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Bilal Yousufzai, Lucas Lindsell, Julia Kammel, Michael Lai; Retinal Vein Occlusion in Young Patients: Assessing Visual Outcomes and Risk Factors. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2048.
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Retinal vein occlusions (RVO) typically affects patients above 60 years old with vascular comorbidities like hypertension and diabetes. We examined the associated risk factors in RVO patients below the age of 45 to determine and compare their risk factors against their older counterparts.
This is a retrospective case series of BRVO, HRVO, and CRVO patients 45 years or younger seen at the Retina Group of Washington from 1997 to 2015. 117 eyes from 117 patients were classified by RVO type, visual acuity (VA), and risk factors including but not limited to hypertension, diabetes, hypercoagulability disorders, and oral contraceptive (OCP) use. All RVO’s were classified as ischemic (at least 5 and 10 disc diameters of nonperfusion for BRVO and CRVO, respectively) or non-ischemic based on IVFA analysis
45% of patients had improved final VA. Patients seeing 20/40 or better by final exam had an average baseline VA of 20/40, whereas those seeing worse than 20/50 had an average baseline VA of nearly 20/200 (P=0.00011). Ischemic status also accounted for a statistically significant worse outcome on final vision (P=0.0038). 73% had at least one associated risk factor, the most common ones being hypertension (35%), OCP use (17%), and hyperlipidemia (14%). Only 9% had an abnormal hypercoagulability workup, the most common being the MTHFR mutation. Of the 8 with the mutation, 5 were tested for homocysteine and found to have normal levels, which doesn’t confer an increased risk for thrombophilia.
Our study shows that RVO is a relatively uncommon disease in younger patients, but that these patients still suffer from the same risk factors (hypertension, hyperlipidemia, diabetes) that account for RVOs in the typical, older patient population. Most young patients presented with good visual acuity (around 20/50) and good perfusion by IVFA at presentation (84%). Poor initial visual acuity and ischemic status on IVFA accounted for a statistically significant worse final outcome. Thus, we recommend that hypercoagulability/vasculitic workup is likely unnecessary in the absence of other disease stigmata or history. OCP use played an important role and should be assessed in these patients. Patients who have a bilateral presentation or other signs of inflammatory or hypercoagulable disease would warrant an appropriate workup.
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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