Dixon Stephan G, Bruce Carl T, Glueck Charles J, Sisk Robert A, Hutchins Robert K, Jetty Vybhav, Wang Ping
Cholesterol, Metabolism, and Thrombosis Center, Jewish Hospital of Cincinnati.
Cincinnati Eye Institute; Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Clin Ophthalmol. 2016 Aug 9;10:1479-86. doi: 10.2147/OPTH.S106969. eCollection 2016.
Our specific aim was to document the pathoetiologic importance of thrombophilia among females presenting with severe ischemic retinal vein (RVO) or retinal artery (RAO) occlusion, without typical risk factors, and to emphasize that the ophthalmologists' diagnosis of thrombophilia has important diagnostic and therapeutic downstream ramifications for nonocular thrombosis, including reproductive outcomes.
We evaluated familial and acquired thrombophilia in 60 females with RVO (central RVO, n=52; branch RVO, n=8) and 16 with RAO (central RAO, n=11; branch RAO, n=5). They were referred by retinologists, without typical risk factors for RVO/RAO and/or severe ocular ischemic presentation. We focused on extraocular thrombotic events, particularly pregnancy complications, including unexplained spontaneous abortion, pre-eclampsia-eclampsia. Thrombophilia measurements in the 76 females were compared with 62 healthy normal females without ocular vascular occlusions (OVOs).
The 76 females with OVO were more likely than 62 normal female controls to have high homocysteine (24% vs 0%, P<0.0001), high anticardiolipin antibody (immunoglobulin M, 17% vs 3%, P=0.012), high (>150%) factor VIII (42% vs 11%, P<0.0001), and high (>150%) factor XI (22% vs 4%, P=0.004). Of the 76 females, 26 (34%) had ≥1 spontaneous abortion; 17 (22%) had ≥2 spontaneous abortions and/or pre-eclampsia-eclampsia. Compared to 62 healthy female controls, these 17 females with pregnancy complications had high homocysteine (29% vs 0%, P=0.0003), high anticardiolipin antibody immunoglobulin M (24% vs 3%, P=0.02), high factor VIII (38% vs 11%, P=0.02), and were marginally more likely to be heterozygous for the factor V Leiden mutation (19% vs 3%, P=0.058).
In females lacking typical risk factors for retinal vascular occlusion or severely ischemic presentation, by diagnosing thrombophilia as an etiology for OVO, the ophthalmologist opens a window to family screening and preventive therapy, with particular relevance to pregnancy outcomes and venous thromboembolism.
我们的具体目标是记录在没有典型危险因素的严重缺血性视网膜静脉阻塞（RVO）或视网膜动脉阻塞（RAO）的女性中，血栓形成倾向的病理病因学重要性，并强调眼科医生对血栓形成倾向的诊断对非眼部血栓形成具有重要的诊断和治疗下游影响，包括生殖结局。
我们评估了60例RVO女性（中央RVO，n = 52；分支RVO，n = 8）和16例RAO女性（中央RAO，n = 11；分支RAO，n = 5）的家族性和获得性血栓形成倾向。她们由视网膜病专家转诊，没有RVO/RAO的典型危险因素和/或严重眼部缺血表现。我们关注眼外血栓形成事件，特别是妊娠并发症，包括原因不明的自然流产、先兆子痫-子痫。将这76名女性的血栓形成倾向测量结果与62名无眼部血管阻塞（OVO）的健康正常女性进行比较。
76例OVO女性比62名正常女性对照组更有可能出现高同型半胱氨酸（24%对0%，P<0.0001）、高抗心磷脂抗体（免疫球蛋白M，17%对3%，P = 0.012）、高（>150%）因子VIII（42%对11%，P<0.0001）和高（>150%）因子XI（22%对4%，P = 0.004）。在这76名女性中，26名（34%）有≥1次自然流产；17名（22%）有≥2次自然流产和/或先兆子痫-子痫。与62名健康女性对照组相比，这17名有妊娠并发症的女性有高同型半胱氨酸（29%对0%，P = 0.0003）、高抗心磷脂抗体免疫球蛋白M（24%对3%，P = 0.02）、高因子VIII（38%对11%，P = 0.02），并且更有可能是因子V莱顿突变的杂合子（19%对3%，P = 0.058）。
在缺乏视网膜血管阻塞或严重缺血表现典型危险因素的女性中，通过将血栓形成倾向诊断为OVO的病因，眼科医生为家庭筛查和预防性治疗打开了一扇窗，这与妊娠结局和静脉血栓栓塞尤其相关。
