Associations of retinal artery occlusion and retinal vein occlusion to mortality, stroke, and myocardial infarction: a systematic review

Woo, Seong-Ryong; Lip, Gregory Y.H.; Lip, Peck Lin

doi:10.1038/eye.2016.111

Cited by 63 publications

(43 citation statements)

References 21 publications

(48 reference statements)

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“…Retinal vascular occlusion is often associated with cardiovascular disease and have many of the same risk factors 8,20,21 . There are also cohort studies which have reported that retinal vascular occlusion increases the risk of stroke 8,[22][23][24] . Interestingly, our study found that the risk of retinal vascular occlusion was higher in NOAC users than in warfarin users in Korea.…”

Section: Discussionmentioning

confidence: 99%

“…Retinal artery occlusion (RAO) results from retinal thromboembolic events originating in the ipsilateral carotid artery, aortic arch, or cardiac origin 5 ; retinal vein occlusion (RVO) is associated with thromboembolism due to degeneration of vascular walls and compression or vasospasm 6 . Retinal vascular occlusion is not only associated with predisposing factors for atheroembolic diseases 7 , but also with the risk of stroke, myocardial infarction, and total mortality 8 .…”

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confidence: 99%

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Efficacy and safety of non-vitamin K-antagonist oral anticoagulants for retinal vascular diseases in patients with atrial fibrillation: Korean cohort study

Park

Lee

et al. 2020

Sci Rep

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We investigated the prevalence of retinal vascular occlusion and intraocular bleeding and compare their risks in patients undergoing anticoagulant therapy, either with non-vitamin K-antagonist oral anticoagulants (NOAC) or warfarin. We performed a cohort study (January 2015 to April 2018) in 281,970 patients with nonvalvular atrial fibrillation (AF) using health claims in the nationwide database of the Health Insurance Review and Assessment service of Korea. A Cox-proportional hazard regression was used to calculate the hazard ratio (HR) for retinal vascular occlusion or intraocular bleeding. The HR of retinal vascular occlusion was estimated to 1.59 (95% confidence interval [CI], 1.35-1.86) for NOAC users compared to that with warfarin users. Among the various types of NOACs, all NOACs showed higher risk of retinal vascular occlusion than did warfarin. For intraocular bleeding, the HR was estimated to be 0.86 (95% CI, 0.75-0.98) for NOAC users compared with that with warfarin users. The risk of retinal vascular occlusion was higher in NOAC users than in warfarin users, while the risk of intraocular bleeding was lower with NOAC therapy. NOACs were not found to be as effective as warfarin for retinal vascular occlusion, but safe in terms of intraocular bleeding.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Efficacy and safety of non-vitamin K-antagonist oral anticoagulants for retinal vascular diseases in patients with atrial fibrillation: Korean cohort study

Park

Lee

et al. 2020

Sci Rep

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“…RVO is closely associated with systemic cardiovascular diseases including hypertension, dyslipidemia, diabetes, kidney disease, atherosclerosis, myocardial infarction, and stroke 3 . Because patients with RVO exhibit characteristics of cardiovascular disease, their cardiovascular morbidity and mortality rates are also increased 3,15,16 . Among these cardiovascular co-morbidities, hypertension is most commonly seen in patients with RVO and is a well-known risk factor of RVO 6 .…”

Section: Discussionmentioning

confidence: 99%

Increasing incidence of macular edema in excessive morning blood pressure surge in patients with retinal vein occlusion

Kim

Shin

Lee

et al. 2020

Sci Rep

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Morning blood pressure surge (MBPS) had been known to be associated with hypertensive target organ injury and vascular events. Retinal vein occlusion (RVO) is also known to be related with underlying cardiovascular risk factors. This study investigated the effect of MBPS on patients with RVO. In total, 76 patients with RVO who had undergone systemic cardiovascular examination including a 24-hour ambulatory blood pressure monitoring, carotid artery intima media thickness, and pulse wave velocity were evaluated between January 2015 and February 2019. The MBPS was calculated as follows: mean systolic blood pressure measured over two hours after awakening minus mean systolic blood pressure measured during the one hour that included the lowest sleep blood pressure. Macular edema was significantly more prevalent in the MBPS group compared with the non-MBPS group. After adjusting for confounding factors, multivariate regression analyses revealed that MBPS independently predicted macular edema in patients with RVO [Odds ratio 4.75, 95% confidence interval 1.136-16.6, p = 0.015]. In conclusion, evaluating blood pressure patterns, especially MBPS, using 24-hour ambulatory blood pressure monitoring may be useful for assessing and predicting ophthalmologic outcome and may facilitate better blood pressure control in patients with RVO. Retinal vein occlusion (RVO) is a common retinal vascular disease that leads to vision loss 1. RVO includes branch retinal vein occlusion (BRVO), which is caused by venous thrombosis at an arteriovenous crossing where an artery and vein share a vascular sheath or at the optic disc, and central retinal vein occlusion (CRVO), which results from thrombosis of the central retinal vein and a disturbance in the venous outflow, at the lamina cribrosa or posterior to it 1-3. The main complication of RVO is macular edema, which can lead visual impairment 4. Macular edema is the swelling or thickening of the macula due to leakage of fluid and blood components from blood vessels and is a major cause of RVO-associated blindness, angiogenesis, and retinal detachment. Therefore, it is associated with poor ophthalmologic outcomes 5. It has been demonstrated that many systemic cardiovascular risk factors such as hypertension, diabetes, dyslipidemia, and systemic inflammatory diseases are associated with RVO; hypertension is one of the most significant risk factors among them 5-7. In hypertensive patients, nocturnal blood pressure (BP) rise and morning BP surge (MBPS) have been known to be associated with an increased risk of target-organ damage and cardiovascular events 8-12. Interestingly, RVO has been shown to have circadian variation as well, with event onset time peaking in the early morning hours in previous studies 13,14. In this study, we evaluated the effect of morning blood pressure surge on patients with RVO.

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“…A recent systematic review on published case-control studies reported mortality as high as 34.7%, stroke in 6.8% and myocardial infarction in 5.7% in RVO patients (over a study period of >5 years). 17 Unsurprisingly, RVO and cardiovascular complications share common systemic co-morbidities such as hypertension, diabetes, hyperlipidaemia and carotid artery disease. We reported a 6.1% mortality in 3 years, although none were thought to be associated with intravitreal drug and procedures.…”

Section: Mortality and Systemic Risk Factorsmentioning

confidence: 99%

<p>Combination Therapy for Macular Oedema in Retinal Vein Occlusions: 3-Year Results from a Real-World Clinical Practice</p>

Horner¹,

Lip²,

Mushtaq³

et al. 2020

OPTH

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To report long-term efficacy and treatment outcomes of the combination therapy for treating macular oedema (MO) in retinal vein occlusions (RVOs) from a real-world UK practice. Methods: The initial reported 66 RVO patients with MO treated with combination therapy (initial Ranibizumab, later optional addition of Ozurdex and laser) were followed up to Year 3: visual acuity (VA) and central retinal thickness (CRT) were analysed against baseline and previous Year 1 results. Safety and adverse events were also recorded. Results: Baseline LogMAR VA of 0.71 (Snellen 6/30) improved to 0.48 (Snellen 6/18) at Year 3 (p=0.006); 63% experienced VA improvement (40% improved ≥3 lines), 27% had worse vision. Stability of mean VA (6/18) was already achieved at first post-loading phase review and was maintained in each subsequent year. Statistically significant CRT improvement was noted in each year (Year 3 median CRT=264µm) compared to baseline (median CRT=531µm). There was a reduction in the mean number of total injections to 2.5 in Year 3 (vs 5.5 in Year 1). Comparing Year 3 against Year 1, mean Ranibizumab injection frequency was 2.1 vs 4.3; mean Ozurdex injection frequency was 0.2 vs 1.1. In Year 3, 39.6% of patients did not require any form of injections, laser frequency was also reduced to 22.9% (vs 81.8% in Year 1). There was no endophthalmitis in the cohort, one progressed to neovascular glaucoma in Year 2 and mortality rate was recorded as 6%. Conclusion: Our real-world clinical practice for RVO patients using a combined therapy is associated with good long-term VA and anatomical outcomes with less intravitreal retreatment rates.

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Associations of retinal artery occlusion and retinal vein occlusion to mortality, stroke, and myocardial infarction: a systematic review

Cited by 63 publications

References 21 publications

Efficacy and safety of non-vitamin K-antagonist oral anticoagulants for retinal vascular diseases in patients with atrial fibrillation: Korean cohort study

Efficacy and safety of non-vitamin K-antagonist oral anticoagulants for retinal vascular diseases in patients with atrial fibrillation: Korean cohort study

Increasing incidence of macular edema in excessive morning blood pressure surge in patients with retinal vein occlusion

<p>Combination Therapy for Macular Oedema in Retinal Vein Occlusions: 3-Year Results from a Real-World Clinical Practice</p>

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