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Hypercoagulable states and central retinal vein occlusion
J Michael Lahey1, John J Kearney, Murat Tunc
1Permanente Medical Group, Hayward, California, Department of Ophthalmology, Retinal Division, Union City, CA 94587, USA. Mike.Lahey@kp.org
Insights
Central retinal vein occlusion (CRVO) evaluation should focus on common risk factors. Testing for antiphospholipid antibodies and elevated homocysteine is most useful, while extensive thrombophilia screening is rarely warranted for CRVO patients.
Area of Science:
- Ophthalmology
- Vascular Medicine
- Hematology
Background:
- Central retinal vein occlusion (CRVO) is a frequent cause of irreversible vision loss.
- Standard workup includes ruling out hypertension, diabetes, hyperlipidemia, and glaucoma.
- Patients lacking identifiable risk factors often undergo extensive thrombophilia testing.
Purpose of the Study:
- To review existing literature and identify laboratory tests associated with CRVO.
- To determine the utility of thrombophilia screening in CRVO patients.
Main Methods:
- Literature review of studies investigating laboratory findings in CRVO.
- Analysis of controlled studies associating specific tests with CRVO occurrence.
Main Results:
- Antiphospholipid antibodies and elevated plasma homocysteine levels are most commonly associated with CRVO.
- Primary thrombophilias are infrequently identified in CRVO patient screenings.
- Extensive thrombophilia testing is generally not indicated for most CRVO patients.
Conclusions:
- Selective thrombophilia evaluation, focusing on specific markers, increases the likelihood of positive findings in CRVO.
- Routine, extensive thrombophilia screening is not recommended for the majority of CRVO patients.
- Older patients with established vascular risk factors do not require thrombophilic screening.
Abstract:
Central retinal vein occlusion is a common cause of permanent visual loss. Work up and laboratory evaluation of patients requires the clinician to rule out hypertension, diabetes, hyperlipidemia, and glaucoma. Patients without an identifiable risk factor are often subject to extensive testing for primary and secondary thrombophilias. The purpose this paper is to review the literature to determine which of these tests is associated with central retinal vein occlusion. Antiphospholipid antibodies and elevated plasma homocysteine levels appear to be the tests associated most commonly in patients with central retinal vein occlusion in most controlled studies. Primary thrombophilias are found rarely when screening patients with central retinal vein occlusion. Extensive testing for thrombophilias is not warranted in the vast majority of patients with central retinal vein occlusion. Older patients with any of the common vascular risk factors do not require thrombophilic screening. By carefully selecting the patients who are evaluated for thrombophilias, the likelihood of finding true-positive tests is increased.