Retinal vein occlusions: The potential impact of a dysregulation of the retinal veins

Abstract

A retinal vein occlusion (RVO) is a sight threatening disease. It can be divided into central vein occlusion and branch retinal vein occlusion. The pathogenesis of the condition remains to be solved. Mechanical compression of the vessel wall or thrombotic occlusion of the vessel lumen, sometimes combined with rheological disorders, are often assumed pathomechanisms. Accordingly, the therapy relies either on mechanical decompression, lyses of thrombi or improvement of rheology. A number of observations however, such as the relationship of RVO to atherosclerotic risk factors, spontaneous reversibility particularly in young patients, rest flow observed in angiography, occlusion despite anticoagulation or thrombocytopenia and finally the positive effect of anti-VEGF therapy are not explained by the present pathogenetic concept. As a new concept we propose a local venous constriction induced by vasoconstrictive molecules diffusing from neighbouring diseased arteries and/or from other neighbouring (hypoxic) tissues. Recognizing these postulated conditions might lead to an earlier identification of impending vein occlusions as well as to a treatment more tailored to the risk factor constellation of the particular patient.

Breast cancer and Flammer syndrome: any symptoms in common for prediction, prevention and personalised medical approach?

“…FS influences the regulation of retinal venous pressure [9] that is well described for the glaucoma pathology [10]. FS has been functionally linked to the retinal vein occlusion [11]. FS plays a role in the pathology of retinitis pigmentosa [12].…”

“…All individual parameters (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15), the prevalence of which has been evaluated in the study, are functionally well linked to each other and altogether demonstrate systemic alterations of the affected person. Although individual BC subtypes differ from each other in the prevalence distribution, all of them demonstrate systemic alterations compared to the diseasefree individuals.…”

Retinal venous pressure measurements in patients with Flammer syndrome and metabolic syndrome

“…Of interest were findings of increased RVP in the two extremes of the population spectrum, namely people with MetS as well as those healthy people with the Flammer syndrome (commonly slim, cold hands and feet, and arterial hypotension) [2,28]. A number of mechanisms leading to increased retinal venous pressure have previously been discussed [29].…”

Pathogenesis of Retinal Vein Occlusion

“…Increased rigidity of the crossing artery induced by arteriolar sclerosis may increase the risk of occlusion. Studies investigating the vulnerebility of A/V crossing sites to BRVO have reported focal thickening of the venous basement membrane and hyperplasia of extracellular matrix and adventitia at A/V crossings [15][16][17][18][19] .…”

“…Atherosclerotic arteries may be producing increased endothelin-1 (ET-1), which may diffuse across to the neighboring vein, stimulating venous vasoconstriction [19] and increase retinal venous pressure [20] . While vascular endothelial cells produce ET-1 under a physiological condition but also all cells under stress produce ET-1.…”