Risk Factors and Treatment Strategies in Patients With Retinal Vascular Occlusions

Chapin, John; Carlson, Karen-Sue; Christos, Paul J.; DeSancho, Maria T.

doi:10.1177/1076029613513320

Cited by 15 publications

(12 citation statements)

References 40 publications

(44 reference statements)

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“…Although our results agree with previous smaller studies showing increased spontaneous RAO, 12,31,32 ICD-9-CM codes do not allow sufficient resolution to identify a specific defect (e.g., Factor V Leiden mutation) that is responsible. In contrast, a common source of emboli, atrial fibrillation, resulted in a lower risk.…”

Section: Discussionsupporting

confidence: 57%

“…24 Medical diagnoses (ICD-9-CM codes in Table S2, available at www.aaojournal.org) studied were coronary artery disease, 11 carotid artery stenosis, 10,11 diabetes mellitus (DM) type 1 and 2 without complications, 3 DM with complications (ophthalmic, renal, or neurologic), 25 hypertension, 10 hypertension with cardiac complications, 26 obesity, 10 peripheral vascular disease, smoking, 27 myxoma, 14,15 congestive heart failure, atrial fibrillation, 11 giant cell arteritis, 28 acute coronary syndrome, 29 ventricular septal defect, 30 atrial/mitral stenosis and/or insufficiency, 13 cardiomyopathy, thrombocytopenia, and hypercoagulable state (including primary and secondary hypercoagulable states, homocystinuria, and presence of antiphospholipid antibodies). 12,31,32 Hospital conditions included anemia, transfusion, cardiogenic shock, and postoperative bleeding. Stroke was included as embolic, thrombotic, transient ischemia, and “other.” 33 …”

Section: Methodsmentioning

confidence: 99%

“…3,10,11 Associations also have been documented for spontaneously developing RAO and hypercoagulable state, 12 valvular heart disease, 13 and myxoma. 14,15 Accordingly, we hypothesized that risk factors for RAO after cardiac surgery resemble those of spontaneous RAO.…”

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confidence: 96%

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Perioperative Retinal Artery Occlusion

et al. 2017

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Purpose To study the incidence and risk factors for retinal artery occlusion (RAO) in cardiac surgery. Design Retrospective study using the National Inpatient Sample (NIS). Methods The NIS was searched for cardiac surgery. Retinal artery occlusion was identified by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Postulated risk factors based on literature review were included in multivariate logistic models. Main Outcome Measures Diagnosis of RAO. Results A total of 5 872 833 cardiac operative procedures were estimated in the United States from 1998 to 2013, with 4564 RAO cases (95% confidence interval [95% CI], 4282–4869). Nationally estimated RAO incidence was 7.77/10 000 cardiac operative procedures from 1998 to 2013 (95% CI, 7.29–8.29). Associated with increased RAO were giant cell arteritis (odds ratio [OR], 7.73; CI, 2.78–21.52; P < 0.001), transient cerebral ischemia (OR, 7.67; CI, 5.31–11.07; P < 0.001), carotid artery stenosis (OR, 7.52; CI, 6.22–9.09; P < 0.001), embolic stroke (OR, 4.43; CI, 3.05–6.42; P < 0.001), hypercoagulability (OR, 2.90; CI, 1.56–5.39; P < 0.001), myxoma (OR, 2.43; CI, 1.39–4.26; P = 0.002), diabetes mellitus (DM) with ophthalmic complications (OR, 1.89; CI, 1.10–3.24; P = 0.02), and aortic insufficiency (OR, 1.85; CI, 1.26–2.71; P = 0.002). Perioperative bleeding, aortic and mitral valve surgery, and septal surgery increased the odds of RAO. Negatively associated with RAO were female gender (OR, 0.77; CI, 0.66–0.89; P < 0.001), thrombocytopenia (OR, 0.79; CI, 0.62–1.00; P = 0.049), acute coronary syndrome (OR, 0.72; CI, 0.58–0.89; P = 0.003), atrial fibrillation (OR, 0.82; CI, 0.70–0.95; P = 0.01), congestive heart failure (OR, 0.73; CI, 0.60–0.88; P < 0.001), DM 2 (OR, 0.74; CI, 0.61–0.89; P = 0.001), and smoking (OR, 0.82; CI, 0.70–0.97; P = 0.02). Conclusions Risk factors for RAO in cardiac surgery include giant cell arteritis, carotid stenosis, stroke, hypercoagulable state, and DM with ophthalmic complications; associated with lower risk were female gender, thrombocytopenia, acute coronary syndrome, atrial fibrillation, congestive heart failure, DM 2, and smoking. Surgery in which the heart was opened (e.g., septal repair) versus surgery in which it was not (e.g., CABG) and perioperative bleeding increased the risk of RAO.

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Section: Discussionsupporting

confidence: 57%

Section: Methodsmentioning

confidence: 99%

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Perioperative Retinal Artery Occlusion

et al. 2017

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“…Nevertheless, these tests were performed following the suggestions of ophthalmologists, at the request of patients, because of young age of the patient (26, 37 and 56 years old) and in cases wherein there was no other obvious cause of retinal vein thrombosis, except from potential thrombophilia. Central retinal vein thrombosis may be caused by both local (retinal vein pressure by hardened arteries, increased intraocular pressure, hindrance of the outflow of venous blood from the eyeball to the heart, for example due to thrombosis in the venous sinuses of the dura mater or stenosis of the internal jugular vein) and general factors (hypertension, hyperlipidemia, diabetes and congenital and acquired hypercoagulable states) [14]. It is worth taking into consideration that it is not completely certain whether the use of anticoagulants in patients with retinal vein thrombosis makes any clinical sense at all [4].…”

Section: Discussionmentioning

confidence: 99%

Thrombophilia diagnosis

Spychalska-Zwolińska¹,

Zwoliński²,

Mieczkowski³

et al. 2015

Blood Coagulation &Amp; Fibrinolysis

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It is estimated that 30-50% of patients suffering from deep vein thrombosis (DVT) could be diagnosed with congenital or acquired thrombophilia. Its diagnosis, however, rarely changes the clinical management, but is associated with significant costs and negative psychological and social aspects. The aim of this study was to perform a retrospective analysis of the causes and clinical consequences of diagnostics for thrombophilia. A retrospective review of the medical records of 5600 patients was performed, 62 of whom had, at the time, been diagnosed for thrombophilia because of a thromboembolic event. A review of the current literature on the validity of diagnostic tests for hypercoagulability in certain clinical conditions was also performed. The most common reason for thrombophilia testing was episodes of lower limb DVT (56%). The most frequently diagnosed abnormalities were the heterozygous form of the V Leiden gene (18%), protein S deficiency (11%), and the anti cardiolipin antibody IgG (11%). In 45% of the patients, laboratory results did not confirm the presence of any congenital thrombophilia. After receiving the results, 11% of the respondents completed oral anticoagulation therapy after 3 months, and 28% of patients qualified for indefinite use of oral anticoagulant therapy. In most of the cases examined, the diagnosis of thrombophilia did not significantly affect the treatment. A common aberration identified in patients with a history of thromboembolic incidents was the coexistence of risk factors for atherosclerosis.

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“…Of the two main types of RVO, branch RVO is four to six times more prevalent than central RVO Kolar 2014). Current mainstream therapies, represented by anti-vascular endothelial growth factor, laser photocoagulation and vitrectomy, are directed towards vision-threatening sequelae of RVO, namely macular oedema, neovascularization and vitreous haemorrhage Wong & Scott 2010;Hahn & Fekrat 2012;Chapin et al 2013;Kolar 2014;MacDonald 2014;Bertelmann et al 2016). Nowadays, treatment for RVO only temporizes against a chronic disease and novel approaches are still evolving.…”

Section: Introductionmentioning

confidence: 99%