinal vein occlusion in young patients: A nationwide population-based study.

This study aimed to investigate the impact of the cumulative burden of metabolic syndrome (MetS) on the incidence of retinal vein occlusion (RVO) in young adults. We included 1,408,093 subjects aged ≥20 and <40 years without a history of RVO who underwent four consecutive annual health examinations during 2009-2012 from the database of the Korean National Health Insurance Service. The metabolic burden was evaluated based on the cumulative number of MetS diagnoses at each health examination (0-4 times) and the cumulative number of each MetS component diagnosed at each health examination (0-4 times per MetS component). Cox proportional hazards models were used to estimate the risk of RVO according to metabolic burden. The risk of RVO was positively correlated with the cumulative number of MetS diagnoses over the four health examinations. All five MetS components were independently associated with an increased risk of RVO. Subgroup analysis for the impact of MetS on RVO occurrence revealed that MetS had a greater impact on female subjects (P <0.001). Prompt detection of metabolic derangements and their treatment might be important to decrease the risk of RVO in young adults, especially women.

Retinal vein occlusion in patients with primary angle closure: a prospective case–control study

ObjectifComparer la prévalence de la fermeture de l'angle dans des yeux présentant une occlusion veineuse rétinienne (OVR) et dans des yeux témoins, d'une part, et vérifier s'il existe une association entre la fermeture de l'angle et l'OVR, d'autre part. Patients et méthodesCette étude cas-témoins prospective qui a été réalisée à l'insu regroupait des patients ayant des antécédents d'OVR (cas cliniques) et des sujets témoins appariés pour l’âge et l'erreur de réfraction. Ont été analysées les caractéristiques cliniques des patients et les images des structures de l'angle obtenues par tomographie par cohérence optique (OCT) du segment antérieur. RésultatsAinsi, 88 patients (44 par groupe) ont été inclus dans notre étude. L’âge moyen des sujets dans les groupe OVR et témoin était de 59,8 ± 11,6 ans et de 60,8 ± 9,0 ans, respectivement (p = 0,667). Il n'y avait pas de différence statistiquement significative entre les 2 groupes quant aux caractéristiques cliniques, notamment la pression intraoculaire (p = 0,837) et la classification de Shaffer (p = 0,620). Aucune des caractéristiques des structures de l'angle visibles dans les images de l'OCT du segment antérieur ne différait significativement d'un groupe à l'autre. Le nombre de diagnostics de fermeture de l'angle relevés dans le groupe OVR (1 cas de fermeture primaire de l'angle et 7 suspicions de fermeture primaire de l'angle) et dans le groupe témoin (6 suspicions de fermeture primaire de l'angle) ne différait pas de manière significative (p = 0,560). La profondeur de la chambre antérieure (PCA) était moins prononcée dans les yeux atteints d'OVR (2,72 ± 0,31 mm) que dans les yeux controlatéraux exempts d'OVR (2,76 ± 0,31 mm; p = 0,014). ConclusionsCette étude prospective à l'insu comprenant des cas-témoins appariés n'a pas mis au jour de différence significative quant aux mesures cliniques ni aux images des structures de l'angle obtenues à l'OCT du segment antérieur dans des yeux présentant une OVR, comparativement à des yeux témoins. Cela dit, la PCA était légèrement moins prononcée dans les yeux atteints d'OVR que dans les yeux controlatéraux exempts d'OVR. D'après l'ensemble des résultats obtenus, il est peu probable qu'il existe une association entre les mécanismes à l'origine de la fermeture primaire de l'angle et l'OVR. Cependant, la PCA moins prononcée observée en présence d'OVR pourrait accroître le risque de blocage pupillaire intermittent ou permanent.

Risk of Pseudophakic Cystoid Macular Edema in Fellow-Eye Cataract Surgeries: A Multicenter Database Study

To quantify the risk of pseudophakic cystoid macular edema (pCME) in fellow-eye cataract surgery and to determine risk factors, including prior first-eye pCME. Retrospective, clinical database study. Patients undergoing bilateral nonsimultaneous cataract surgeries in 8 UK National Health Service clinical centers between July 2003 and March2015. We excluded patients with a history of diabetic macular edema (DME) or CME and perioperative topical nonsteroidal anti-inflammatory drug use in either eye. We calculated the overall risk of pCME and used Poisson model with robust estimation of standard error to identify potential risk factors for pCME in the fellow eye. The risk of postoperative clinical pCME in the fellow eye. A total of 54 209 patients were included. The mean age was 74.6 ± 10.4 years, and 38.8% were male. The fellow eye developed pCME in 544 patients (1%). The risk of fellow-eye pCME among patients without first-eye pCME was 0.9%. However, the risk of fellow-eye pCME among those with first-eye pCME was 10.7%. In the fully adjusted model, we found that the risk factors for the development of fellow-eye pCME were first-eye pCME (RR, 8.55, 95% confidence interval [CI], 6.19-11.8), epiretinal membrane (ERM) (RR, 4.1, CI, 2.63-6.19), history of retinal vein occlusion (RR, 2.94, CI, 1.75-4.93), diabetes without history of DME (RR, 2.08, CI, 1.73-2.5), advanced cataract (RR, 1.75, CI, 1.16-2.65), prostaglandin analogue use preoperatively (RR, 1.49, CI, 1.13-1.97), and male sex (RR, 1.19, CI, 1.0-1.41). History of pCME in the first-operated eye is the strongest independent risk factor for the development of pCME in the fellow eye. Our findings may guide clinicians in counseling patients on the risk of pCME before performing cataract surgery in the fellow eye and help in identifying high-risk patients who may benefit from prophylactic therapy. Proprietary or commercial disclosure may be found after the references.

1198TiP A phase Ib/II open-label, nonrandomized study of FGFR inhibitor futibatinib in combination with MEK inhibitor binimetinib in patients with advanced KRAS-mutant cancer

Treatment options for patients (pts) with KRAS-mutant (KRASmt) cancer, including non–small cell lung cancer (NSCLC), are limited. Combination of MEK inhibitors (MEKi) plus futibatinib had synergistic antitumor activity in different KRASmt NSCLC cell lines. An open-label, nonrandomized phase 1b/2 study (NCT04965818) is being conducted to assess the safety and preliminary antitumor activity of futibatinib plus MEKi binimetinib in pts with KRASmt advanced NSCLC. This phase 1b/2 study contains 2 parts. In the phase Ib dose escalation part, the recommended phase II dose (RP2D) and regimen of futibatinib plus binimetinib in pts with advanced cancer (part 1) will be determined. In the phase II part, pts with KRASmt advanced NSCLC will be enrolled in a cohort of 18 pts to evaluate the preliminary antitumor activity of futibatinib plus binimetinib at the RP2D and regimen (part 2). Pts eligible for part 1 may have any type of advanced cancer for which no other treatment options are available. Pts with KRASmt advanced NSCLC in part 2 must have their KRAS mutation determined by local results from a tumor tissue specimen and have had disease progression on prior standard of care therapy including anti–PD-(L)1 therapy and platinum-based chemotherapy. Key exclusion criteria include any history of known phosphate homeostasis disorder and current evidence of any clinically significant retinal or corneal disorder and any history of retinal vein occlusion. The primary objective is to determine an RP2D based on safety, preliminary activity, and PK/PD results (part 1) and to assess the preliminary antitumor activity of the combination in pts with KRASmt advanced NSCLC based on objective response rate by RECIST 1.1 (part 2). Secondary endpoints include pharmacokinetic parameters, duration of response, disease control rate at 24 weeks, and progression-free survival. Exploratory objectives include correlative analysis to explore biomarkers related to tumor biology and their potential associations with antitumor activity and resistance to the study medications (including circulating tumor DNA). The study was initiated September 2021 and is ongoing. NCT04965818. Professional medical writing and editorial assistance were provided by Tracy Diaz, PhD, and Jennifer Robertson, PhD, at Ashfield MedComms, an Ashfield Health company, and funded by Taiho Oncology, Inc. Taiho Oncology, Inc.

P1065: CONGENITAL ERYTHROCYTOSIS DUE TO HETEROZYGOUS VARIANTS IN THE BISPHOSPHOGLYCERATE MUTASE GENE

Background: Congenital erythrocytosis is an inherited condition characterized by increased red blood cell mass, reflected by persistently elevated hemoglobin (Hb) and hematocrit levels. Erythrocytosis can be primary due to an intrinsic defect of erythropoiesis, or secondary, including germline variants in genes involved in the oxygen-sensing pathway and Hb variants with altered oxygen affinity. A very rare cause involves variants in bisphosphoglyerate mutase (BPGM), which regulates the red blood cell concentration of 2,3-bisphosphoglycerate (2,3-BPG), an important modifier of Hb-oxygen affinity. Aims: We report three European families with erythrocytosis and partial BPGM deficiency due to heterozygosity for variants in the BPGM gene, including one novel variant. Methods: The study was performed on adults of three families with JAK2-negative erythrocytosis. DNA analysis concerned sequencing of relevant coding exons, including flanking splice-site consensus sequences, of the eight major genes involved in secondary congenital erythrocytosis (EPOR, HBB, HBA1, HBA2, VHL, EPAS1, ELGN1, and BPGM). Identified variants were evaluated using Ensembl, gnomAD, PolyPhen-2, and SIFT. BPGM enzyme activity was determined as described by Beutler. Quantitative analysis of 2,3-BPG was performed using liquid chromatography tandem mass spectrometry. Hb-oxygen affinity, reflected by p50 levels (the oxygen pressure when Hb is 50% saturated with oxygen), was analyzed using the Hemox Analyzer (TCS Scientific). Results: In the first family (Table 1), a novel missense variant (c.535C>T p.(Arg179Cys) was identified in BPGM. Both the 65-year-old mother with complaints of headaches, and her 39-year-old son with a medical history of retinal vein occlusion were heterozygous for this variant. Allele frequency in gnomAD was 3.98-5. The predicted effect ranged from either deleterious (SIFT) to benign (HumVar model of Polyphen-2). Subsequent functional analysis showed low-normal BPGM activity, whereas 2,3-BPG and p50 levels were decreased (Table 1). In the second and third families, three male individuals were heterozygous for the c.269G>A p.(Arg90His) missense variant in BPGM. This variant was only once previously reported, and has an allele frequency of 1.06-5. All affected subjects had mild erythrocytosis without any additional clinical features, and showed decreased BPGM activity, decreased 2,3-BPG levels and decreased p50 (Table 1). Image:Summary/Conclusion: We describe five individuals from three families in which heterozygosity for missense variants in BPGM is associated with congenital erythrocytosis. Our findings further strengthen the hypothesis of an autosomal dominant inheritance pattern of BPGM variants. Our data also demonstrate the added value of functional analyses to validate gene panel and in silico analysis results for their clinical relevance. Future cases may help to interpret the impact of BPGM variants on hematological and clinical phenotype.

Risk factors in central retinal vein occlusion: A multi-center case-control study conducted on the Italian population : Demographic, environmental, systemic, and ocular factors that increase the risk for major thrombotic events in the retinal venous system.

To explore the risk factors for central retinal vein occlusion (CRVO) by comparing a large sample of patients with healthy controls. Multi-center case-control study. The study group includes patients affected by central retinal vein occlusion, confirmed angiographically, aged 50 years old or above (Group A). The control group includes healthy subjects without an history of retinal vein occlusion (Group B). Outcome measures: age, gender, active smoking, presence of uncontrolled arterial hypertension (uHTN), presence of the following comorbidities: diabetes mellitus type II (DMII), chronic liver disease (CLD), chronic kidney disease (CKD), thyroid disease (TD), systemic lupus erythematosus (SLE), hyperhomocystenemia (HHcy), dyslipidemia (DLip), carotid artery disease (CAD), glaucoma, atrial fibrillation (AF), migraine headache (MH), chronic obstructive pulmonary disease (COPD), obstructive sleep apnea syndrome (OSAS), history of myocardial infarction (MI). Odds-ratios were calculated with logistic regression analysis. A total of 203 patients (Group A) and 339 controls (Group B). Statistically-significant differences were found for the following variables: age (OR: 1.109 [1.081-1.138], p < .001), active smoking (OR: 2.048 [1.210- 3.466], p < .008), DMII (OR: 4.533 [2.097-9.803], p < .001), HHcy (OR: 4.507 [2.477-10.001 ], p < .001), DLip (OR: 2.255 [1.352-3.762], p = .002), CAD (OR: 6.632 [2.944- 14.942], p < .001), glaucoma (OR: 4.656 [2.031-10.673], < .001), OSAS (OR: 1.744 [1.023-2.975], < .041), uHTN (OR: 3.656 [2.247-5.949], < .001). No statistically-significant differences were found for the other variables. Older age, active smoking, as well as presence of DMII, HHcy, DLip, CAD, glaucoma, OSAS, and uHTN, all increase the risk for CRVO. A comprehensive assessment of patients with CRVO is paramount. Adequate control of all the aforementioned risk factors is likely of great significance in reducing the incidence of CRVO among the general population, and it likely plays an important role in improving the prognosis following the occlusive event.

Pachychoroid disease and its association with retinal vein occlusion: a case\u2013control study

The development of a retinal vein occlusion (RVO) is multifactorial. This study investigates pachychoroid as a risk factor for RVO or as an entity sharing common pathophysiology with RVO. A database screening at the University Eye Hospital, Ludwig-Maximilian University Munich, Germany was performed for patients diagnosed with central or branch RVO (CRVO/BRVO). In every patient a complete ophthalmologic examination was performed, including posterior segment enhanced depth spectral domain optical coherence tomography (EDI-SD-OCT). The SD-OCT scans of respective partner eyes without history of RVO were compared to an age- and refraction-matched, randomly recruited normal control group. In total, 312 eyes of 312 patients were included in this study, with 162 eyes in the RVO and 150 eyes in the control group. A significantly higher subfoveal choroidal thickness (SFCT) was found in the RVO (310.3 ± 72.5 (94 to 583) µm) as compared to the control group (237.0 ± 99.0 (62 to 498); p < 0.00001). Moreover, the RVO group showed a significantly higher prevalence of a symptomatic pachychoroid (22 vs. 9 eyes; odds ratio: 2.46; 95 CI: 1.10 to 5.53; p = 0.029). Since pachychoroid disease represents a bilateral entity, it might be a risk factor for RVO, or share risk factors with RVO.

Retinal Vessel Phenotype in Patients with a History of Retinal Vein Occlusion

Introduction: The aim of the study was to estimate the phenotype of retinal vessels using central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), tortuosity, and fractal analysis in the unaffected contralateral eye of patients with central or branch retinal vein occlusion (CRVO or BRVO). Methods: Thirty-four patients suffering from CRVO, 15 suffering from BRVO, and 49 controlled matched subjects had a fundus image analyzed using the VAMPIRE software. The intraclass correlation coefficient and a Bland-Altman plot were done for the reproducibility study. Results: There was a lack of evidence of difference between the control group and the CRVO group for CRAE (p = 0.06), CRVE (p = 0.3), and arterio-venule ratio (AVR, p = 0.6). Contralateral eyes of CRVO exhibited a significantly higher arterial and minimum arterial tortuosity values (p = 0.012), as compared with control eyes. Contralateral eyes of patients with a history of BRVO had a significantly higher CRAE (p = 0.02), AVR (p = 0.006), and minimal arterial tortuosity (p = 0.05). Fractal analysis showed that contralateral eyes of BRVO had higher values of fractal parameters (D0a, p = 0.005). Conclusion: This study suggests that CVRO or BRVO is not triggered by the same retinal vascular phenotypes in the contralateral eye. The morphology of retinal vasculature may be associated with the occurrence of RVO, independently of known risk factors.

Safety and Preliminary Efficacy Results from a Phase II Study Evaluating Combined BRAF and MEK Inhibition in Relapsed/Refractory Multiple Myeloma (rrMM) Patients with Activating BRAF V600E Mutations: The GMMG-Birma Trial

Safety and Preliminary Efficacy Results from a Phase II Study Evaluating Combined BRAF and MEK Inhibition in Relapsed/Refractory Multiple Myeloma (rrMM) Patients with Activating BRAF V600E Mutations: The GMMG-Birma Trial

MACULAR EDEMA AFTER CATARACT SURGERY IN EYES WITH PREOPERATIVE RETINAL VEIN OCCLUSION.

To evaluate the incidence of pseudophakic macular edema (PME) in eyes with a history of retinal vein occlusion before cataract surgery and to identify any associated risk factors. The records of 21,332 eyes that underwent cataract surgery were retrospectively reviewed. Eyes that had retinal vein occlusion preoperatively with no evidence of macular pathology on optical coherence tomography at the time of surgery and no macular edema treatment at least 6 months before surgery were included. Eyes with diabetes or diabetic retinopathy, those with a history of previous intraocular surgery or with intraoperative complications, and those administered glaucoma and nonsteroidal antiinflammatory eye drops were excluded. Pseudophakic macular edema developed in 31 (27.4%) of 113 eyes within 3 months of cataract surgery. Mean visual acuity for eyes with PME (0.48 logarithm of the minimum angle of resolution [logMAR; 20/60 Snellen equivalent]) at 3 months after surgery was significantly worse than that for eyes without PME (0.28 logMAR; 20/38, P = 0.020). However, there was no significant difference in the visual acuity between the 2 groups 6 months after the surgery. Taking into consideration various baseline factors, a history of previous treatment of macular edema was significantly associated with an increased risk of PME (odds ratio, 11.022; 95% confidence interval, 7.258-17.712; P = 0.009). A higher number of intravitreal injections used to treat macular edema also significantly increased the risk of PME (odds ratio, 1.902; 95% confidence interval, 1.032-4.227; P = 0.031). Pseudophakic macular edema frequently developed after phacoemulsification cataract surgery in patients with a history of retinal vein occlusion. The risk of PME further increased when the patient had undergone macular edema treatment and had a higher prevalence of intravitreal injection treatment.

SAFETY OF INTRAVITREAL DEXAMETHASONE IMPLANT (OZURDEX): The SAFODEX study. Incidence and Risk Factors of Ocular Hypertension.

To analyze the incidence, risk factors, and time course of intraocular pressure elevation after intravitreal dexamethasone implant (Ozurdex). The medical charts of 421 consecutive eyes (361 patients) receiving one or more Ozurdex implant between October 2010 and February 2015 were reviewed retrospectively. Ocular hypertension was defined as intraocular pressure of at least 25 mmHg or an increase of at least 10 mmHg from baseline. The main indications for treatment were retinal vein occlusion (34%), diabetic macular edema (30%), postsurgical macular edema (17%), uveitis (14%), and other etiologies (5%). Among 1,000 intravitreal injections, ocular hypertension was recorded for 28.5% of injected eyes over a mean follow-up period of 16.8 months (3-55). Intraocular pressure-lowering medication was required for 31% of eyes. Only three eyes with preexisting glaucoma required filtering surgery to manage postinjection intraocular pressure elevation. Early retreatment between the third and fourth month does not increase the risk of intraocular pressure elevation. Younger age, male sex, Type 1 diabetes, preexisting glaucoma treated with dual or triple therapy, and a history of retinal vein occlusion or uveitis were significant risk factors for ocular hypertension after dexamethasone implant injection (P < 0.05 for all the above). Episodes of ocular hypertension after Ozurdex implant were generally transient and successfully managed with topical treatment. An analysis of the risk factors may help to determine the risk-benefit ratio for individual patients treated with dexamethasone implants.

Systematic Evaluation of Optical Coherence Tomography Angiography in Retinal Vein Occlusion

To evaluate the clinical utility of optical coherence tomography angiography (OCTA) in patients with retinal vein occlusion (RVO), and to systematically compare OCTA images with changes seen on color fundus photography and fluorescein angiography (FA). Reliability analysis. Eighty-one eyes of 76 patients with a history of RVO (branch, central, or hemicentral), both acute and chronic, underwent OCTA and color fundus photography. In 29 eyes, data were compared to FA imaging. Comparative and multimodal analysis of the 3 imaging procedures were performed. We identified good agreement between FA and OCTA scans centered on the macula for capillary nonperfusion (intraclass correlation coefficient [ICC] 0.825 for the 3 × 3-mm scan and 0.891 for the 8 × 8-mm scan). Agreement for area of capillary changes (dilation, pruning, and telangiectasia) was also substantial (ICC 0.712 for the 3 × 3-mm scan and 0.787 for the 8 × 8-mm scan). For foveal avascular zone grading, agreement was good for the 3 × 3-mm scan (kappa = 1.000 for radius and kappa = 0.799 for outline) but poor for the 8 × 8-mm scan (kappa = 0.156 for radius and kappa = 0.600 for outline). The quality of the images obtained was an important issue for OCTA, as 15.1% of scans were nongradable, particularly in patients unable to maintain fixation. OCTA is a quick, reliable, and noninvasive method to evaluate the area of capillary nonperfusion and foveal avascular zone morphology in patients with RVO. However, good fixation is a requirement for acquisition of good-quality images.

Association between retinal vein occlusion, axial length and vitreous chamber depth measured by optical low coherence reflectometry.

BackgroundResults of ocular biometric measurements in retinal vein occlusion (RVO) eyes are still inconclusive and controversial. The aim of this study was to evaluate the association between ocular axial length (AL), vitreous chamber depth (VCD) and both central (CRVO) and branch retinal vein occlusions (BRVO) using optical low coherence reflectometry (OLCR).MethodsBoth eyes of 37 patients with unilateral CRVO (mean age: 66 ± 14 years, male:female - 21:16) and 46 patients with unilateral BRVO (mean age: 63 ± 12 years, male:female - 24:22) were enrolled in this study. The control group consisted of randomly selected single eyes of 67 age and gender matched volunteers without the presence or history of RVO (mean age: 64 ± 14 years, male:female - 34:33). Optical biometry was performed by OLCR biometer (LenStar LS 900). Average keratometry readings, central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), AL and VCD of eyes with RVO were compared with those of fellow eyes using paired t-tests and with those of control eyes using independent t-tests.ResultsMean CCT, ACD and LT, average keratometry readings of affected RVO eyes, unaffected fellow eyes and control eyes was not statistically different in either groups. In eyes with CRVO mean AL and VCD of affected eyes were significantly shorter than those of control eyes (p < 0.001, p < 0.05), mean difference in AL and VCD between the affected and control eyes was 0.56 ± 0.15 mm and 0.45 ± 0.19 mm, respectively. In eyes with BRVO, mean AL of the affected eyes was significantly shorter with a mean difference of 0.57 ± 0.15 mm (p < 0.001) and the VCD was significantly shorter with a mean difference of 0.61 ± 0.15 mm (p < 0.001) comparing with the control eyes.ConclusionShorter AL and VCD might be a potential anatomical predisposing factor for development either of CRVO or BRVO.

Risk evaluation for cerebrovascular accident in cases of retinal vein occlusion

ObjectivesThe aim of this study was to evaluate the risk factors that may predict the development of cerebrovascular accidents (CVAs) in patients with retinal vein occlusion (RVO).BackgroundRisk factors for RVO include hypertension, hyperlipidaemia, diabetes mellitus and vascular diseases, which are the same risk factors for CVAs.Materials and MethodsTwenty patients with RVO (group A) and 20 normal controls with no history of RVO (group B) were examined and investigated using colour fundus photography and fluorescein angiography, carotid duplex ultrasonography and blood examinations for bleeding disorders, diabetes mellitus and hyperlipidaemia. The risk for CVAs was evaluated in both groups during a follow-up period of 12 months.ResultsFour patients (20%) in group A suffered from some degree of CVA throughout the follow-up period, ranging from transient ischaemic attacks in three patients to cerebrovascular stroke in one patient. In contrast, none of the other control group individuals suffered any type of CVA during the follow-up period. Sixteen patients (80%) in the cases group had some degree of stenosis of their ipsilateral internal carotid artery (ICA), compared with only 12 individuals (60%) in the control group. The mean percentage degree of stenosis of the ipsilateral ICA detected by carotid ultrasonography in group A was 15.25%, whereas the mean percentage degree of stenosis in group B was 8%.ConclusionThe number of individuals who had CVAs and some degree of stenosis of their ipsilateral ICA was higher in patients with RVO than in the control group, and the mean percentage degree of carotid stenosis was higher in group A than in group B.

Coronary artery disease, cerebral non-fatal ischemic stroke in retinal vein occlusion: An 8-yr follow-up

Forty-five consecutive subjects (26M, 19F; mean age 54 ± 14 yrs) with a diagnosed retinal vein occlusion (RVO), were followed-up for 8 yrs. As many as 145 sex-age- and blood pressure-matched individuals (78M, 67F; mean age 54.4 ± 13.5 yrs), that did not experience any vascular event, served as controls. At the time of the RVO, controls and subjects did not differ as to hypercholesterolemia, hypertrigliceridemia, diabetes mellitus, smoking habits, inherited/acquired thrombophilia. At the follow-up completion, they differed as to statin consumption ( p = 0.016). During the 8-yrs follow-up, in the control population, 11 out of 145 (7.6%) subjects had experienced a major vascular event (8 coronary artery disease; 3 cerebral non-fatal ischemic stroke). In contrast, of the 45 subjects with a history of RVO, as many as 10 (22.2%) had experienced a major vascular event: 4 coronary artery disease; 4 cerebral non-fatal ischemic stroke; 2 cardiovascular + cerebrovascular event ( p = 0.012). A prolonged antiplatelet treatment, prior to the major vascular event, was found in 5/45 cases (11.1%) vs 23/145 (15.9%) controls ( p = 0.63). In contrast, a long-lasting administration of anti-hypertensive drugs, to achieve a control of blood pressure, was found in 83.4% of controls and only in 46.7% of cases ( p < 0.0001). In conclusion, in a 8-yr follow-up, coronary artery disease and/or non-fatal ischemic stroke were more common in subjects with a history of RVO than in a large setting of subjects comparable for cardiovascular risk factors. These data also argue for RVO as a vascular disease in which aggressive anti-hypertensive therapy to prevent stroke and/or myocardial infarction is needed.

Subcutaneous nadroparin calcium in the treatment of retinal vein occlusion

Abstract Purpose To date, no systemic intervention has been demonstrated to favorably affect the natural history of retinal vein occlusion (RVO). The purpose of this study was to evaluate the efficacy of nadroparin calcium in the treatment of RVO. Methods 13 patients with acute RVO (i.d. within a week of onset) were treated with subcutaneous injections of nadroparin calcium for 2 months. The same dose used for the treatment of deep venous thrombosis (200UI/kg/die) was given. Best corrected visual acuity (BCVA) in the affected eye was measured at baseline and after 3 months. In addition, macular thickness was measured by Stratus OCT (Carl Zeiss Meditec, USA) at baseline and after 3 months. Results Mean visual acuity was 0.39±0.33 at baseline and 0.70±0.32 after 3 months; differences were statistically significant (P=0.024). Macular thickness was measured in 8 patients; mean thickness was 510±239 μm at baseline and 331±190 μm after 3 months; differences were not statistically significant (P=0.12). After 3 months, fluorescein angiography disclosed no signs of retinal ischemia in all cases. Conclusion This preliminary study suggest that subcutaneous nadroparin calcium may be effective in the treatment of RVO. Larger long‐term studies are warranted to confirm this results.

Clinical pseudophakic cystoid macular edema: Risk factors for development and duration after treatment

To characterize the incidence, duration, and risk factors for and outcome of cystoid macular edema (CME) after cataract surgery and investigate the effects of treatment regimens on visual outcome and duration. University-based comprehensive ophthalmology practice. This study included 1659 consecutive cataract surgeries performed by residents between 2001 and 2006. Cases were classified according to the presence of CME. Subset analysis excluded patients with diabetes mellitus (DM). The CME groups were analyzed according to type of treatment to compare duration of CME and final best corrected visual acuity. The incidence of postoperative CME was 2.35% (39/1659), and history of retinal vein occlusion (RVO) was predictive of postoperative CME (odds ratio [OR], 47.12; P<.001). When patients with DM were excluded, the incidence of CME was 2.14% (29/1357) and history of RVO (OR, 31.75; P<.001), epiretinal membrane (ERM) (OR, 4.93; P<.03), and preoperative prostaglandin use (OR, 12.45; P<.04) were predictive of postoperative CME. Patients with DM and/or intraoperative complications did not have an increased risk for CME when treated with prophylactic postoperative nonsteroidal antiinflammatory drugs (NSAIDs) for 3 months. Groups treated with NSAIDs plus a steroid had significantly shorter resolution times than the untreated group (P = .004). A history of RVO, ERM, and preoperative prostaglandin use were associated with an increased risk for pseudophakic CME. Treatment with NSAIDs plus steroids was associated with faster resolution of CME than no treatment. Treating high-risk patients with NSAIDs after cataract surgery decreases the incidence of postoperative CME to that of patients who are not at high risk.

Homocysteine: a risk factor for retinal venous occlusive disease 1,2

Purpose Recent studies have shown a relationship between elevated levels of homocysteine and vascular disease including cerebrovascular accidents and myocardial infarctions. We evaluated patients with a recent retinal vein occlusion to determine if there was an associated elevation of homocysteine. Design Age and gender matched case-controlled study. Participants Twenty patients with retinal venous occlusive disease within the previous 6-month period and 40 control patients without retinal venous occlusive disease were enrolled in the study. Methods Twenty patients with a history of retinal vein occlusion underwent laboratory testing to determine serum homocysteine levels. In addition, a health survey was completed and several laboratory tests relating to vascular disease including cholesterol were checked. Two control groups were selected. The first group included patients with diabetes and no history of retinal vascular occlusive disease. The second control group included nondiabetic patients who also had no prior history of retinal vascular occlusive disease. Main outcome measures The main parameter measured in this study is fasting homocysteine. Results Fifteen of 20 patients (75%) with retinal vein occlusion disease had an elevated fasting serum homocysteine level, whereas only 5 of 40 control patients (13%) had an abnormal homocysteine level ( P < 0.0005). Conclusions Patients with retinal venous occlusive disease have higher levels of homocysteine, which may serve as a modifiable risk factor.

Asymptomatic miniocclusions of the optic disc veins in glaucoma.

This study was done to document photographically the evolution of asymptomatic venous stasis changes of the optic disc in glaucoma, estimate their prevalence, and report the clinical findings. Asymptomatic venous miniocclusions were found to develop and occasionally disappear in the optic disc stereophotographs of nine patients with early to moderate glaucoma or ocular hypertension during a mean follow-up of 9 years. In the 1664 photographs examined, a prevalence of 3% was found. None of the patients had a history of retinal vein occlusion or venous stasis retinopathy. Progression of glaucomatous optic disc changes occurred in eight of nine patients. It is possible that asymptomatic miniocclusions are secondary to the changes at the bottom of the optic cup. The miniocclusions, which are easily missed if not looked for, may be an early indicator of glaucomatous progression of the optic disc cupping.