Risk of stroke in retinal vein occlusion

Park, Sang Jun; Choi, Nam Kyong; Yang, Bo; Park, Kyu Hyung; Woo, Se Joon

doi:10.1212/wnl.0000000000002085

Cited by 46 publications

(31 citation statements)

References 32 publications

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“…Recent studies have shown that after RAO and RVO, patients have an increased risk of ischemic stroke and myocardial infarction, particularly during the first weeks after the occlusion. [ 8 , 16 , 17 ] , [ 18 ] It is unclear whether this is an epiphenomenon explained by diseases sharing similar risk factors (eg, CAD is a strong risk factor for both IS and RAO, and atherosclerosis is a risk factor for myocardial infarction, ischemic stroke and RAO), or by sharing the same pathophysiology.…”

Section: Discussionmentioning

confidence: 99%

Atrial fibrillation in retinal vascular occlusion disease and non-arteritic anterior ischemic optic neuropathy

et al. 2017

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BackgroundPatients with retinal vascular occlusion disease have an increased risk for ischemic stroke and share some risk factors with cerebrovascular disease. The purpose of this study was to analyze the prevalence of atrial fibrillation (AF) in subjects with retinal vascular occlusive disease and anterior ischemic optic neuropathy and to compare these data to an ischemic stroke group.MethodsProspective, observational single-center trial. Subjects with retinal artery occlusion (RAO), retinal vein occlusion (RVO) and anterior ischemic optic neuropathy (AION) were included. Patients with ischemic stroke (IS) from a previous observational trial were used as control. Investigation included 7-day Holter ECG, echocardiography, duplex ultrasonography of the carotid arteries, and 24-hour blood pressure monitoring. Further vascular risk factors were documented.ResultsDuring the 1-year study period, 101 patients were recruited. The control group with ischemic stroke consisted of 272 subjects. At inclusion, the prevalence of AF was 12% (RAO), 10.2% (RVO), 11.1% (NAION) and 15.8% (IS). The final prevalence after Holter ECG rose to 16% (RAO), 18.4% (RVO), 14.8% (NAION) and 26.5% (IS). No significant difference was measured between groups.ConclusionsWe detected a similar prevalence of AF in all groups. RVO patients tended to exhibit a higher AF detection rate and lower number needed to screen than RAO and NAION. The detection of AF rose considerably via Holter ECG. As a consequence, we recommend prolonged ECG monitoring in patients with acute ophthalmic vascular diseases.

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Section: Discussionmentioning

confidence: 99%

Atrial fibrillation in retinal vascular occlusion disease and non-arteritic anterior ischemic optic neuropathy

et al. 2017

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“…18 While RVO is not an independent risk factor for cardiovascular or stroke-related mortality, patients with RVO have a high risk of hypertension (48%-85%) and an increasing trend in incident strokes. 17,19–22, 24, 27 A recent longitudinal study showed an increased risk of stroke in individuals with RVO versus the comparison group (16.8% vs 10.7%). 23 Central RVO has been associated with increased mortality that is likely attributable to systemic cardiovascular disorders.…”

Section: Discussionmentioning

confidence: 99%

Ambulatory Blood Pressure Patterns in Patients With Retinal Vein Occlusion

Rao

Ulrich

Viera

et al. 2016

Retina

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Purpose Failure of blood pressure (BP) to dip during sleep (non-dipper pattern) is associated with cardiovascular disease (CVD) and stroke. The prevalence and degree of non-dipping and masked hypertension in patients with retinal vein occlusion (RVO), which is associated with stroke, has not been previously examined. Methods We measured clinic and 24-hour ambulatory BPs in 22 patients with RVO and 20 control participants without known eye disease matched by age and sex. Mean BP dipping, defined as the ratio of difference in mean awake and sleep systolic BPs to mean awake systolic BP, and masked and nocturnal hypertension were compared between groups. Results Mean 24-hour ambulatory BP was 144/79 mmHg among those with RVO and 136/77 mmHg among controls. Patients with RVO had an almost two-fold higher prevalence of non-dipping pattern (80.8% (95% CI 52.8, 94.1) vs. 50.4% (95% CI 26.1, 74.5);p=0.008). Average sleep systolic BP dip in RVO patients was 6.1% vs. 11.9% in controls (p=0.004). More RVO patients had masked hypertension by ambulatory BPs than controls (71% vs. 50%), but this difference was not statistically significant. Conclusion Our data suggest an association between RVO and non-dipper BP pattern. Ambulatory BP monitoring may be useful in the evaluation of patients with RVO by identifying those who may benefit from more aggressive BP control.

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“…A validation study comparing diagnoses between the database and patients' medical records showed an overall positive predictive value of the diagnosis of 83.4% . Detailed information regarding the NHIS and the database has been reported elsewhere …”

Section: Methodsmentioning

confidence: 99%

“…9 Detailed information regarding the NHIS and the database has been reported elsewhere. 8,[10][11][12][13][14][15][16][17] Databases from anonymous sources are open to any researchers whose study protocol has been approved by the Official Review Committee of the NHIS. The present study was approved by the Institutional Review Board (IRB) of the Seoul National University Bundang Hospital (IRB No.…”

Section: Study Populationmentioning

confidence: 99%

Risk of ischemic stroke after third, fourth, and sixth cranial nerve palsies in type 2 diabetes

Park

Yang

Byun

et al. 2018

Journal of Diabetes

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Background The aim of this study was to define the risk of ischemic stroke among newly diagnosed type 2 diabetes (T2D) patients who developed ocular motor cranial nerve (CN) palsies. Methods From the National Health Insurance Service – National Sample Cohort database (2002‐2013) of a random sample of 1 025 340 Koreans, patients with newly diagnosed T2D aged ≥20 years were included in the study. The incidence of ocular motor CN palsies was identified using diagnostic codes for third, fourth, and sixth CN palsies. To determine the effect of incident ocular motor CN palsy on subsequent ischemic stroke, covariate Cox regression was used (Model 1 included only ocular motor CN palsy as a time‐varying covariate; Model 2 included ocular motor CN palsy and demographic information; Model 3 included all variables in Model 2 as well as comorbidity, concomitant medication, and the Charlson comorbidity index score). Results Of 45 820 T2D patients, 75 developed ocular motor CN palsy and 1411 had ischemic stroke. Four patients experienced ischemic stroke after the development of ocular motor CN palsy. Incident ocular motor CN palsy was associated with the subsequent risk of ischemic stroke in Models 1, 2 and 3 (hazard ratios [95% confidence intervals] 3.74 [1.40‐9.98], 3.33 [1.25‐8.89], and 2.96 [1.11‐7.92], respectively). Male sex, older age, and lower income were associated with an increased risk of ischemic stroke. Among confounders, hypertension, atrial fibrillation, and congestive heart failure were associated with the risk of ischemic stroke. Conclusions Physicians should pay more attention to manageable risk factors of ischemic stroke when diabetic patients suffer from ocular motor CN palsies.

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Risk of stroke in retinal vein occlusion

Abstract: The present study provides new evidence that patients with incident RVO are at increased risk of stroke just after RVO occurrence. Immediate risk evaluation and proper treatment of stroke risk factors in patients with RVO are needed to reduce stroke-related mortality and morbidity.

Cited by 46 publications

References 32 publications

Atrial fibrillation in retinal vascular occlusion disease and non-arteritic anterior ischemic optic neuropathy

Atrial fibrillation in retinal vascular occlusion disease and non-arteritic anterior ischemic optic neuropathy

Ambulatory Blood Pressure Patterns in Patients With Retinal Vein Occlusion

Risk of ischemic stroke after third, fourth, and sixth cranial nerve palsies in type 2 diabetes

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