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Thrombophilia and retinal vascular occlusion

Charles J Glueck1, Robert K Hutchins, Joel Jurantee

  • 1Cholesterol Center, Jewish Hospital of Cincinnati, Cincinnati, OH, USA.

Clinical Ophthalmology (Auckland, N.Z.)
|September 13, 2012
PubMed

Insights

Thrombophilia, particularly high homocysteine, is linked to retinal vascular occlusions (CRVO, CRAO, AF). Treatment with vitamins normalized homocysteine in most patients, suggesting a treatable cause for these conditions.

Area of Science:

  • Ophthalmology
  • Hematology
  • Vascular Medicine

Background:

  • Retinal vascular occlusions, including central retinal vein occlusion (CRVO), central retinal artery occlusion (CRAO), and amaurosis fugax (AF), can lead to vision loss.
  • Thrombophilia, a condition characterized by an increased tendency to form blood clots, is a potential risk factor for these occlusive events.

Purpose of the Study:

  • To investigate the association between thrombophilia and CRVO, CRAO, and AF.
  • To assess the effectiveness of normalizing elevated homocysteine levels.
  • To examine the role of estrogen therapy in women who develop these conditions and have underlying thrombophilia.

Main Methods:

  • A case-control study involving 132 CRVO, 15 CRAO, and 17 AF cases compared to 105 healthy controls.
  • Thrombophilia-hypofibrinolysis measures were assessed in all participants.
  • Cardiovascular disease risk factors were compared between cases and controls.

Main Results:

  • CRVO cases showed higher rates of elevated homocysteine, anticardiolipin IgM, and Factor VIII compared to controls.
  • CRAO-AF cases had increased prevalence of high homocysteine and lupus anticoagulant.
  • Four CRVO cases and one CRAO case occurred after estrogen therapy initiation in women with thrombophilia.
  • Vitamin therapy (folic acid, B6, B12) normalized homocysteine in 81% of CRVO cases and 100% of CRAO-AF cases.

Conclusions:

  • Treatable thrombophilias, especially hyperhomocysteinemia, are more prevalent in patients with retinal vascular occlusions than in the general population.
  • Retinal vascular occlusions can occur in women using estrogens or estrogen agonists who have underlying thrombophilia.
Abstract

Keywords:
amaurosis fugaxcentral retinal artery occlusioncentral retinal vein occlusionestrogenestrogen agonistretinal vascular occlusionthrombophilia

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