Etiological factors in young patients with Retinal Vein Occlusion

Abstract

Objective: To present the etiological factors of patients with Retinal Vein Occlusion (RVO) under the age of 50 years.
 Methods: The study was conducted at Ege University Medicine Faculty Department of Ophthalmology. The clinical records of patients with RVO under the age of 50 seen between January 2014 and March 2018 were analyzed retrospectively. Forty patients comprised the study. Detailed ophthalmologic examination was performed. Past medical history, drug use, thrombophilic features, hyperviscosity syndromes and pathologies that may cause vasculitis were noted.
 Results: Forty patients, 22 (55%) male and 18 (45%) female, were included. Mean age was 41.6 ± 10.01 years. Mean intraocular pressure and best-corrected visual acuity were 16.8 ± 5.47mmHg and 0.76 ± 0.64 logMAR, respectively. Hyperhomocystenemia (15 patients, 37.5%), Behçet’s disease (three patients, 7.5%), diabetes and/or hypertension (16 patients, 40%), methylenetetrahydrofolate reductase gene mutation (11 patients, 27.5%), prothrombin gene mutation (four patients, 10%) and factor V Leiden mutation (five patients, 12.5%) were present among the patients as etiological factor. Multiple etiological factors were detected in 11 (27.5%) patients. Factor V Leiden mutation and methylenetetrahydrofolate reductase gene mutation were detected in one patient (2.5%) with Behçet’s disease. Four patients with diabetes and/or hypertension also had hyperhomocystenemia and one of them had additionally prothrombin gene mutation. Two patients with methylenetetrahydrofolate reductase gene mutation also had a factor V Leiden mutation and one of them had additionally a prothrombin gene mutation. Three patients with methylenetetrahydrofolate reductase gene mutation also had hyperhomocystenemia and one patient with prothrombin gene mutation also had methylenetetrahydrofolate reductase gene mutation.
 Conclusions: Etiological factors that might result in RVO in young individuals should be investigated in detail. Targeted therapies may help to prevent development of new RVOs and potential vascular problems in other organs.
 doi: https://doi.org/10.12669/pjms.35.5.546
 How to cite this:Nalcaci S, Degirmenci C, Akkin C, Mentes J. Etiological factors in young patients with Retinal Vein Occlusion. Pak J Med Sci. 2019;35(5):---------. doi: https://doi.org/10.12669/pjms.35.5.546
 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Risk factors for central retinal vein occlusion in young adults

“…[33][34][35] Extensive hypercoagulability workup is usually suggested if older patients do not possess any of the traditional risk factors, or if the patient is younger than 50 years, or has bilateral CRVO, or a prior history or family history of thrombosis. 5,16,19,34,36 Hypercoagulable disorders were significantly more prevalent in CRVO patients under the age of 45 years. 37 In young CRVO patients, hyperhomocysteinemia and antiphospholipid antibodies are more commonly seen compared with age-matched controls without the disease.…”

“…Many authors have advocated for extensive hypercoagulability workup in this patient group, although evidence favoring this approach is limited. 5,16,19 The aim of this study was to identify systemic and ocular risk factors associated with CRVO in young adults between the ages of 18 to 40 years, who were admitted to hospital for workup and management, using the National Inpatient Sample (NIS) database from 2002 to 2014.…”

Hemi- and Central Retinal Vein Occlusion Associated with COVID-19 Infection in Young Patients without Known Risk Factors

“…In a series of 95 patients diagnosed with CRVO between 18 and 40 years of age, Chen et al identified that statistically significant (p<0.001) risk factors for CRVO in young adults included primary open angle glaucoma, retinal vasculitis, pseudotumor cerebri, hypercoagulable state, hyperlipidemia, and a prior history of venous thromboembolic disease. 54 , 55 Other studies have identified that CRVO in young adults may be linked to smoking, migraine headaches, collagen vascular disease, medications (oral contraceptives, diuretics, sympathomimetics), and thrombophilia. 49 , 55 , 56 , 57 , 58 , 59 , 60 Young adults presenting with RVO may need a hypercoagulability workup to exclude systemic coagulopathies requiring anticoagulation, such as protein C and S deficiency, Factor V Leiden mutation, hyperhomocysteinemia, antiphospholipid antibody syndrome, prothrombin gene mutation, antithrombin deficiency, hyperviscosity syndrome, amongst others.…”

Clinical Features of Central Retinal Vein Occlusion in Young Patients

“…According to previous studies, the incidence of CRVO in patients \ 50 years old is 0.23/1000, whereas that in patients C 50 years old is 1.95/1000 [9]. CRVO in young patients accounts for 10-15% of the total number of CRVO cases [10], and most studies have shown that CRVO in young patients is more prevalent in men than in women [1,5,11,12]. Young people are more sensitive to vision loss, and due to the rarity of the condition in these patients, CRVO in young patients is often reported, resulting in the overestimation of the number of cases.…”

“…CRVO causes varying degrees of visual impairment. Currently, the literature defines CRVO cases in patients \ 50 years old as CRVO in the young [1][2][3][4][5][6]. However, some studies have defined CRVO in the young as that occurring in patients either \ 40 [7] or \ 55 [8] years old.…”