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Neha Rajendra Chandak, Shashank Banait, Sachin Daigavane; Serum Hyperhomocystinemia: A Risk Factor for Retinal Vein Occlusions. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3190.
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Studies have shown relationship between elevated homocysteine levels and vascular disease including cerebrovascular accidents and myocardial infarctions. This study tested the hypothesis that patients with a recent retinal vein occlusion (RVO) had elevated homocysteine and also determined possible association with visual acuity and homocysteine levels.
This case-control study was carried out in individuals > 18 years from a rural area of India over 1.5 years (2014-2015). We measured homocysteine in 100 patients with recent RVO and 96 age and sex-matched healthy controls having no evidence of retinal vascular disease. 77 patients had Branch RVO, 15 had Central RVO, 5 had Hemi-central RVO and 3 patients had Macular RVO. Patients with history of renal failure (serum creatinine> 2.0); patients on Methotrexate, Phenytoin, Carbamazepine, Tricyclic antidepressants, Vitamin B6, B12, or Folic Acid and patients with recent myocardial infarction or other vascular occlusive events were excluded from the study. Institutional Ethical Approval was obtained.Blood samples were drawn after an overnight fast of atleast 8 hours, and measured by high performance liquid chromatography and fluorescence detection. Normal homocysteine value in our laboratory: 5.0-13.9 μmol/L.Visual acuity was measured by Snellen’s Chart. Chi-square test was used for statistical analysis. The 2 groups were compared using paired-t test.
Mean age of RVO cases was 68.1+11.1 years and that of healthy controls was 68.2+10.7 (p value: 0.91). Mean homocysteine in RVO cases was 16.1+8.3 μmol/L and in healthy controls was 8.96 + 5.6 (p value <0.001). Hyperhomocysteinemia was seen in 78% of RVO cases but only 2.1% controls (Odd’s ratio- 3.76, 95% confidence interval- 1.06-13.40, p= 0.001). In patients with CRVO, visual acuity was better in patients with normal homocysteine compared to those with elevated homocysteine. Visual acuity was not compared to homocysteine in BRVO patients due to different variables like macular oedema, macular ischemia and specific location of branch occluded, which influence the visual acuity.
Patients with RVOs had higher levels of homocysteine. In addition to being a marker for vascular disease that is easily tested, homocysteine is a modifiable risk factor. Therapeutic studies are needed to determine end point of treatment and if lowering homocysteine with vitamin supplementation will decrease future risk of RVOs.
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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