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Vlad Matei, Jonathan Xia, Chan Nguyen; The Role of Aspirin and Statins in Retinal Vein Occlusions. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2047.
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Aspirin and statins are crucial in the management of atherosclerotic cardiovascular disease, but their role in retinal vein occlusions (RVOs) is unknown. Since the pathophysiology of RVO also involves atherosclerosis, we conducted a retrospective, case-control study to examine the role of aspirin and statins in RVO.
We reviewed records of county- and university-hospital patients aged 18 or older who were initially diagnosed with branch RVO (BRVO), central RVO (CRVO), or hemi-RVO (HRVO) between 2006 and 2014. To determine whether aspirin or statins may prevent RVO, we compared the prevalence of aspirin and, separately, statin use among patients who had had an RVO, versus among controls who had no RVO during at least 24 months of follow-up. To examine the therapeutic benefit of statins, we compared the visual acuity (VA) at final follow-up of RVO patients who had been taking a statin prior to the RVO, versus those who had not been taking a statin. To increase the chance of detecting a preventive benefit, we included only patients with the RVO risk factors of hypertension (HTN) and open-angle glaucoma (OAG). We excluded all glaucoma suspects and patients with severe non-proliferative or proliferative diabetic retinopathy.
We analyzed 43 eyes (23 CRVOs, 16 BRVOs, and 4 HRVOs) from 42 patients, along with 129 controls. The RVO cases and the controls were similar except for a higher prevalence of diabetes mellitus and slightly more advanced OAG among the controls. There was no significant difference (p=0.47) in aspirin exposure between the control (60%) and RVO (67%) groups, and the increased statin exposure among controls (72%, vs. 53% for the cases; p=0.03) paralleled their higher prevalence of hyperlipidemia (71%, vs. 50% for the cases; p=0.02). The non-statin and statin RVO groups each had a mean VA of 20/800 at a mean 30 and 43 months of follow-up, respectively, and there were also no significant VA outcome differences within the BRVO and CRVO sub-groups.
To our knowledge, this is the first study focusing on outcomes of RVO patients with baseline OAG and on the role of statin therapy in RVO. We found that RVO patients with HTN and OAG suffered very poor visual outcomes, substantially worse than those reported by other authors in the era of anti-vascular endothelial growth factor intravitreal injections, even when accounting for baseline VA, co-morbid OAG, and unrelated causes of vision loss.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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