Role of factor V Leiden and prothrombin 20210A in patients with retinal artery occlusion

Weger, Martin; Renner, Wilfried; Pintér, Olivér; Stanger, Olaf; Temmel, Werner; Fellner, Peter; Schmut, O.; Haas, Anton

doi:10.1038/sj.eye.6700495

Cited by 24 publications

(17 citation statements)

References 26 publications

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“…They include familial and acquired thrombophilia (low protein C, lupus anticoagulant) in patients with CRAO38, antiphospholipid antibodies39 and homocysteinemia38,40,41; however, factor V Leiden, prothrombin 20210A and homozygosity for the MTHFR C677T have not been found to be associated with RAO27,40. In our study we did not conduct hematological studies systematically; therefore, we have no information on this aspect of RAO.…”

Section: Discussionmentioning

confidence: 93%

Retinal Artery OcclusionAssociated Systemic and Ophthalmic Abnormalities

Hayreh¹,

Podhajsky²,

Zimmerman³

2009

Ophthalmology

332

357

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Objective-To investigate systematically the various associated systemic and ophthalmic abnormalities in different types of retinal artery occlusion (RAO). Design-Cohort study.Participants-439 consecutive untreated patients (499 eyes) with RAO, first seen in our clinic from 1973 to 2000.Methods-At first visit, all patients had a detailed ophthalmic and medical history, and comprehensive ophthalmic evaluation. Visual evaluation was done by recording visual acuity, using the Snellen visual acuity chart, and visual fields with a Goldmann perimeter. Initially they also had carotid Doppler/angiography and echocardiography. The same ophthalmic evaluation was performed at each follow-up visit.Main Outcome Measures-Demographic features, associated systemic and ophthalmic abnormalities and sources of emboli in various types of RAO.Results-RAO was classified into various types of central (CRAO) and branch (BRAO) artery occlusion. In both nonarteritic CRAO and BRAO the prevalence of diabetes mellitus, arterial hypertension, ischemic heart disease, and cerebrovascular accidents were significantly higher compared to the prevalence of these conditions in the matched US population (all p<0.0001). Smoking prevalence, compared to the US population, was significantly higher for males (p=0.001) with nonarteritic CRAO and for females with BRAO (p=0.02). Ipsilateral internal carotid artery had ≥50% stenosis in 31% of nonarteritic CRAO patients and 30% of BRAO, and plaques in 71% of nonarteritic CRAO and 66% of BRAO. Abnormal echocardiogram with embolic source was seen in 52% of nonarteritic CRAO and 42% of BRAO. Neovascular glaucoma developed in only 2.5% of nonarteritic CRAO eyes.Conclusion-This study showed that in CRAO as well as BRAO the prevalence of various cardiovascular diseases and smoking was significantly higher compared to the prevalence of these conditions in the matched US population. Embolism is the most common cause of CRAO and BRAO;Correspondence to: Dr. S.S. Hayreh, Department of Ophthalmology and Visual Sciences, University Hospitals & Clinics, 200 Hawkins Drive, Iowa City, Iowa 52242-1091, Telephone No. 319-356-2947 sohan-hayreh@uiowa.edu. The authors have no conflict of interest.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptOphthalmology. Author manuscript; available in PMC 2010 October 1. Published in final edited form as:Ophthalmology . 2009 October ; 116(10): 1928-1936. doi:10.1016/j.ophtha.2009.006. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript plaque in the carotid artery is usually the source o...

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Section: Discussionmentioning

confidence: 93%

Retinal Artery OcclusionAssociated Systemic and Ophthalmic Abnormalities

Hayreh¹,

Podhajsky²,

Zimmerman³

2009

Ophthalmology

332

357

View full text Add to dashboard Cite

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“…All the available studies [14][15][16][17][18][19][20][21][22][23][24][25][26][27], however, have assessed one or just few factors.…”

Section: Discussionmentioning

confidence: 99%

“…A systemic evaluation should therefore include the search for these conditions in each patient with RAO. In the literature only few data about the prevalence of thrombophilic conditions in RAO are available; generally they are case reports and studies on small series of patients in whom the authors examined the association of RAO with separate risk factors such as hyperhomocysteinaemia [14][15][16][17][18][19], C677T methylenetetrahydrofolate reductase MTHFR C677T polymorphism [15][16][17][18]20], factor V Leiden [16,[19][20][21][22][23][24], prothrombin G20210A polymorphism [16,[19][20][21][22][23][24], and lipoprotein(a) levels [25][26][27]. Primary antiphospholipid syndrome has been associated with severe retinal vascular occlusion in young patients [28].…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular and thrombophilic risk factors in patients with retinal artery occlusion

Marcucci¹,

Sodi

Giambene

et al. 2007

Blood Coagulation &Amp; Fibrinolysis

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This article evaluates the prevalence of cardiovascular and thrombophilic risk factors in patients with retinal artery occlusion. Forty-one patients with a first episode of a retinal artery occlusion underwent complete ophthalmic examination, routine blood testing and specific laboratory tests for thrombophilia, such as fasting and postmethionine homocysteine, lipoprotein(a), plasminogen activator inhibitor-1, factor VIII, factor V Leiden, factor II G20210A polymorphism, lupus anticoagulant and anticardiolipin antibodies. The control population consisted of 100 healthy individuals comparable as regards age and sex. At univariate analysis, hypertension, smoking, dyslipidaemia (both high cholesterol and triglyceride levels), antiphospholipid antibodies, hyperhomocysteinaemia, elevated factor VIII and lipoprotein(a) levels were significantly associated with retinal artery occlusion; at multivariate analysis, adjusted for age, sex, traditional and thrombophilic risk factors, smoking, hypercholesterolaemia, elevated homocysteine and lipoprotein(a) levels confirmed their independent role as risk factors for retinal artery occlusion. In conclusion, the results of the present pilot study demonstrate that the prevalence of hypercholesterolaemia and smoking and the 'thrombophilic burden' are increased in patients with retinal artery occlusion. Our findings may have implications for the management of these patients, suggesting the need for an intensive and tailored secondary prevention and new therapeutic approaches.

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“…Several forms of RAO exist [8][9][10], and the mechanism behind them is still not fully understood [6]. RAO is associated with systemic cardiovascular disease [3,4,18,19,27,[32][33][34], and one reason for this is hypoperfusion due to severe stenosis of the carotid artery, but only for stenosis > 70% [1,7,24,29]. It is assumed that systemic emboli, mainly from the carotid artery but also possibly from endocarditis, are the main reason for RAO [11].…”

Section: Introductionmentioning

confidence: 99%

“…Since the EAGLE study showed that intra-arterial thrombolysis is not beneficial for patients with RAO [28], current research has mainly focused on risk factors for RAO [1,3,4,11,18,19,21,23,27,[32][33][34]. Thus, understanding of flow conditions and blood clot dynamics in the internal carotid artery (ICA) and ophthalmic artery (OA) may help to improve treatment concepts for RAO.…”

Section: Introductionmentioning

confidence: 99%

Analysis of emboli and blood flow in the ophthalmic artery to understand retinal artery occlusion

Kaufmann¹,

Leisser²,

Gemsa³

et al. 2014

Biomedical Engineering / Biomedizinische Technik

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Retinal artery occlusion (RAO) is a common ocular vascular occlusive disorder that may lead to partial or complete retinal ischemia with sudden visual deterioration and visual field defects. Although RAO has been investigated since 1859, the main mechanism is still not fully understood. While hypoperfusion of the ophthalmic artery (OA) due to severe stenosis of the internal carotid artery might lead to RAO, emboli are assumed to be the main reason. Intra-arterial thrombolysis is not a sufficient treatment for RAO, and current research is mainly focused on risk factors. In this study, a computational fluid dynamic model is presented to analyse flow conditions and clot behaviour at the junction of the internal carotid artery and OA based on a realistic geometry from a RAO patient. Clot diameters varied between 5 and 200 μm, and the probability of clots reaching the OA or being washed into the brain was analysed. Results show sufficient blood flow and perfusion pressure at the end of OA. The probability that clots from the main blood flow will to be washed into the brain is 7.32 ± 1.08%. A wall shear stress hotspot is observed at the curvature proximal to the internal carotid artery/OA junction. Clots released from this hotspot have a higher probability of causing RAO. The occurrence of such patient-specific pathophysiologies will have to be considered in the future.

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Role of factor V Leiden and prothrombin 20210A in patients with retinal artery occlusion

Cited by 24 publications

References 26 publications

Retinal Artery OcclusionAssociated Systemic and Ophthalmic Abnormalities

Retinal Artery OcclusionAssociated Systemic and Ophthalmic Abnormalities

Cardiovascular and thrombophilic risk factors in patients with retinal artery occlusion

Analysis of emboli and blood flow in the ophthalmic artery to understand retinal artery occlusion

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