Systemic diseases associated with various types of retinal vein occlusion

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Abstract

PURPOSE: To investigate systemic diseases associated with various types of retinal vein occlusion.

METHODS: We investigated prospectively in 1090 consecutive patients with retinal vein occlusion, almost all Caucasian (consistent with the racial pattern here), the prevalence of associated systemic disorders before or at the onset of various types of retinal vein occlusion. The patients were categorized into six types of retinal vein occlusion based on defined criteria: nonischemic and ischemic central retinal vein occlusion, nonischemic and ischemic hemi-central retinal vein occlusion, and major and macular branch retinal vein occlusion. The patients had a detailed ophthalmic and systemic evaluation according to our protocol. For data analysis, patients were divided into three age groups: young (younger than 45 years), middle-aged (45 to 64 years), and elderly (65 years or older). The observed prevalence rates of major systemic diseases were compared among central retinal vein occlusion, hemi-central retinal vein occlusion, and branch retinal vein occlusion using a polytomous logistic regression analysis adjusting for gender and age. Logistic regression adjusting for age and gender was also used to compare the observed prevalence of systemic disease between nonischemic and ischemic in central retinal vein occlusion and hemi-central retinal vein occlusion and between major and macular branch retinal vein occlusion. These observed prevalence rates were also compared with those expected in a gender-matched and age-matched control population from estimates from the US National Center for Health Statistics.

RESULTS: There was a significantly higher prevalence of arterial hypertension in branch retinal vein occlusion compared with central retinal vein occlusion (P < .0001) and hemi-central retinal vein occlusion (P = .028). Branch retinal vein occlusion also had a significantly higher prevalence of peripheral vascular disease (P = .0002), venous disease (P = .011), peptic ulcer (P = .031), and other gastrointestinal disease (P < .0001) compared with central retinal vein occlusion. The proportion of patients with branch retinal vein occlusion with cerebrovascular disease was also significantly (P = .049) greater than that of the combined group of patients with central retinal vein occlusion and patients with hemi-central retinal vein occlusion. There was no significant difference in prevalence of any systemic disease between central retinal vein occlusion and hemi-central retinal vein occlusion. A significantly greater prevalence of arterial hypertension (P = .025) and diabetes mellitus (P = .011) was present in the ischemic central retinal vein occlusion compared with the nonischemic central retinal vein occlusion. Similarly, arterial hypertension (P = .0002) and ischemic heart disease (P = .048) were more prevalent in major branch retinal vein occlusion than in macular branch retinal vein occlusion. Relative to the US white control population, the combined group of patients with central retinal vein occlusion and patients with hemi-central retinal vein occlusion had a higher prevalence of arterial hypertension (P < .0001), peptic ulcer (P < .0001), diabetes mellitus (in ischemic type only, P < .0001), and thyroid disorder (P < .0001). The patients with branch retinal vein occlusion showed a greater prevalence of arterial hypertension (P ≤ .005), cerebrovascular disease (P = .007), chronic obstructive pulmonary disease (P = .012), peptic ulcer (P < .0001), diabetes (in young only, P = .0005), and thyroid disorder (P = .003) compared with the US white control population.

CONCLUSIONS: The findings of our study revealed that a variety of systemic disorders may be present in association with different types of retinal vein occlusion and in different age groups, and that their relative prevalence differs significantly, so that the common practice of generalizing about these disorders for the entire group of patients with retinal vein occlusion can be misleading. The presence of a particular associated systemic disease does not necessarily imply a cause-and-effect relationship with that type of retinal vein occlusion; the particular disease may or may not be one of the risk factors in a multifactorial scenario predisposing an eye to develop a particular type of retinal vein occlusion. Based on our study, we think that apart from a routine medical evaluation, an extensive and expensive workup for systemic diseases is unwarranted in the vast majority of patients with retinal vein occlusion.

Section snippets

Patients and methods

At the Ocular Vascular Clinic of the University of Iowa Hospitals and Clinics, we prospectively investigated the prevalence of systemic disorders before or at the onset of various types of retinal vein occlusion in 1090 consecutive patients, seen between 1973 and 1990 (Table 1). There were an additional 10 patients that were excluded from the study because they did not have any systemic evaluation performed for logistic reasons.

Diagnostic criteria for the six types of retinal vein occlusion

Results

Table 1 summarizes the demographic characteristics of patients in the six types of retinal vein occlusion. Almost all patients in this study were Caucasian, consistent with the racial pattern in the population of Iowa and adjoining states.

TABLE 2, TABLE 3 include information on the prevalence of major systemic diseases (and selected subgroups) present before or at onset of retinal vein occlusion in patients with central retinal vein occlusion and branch retinal vein occlusion, respectively.

Discussion

It is beyond the scope of this article to review and discuss the voluminous, often contradictory, literature on the subject of systemic diseases associated with the various types of retinal vein occlusion. We would like to comment briefly on some pertinent issues and compare our findings with those of some larger series reported in the literature.

In the present study, we investigated the prevalence of systemic diseases in 1090 consecutive patients with various types of retinal vein occlusion.

Conclusion

Our study revealed that a variety of systemic disorders may be present in association with six types of retinal vein occlusion and in different age groups, and that their prevalence differs significantly, so that the common practice of generalization about these disorders, covering the entire range of patients with retinal vein occlusion, can be misleading. The presence of a particular associated systemic disorder does not necessarily mean cause-and-effect relationship with that type of retinal

Supplementary data

Acknowledgements

We are grateful to Cynthia R. Long, PhD, for her valuable help in the statistical data analysis of this study.

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    This work is supported by Grant EY-1151 and RR-59 from the National Institutes of Health, Bethesda, Maryland, and in part by unrestricted grants from Research to Prevent Blindness, Inc, New York, New York, and from Alcon Research Institute, Fort Worth, Texas.

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    Dr Hayreh is a Research to Prevent Blindness Senior Scientific Investigator.

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