Department of Ophthalmology, University of California, San Francisco, San Francisco, California.
Tongliao City Hospital, Tongliao, Inner Mongolia, China.
Retina. 2018 Jun;38(6):1175-1179. doi: 10.1097/IAE.0000000000001661.
To investigate whether the results of early tests for hypercoagulability are correlated with the development of central retinal vein occlusion risk factors later in life and to evaluate the necessity of these tests in younger patients.
This was a retrospective, observational case series. From January 1995 to December 2014, 55 patients aged below 56 years with central retinal vein occlusion (CRVO) were enrolled in the study. Laboratory evaluations for homocysteine, activated protein C resistance, protein C activity, protein S activity, antithrombin III activity, antiphospholipid antibodies, and anticardiolipin antibodies were obtained at the onset of CRVO. After 24 to 205 months, the presence of risk factors for CRVO such as hypertension, obesity, hyperlipidemia, diabetes mellitus, sleep apnea, and glaucoma was determined. Bilateral correlation and logistic regression were performed to determine the correlations between the results of the initial laboratory tests and the diagnosis of CRVO risk factors.
The median follow-up was 168.5 months. Five patients completed at least 24 months of follow-up, 9 patients completed at least 5 years, and 36 patients completed at least 10 years. Five patients had no or less than 24 months' follow-up. Fourteen of 50 patients (28%) had at least one positive test result at the onset of CRVO. At the end of follow-up, 11 patients had been diagnosed with obesity (22%), 29 with hypertension (58%), 21 with hyperlipidemia (42%), 24 with diabetes (8%), 5 with sleep apnea (10%), and 8 with glaucoma (16%). Among 36 patients with a minimum 10 years' follow-up, 30 (83%) developed at least one common risk factor, and none experienced any thromboembolic events. There were no correlations between test results and the diagnosis of any risk factors in patients with a minimum of 2, 5, or 10 years' follow-up (P > 0.05).
The results of laboratory tests evaluating hypercoagulability in young patients with CRVO are not correlated with later-developed commonly known risk factors. Many of the common risk factors were present by the end of the study, suggesting that they still remain the core etiology for the disease. The value of the thrombophilic tests is brought into question, as none of the patients demonstrated further clotting or any unusual thrombi with long-term follow-up.
探讨早期高凝状态检测结果是否与日后发生视网膜中央静脉阻塞（CRVO）的危险因素有关，并评估这些检测在年轻患者中的必要性。
本研究为回顾性观察性病例系列研究。1995 年 1 月至 2014 年 12 月，共纳入 55 例年龄小于 56 岁的 CRVO 患者。在 CRVO 发病时，我们获得了同型半胱氨酸、活化蛋白 C 抵抗、蛋白 C 活性、蛋白 S 活性、抗凝血酶 III 活性、抗磷脂抗体和抗心磷脂抗体的实验室检查结果。24 至 205 个月后，确定了 CRVO 的危险因素，如高血压、肥胖、高血脂、糖尿病、睡眠呼吸暂停和青光眼。进行双侧相关性和逻辑回归分析，以确定初始实验室检查结果与 CRVO 危险因素诊断之间的相关性。
中位随访时间为 168.5 个月。5 例患者完成了至少 24 个月的随访，9 例完成了至少 5 年的随访，36 例完成了至少 10 年的随访。5 例患者的随访时间少于 24 个月。50 例患者中有 14 例（28%）在 CRVO 发病时至少有一项阳性检查结果。随访结束时，11 例患者被诊断为肥胖（22%），29 例为高血压（58%），21 例为高血脂（42%），24 例为糖尿病（8%），5 例为睡眠呼吸暂停（10%），8 例为青光眼（16%）。在 36 例至少随访 10 年的患者中，30 例（83%）出现至少一种常见危险因素，且均未发生任何血栓栓塞事件。在至少随访 2、5 或 10 年的患者中，检测结果与任何危险因素的诊断均无相关性（P＞0.05）。
在患有 CRVO 的年轻患者中，评估高凝状态的实验室检查结果与日后发生的常见已知危险因素无关。在研究结束时，许多常见危险因素已经存在，这表明它们仍然是疾病的核心病因。由于在长期随访中，没有患者出现进一步的凝血或任何异常血栓，因此质疑血栓形成检测的价值。
