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Noureen Khan, Michael Lai; Retinal Vein Occlusions in Young Patients: Visual Outcomes and Associated Systemic Risk Factors. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4648.
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© ARVO (1962-2015); The Authors (2016-present)
To assess the visual outcomes in patients forty years of age and younger with retinal vein occlusion and to identify associated systemic risk factors.
This is a retrospective, comparative, consecutive case series. Fifty eyes from 50 patients were diagnosed with branched retinal vein occlusion (BRVO), hemi-central retinal vein occlusion (HRVO) or central retinal vein occlusion (CRVO) that presented in patients 40 years or younger from 1997 to 2002. Risk factors (hypertension, hyperlipidemia, diabetes, obesity, glaucoma, smoking, OCP use, hypercoagulable lab abnormalities, and final visual acuity (VA) were recorded and compared.
Final visual acuity (VA) found that 46% had improved visual outcomes. Seventy eight percent ended up with at least 20/60 vision or better. Patients with good baseline vision (20/60 or better) were found to have statistically significant better final VA compared to patients with baseline vision of less than 20/60 (P= <0.0001). Additionally, patients with retinal ischemia on FA are also found to have a statistically significant worse outcome on visual prognosis (P= 0.0017). Forty eight percent of patients were found to have at least one systemic risk factor, 30% two or more risk factors, and 24% had abnormal hypercoagulable work up. The most common systemic risk factors include HTN (24%) and abnormal hypercoagulable work up (24%). The most common abnormal lab work up was Methylenetetrahydrofolate reductase mutation, which was found in five patients.
There is a strong association between vein occlusion in young patients and at least one systemic risk factor (78%). Most patients presented with good VA (mean 20/50) and non-ischemic disease (86%). Many young RVO patients (24%) had an abnormal hypercoagulable work-up. Most patients improved or maintained vision during follow-up (78%) and obtained good final VA (mean 20/40). Poor baseline VA and retinal ischemia were associated with a worse VA outcome. Given such findings, we recommend that any young patient presenting with retinal vein occlusions undergo extensive evaluation to identify systemic risk factors of thrombosis, including pro-thrombotic medication and undiagnosed hypercoagulable states. Initial evaluation should emphasize baseline VA as well as retinal perfusion status, given that they are strong predictors of final visual outcomes.
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