Risk of Adverse Systemic Events in Retinal Vein Occlusion

Conflicting data exists on whether central and branch retinal vein occlusion (CRVO and BRVO) are linked to systemic adverse events. This study examines this association using the TriNetX US Collaborative Network, encompassing >110 million patients.

Retrospective population-based cohort design.

Central and branch retinal vein occlusion cohorts were compared with control cataract cohorts and between high and low-intensity treatment defined by ≥10 compared with ≤5 anti-VEGF injections.

This study used deidentified data from a national database (2006-2024), using International Classification of Diseases,10th Revision, codes for CRVO and BRVO. Patients were propensity score matched on demographics, medications, and comorbidities. Risk ratios (RRs) were generated for systemic events in patients with CRVO and BRVO compared with controls and between patients with high and low-intensity treatment.

Risk ratios (RRs) and 95% confidence intervals (CIs) of death, myocardial infarction (MI), hemorrhagic stroke, ischemic stroke, and carotid disease.

Central retinal vein occlusion was associated with increased risk of death (RR, 1.30; 95% CI, 1.26-1.35), MI (RR, 1.24; 95% CI, 1.16-1.32), hemorrhagic stroke (RR, 1.35; 95% CI, 1.21-1.51), ischemic stroke (RR, 1.49; 95% CI, 1.4-1.59), and carotid disease (RR, 1.69; 95% CI, 1.59-1.79). Branch retinal vein occlusion was associated with increased risk of death (RR, 1.27; 95% CI, 1.23-1.32), MI (RR, 1.39; 95% CI, 1.30-1.49), hemorrhagic stroke (RR, 1.57; 95% CI, 1.41-1.75), ischemic stroke (RR, 1.66; 95% CI, 1.56-1.77), and carotid disease (RR, 1.67; 95% CI, 1.57-1.77). Central retinal vein occlusion with high-intensity treatment was associated with increased risk of MI (RR, 1.47; 95% CI, 1.12-1.93) compared with low-intensity CRVO treatment, but there were no significant differences in risk of death (RR, 0.98; 95% CI, 0.86-1.11), hemorrhagic stroke (RR, 1.00; 95% CI, 0.63-1.58), ischemic stroke (RR, 1.31; 95% CI, 1.03-1.66), or carotid disease (RR, 1.34; 95% CI, 1.06-1.70). For BRVO with high compared with low-intensity treatment, no significant differences in rates of death (RR, 1.12; 95% CI, 0.96-1.31), MI (RR, 1.30; 95% CI, 0.93-1.81), hemorrhagic stroke (RR, 0.96; 95% CI, 0.60-1.53), ischemic stroke (RR, 1.05; 95% CI, 0.80-1.38), or carotid disease (RR, 1.17; 95% CI, 0.85-1.60) were identified.

Central and branch retinal vein occlusion are associated with increased risk of death, MI, hemorrhagic stroke, ischemic stroke, and carotid disease. High-intensity treatment of CRVO may be associated with increased risk of MI. These results from this data set demonstrate the importance of systemic evaluation after retinal vein occlusion.

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.