Session Title: Vascular Diseases and Diabetic Retinopathy II
Session Date/Time: Friday 18/09/2015 | 16:30-18:00
Paper Time: 17:26
First Author: : S.Ruiz Bilbao SPAIN
Co Author(s): : J. Castellvi M. Soler A. Moll X. Vazquez J. Anglada A. Sabala
PURPOSE:The aim of our study is to assess the risk factors in the first episode of retinal vein thrombosis, systemic detection of other possible diseases and their involvement in the type and severity of the thrombosis.
The ophthalmologist, at the screening visit rules out to all patients an anamnesis notarized for potential cardiovascular risk factors, and any other relevant pathology. Furthermore, they were asked for an analytical screening of thrombosis and referred to the internal medicine department.
We conducted a study of risk factors in 108 eyes of 108 patients with retinal vein thrombosis. At the screening visit all patients underwent anamnesis notarized for potential cardiovascular risk factors (CVRF) such as systemic hypertension, DM, dislipemia, obesity and if they had cardiorespiratory diseases (arrhythmias, pulmonary embolism). They were also asked whether they were or had been smokers, if they had renal pathology or any other relevant pathology and what the current medication was (to rule out possible side effects). Furthermore, they were asked for an analytical screening and were referred to the department of thrombosis in the internal medicine. Each patient was visited by the ophthalmologist every three months (or earlier if needed) during the first year, then every 6 months and finally annually. The analytical monitoring has varied depending on the results of the analytical screening and assessment by the internist . If patients had hyperhomocysteinemia they were conducting an analytical control every 6 months (to test the efficacy of administered oral treatment) and the rest annually.
We studied 108 eyes with a mean age of 67.55 years. Sex revealed a female predominance. CVRF represent: 63.9 % hypertension , 48.1% of dyslipidemias, 36.1 % of DM and smokers 27,8%. Other previous comorbility factors were: obesity 27,8, heart diseases 27,8%, neurological 21,3% and renal 21,3% diseases respectivily. Laboratory revealed high parameters in: 60.7 % glycemia, 53.8 % homocysteine, 46.2% creatinine, cholesterol 41.7% with 40.2 % atherogenic index, 25.5 % triglycerides , 34.3% ANA , and 28.7 % fibrinogen. Cardiac patients had 3.33 times higher risk ischemic thrombosis with a confidence interval (C.I.) 1.15 to 9.68 times. The hiperhomocisteinemia increases the risk of diseases: heart 2.78 times, with a C.I. 1.09 to 7.08 times , 3.75 times renal , with a C.I. 1.26 to 11.12 times , 9.44 times creatine elevation , with a C.I 3.74 to 23.79 times fibrinogen elevation at 2.60 times, with a C.I 1.05 to 6.42 times. Patients under 50 years predominated CRVO with 81.9 % and in older the ORV with 69.1 %. Isquemic thrombosis represented, 70% in ORV and 62% in CRVO cases. Glaucoma is associated in 24,1 % of retinal vein thrombosis cases.
In the study of risk factors for thrombosis we must still need to look into more deeply, rather than just discarding cardiovascular risk known factors. A good medical history and a good systemic study carried out by a multidisciplinary internist ophthalmologist team, will allow us to find out other significant causes in order to optimal control of these diseases.