Trombophilic screening for nonarteritic anterior ischemic optic neuropathy.
BACKGROUND
Nonarteritic anterior ischemic optic neuropathy (NAION) is an ischemic infarction of the optic nerve head, frequently leading to sudden, mostly irreversible loss of vision. In this study blood thrombophilic factors, as well as cardiovascular risk factors were investigated for their relevance to this pathology. Trombophilic risk factors so far not evaluated were included in the study.


METHODS
37 NAION patients (4 with sequential second eye involvement) and 81 matched control subjects were examined. From blood, protein C, protein S, antithrombin, von Willebrand antigen levels (vWFAg), and factor V (Leiden) mutation, factor VIIIC level, plasminogen activity, lipoprotein (a) and fibrinogen levels, and presence of anticardiolipin antibodies were investigated. Possibly relevant pathologies [e.g. diabetes mellitus (DM), hypertension, and ischemic heart disease] were also registered.


RESULTS
Elevated Lp(a) and vWFAg levels, DM, F V (Leiden), hypercholesterolemia, and hyperfibinogenemia proved to be significant risk factors associated with NAION. Forward stepwise logistic regression analysis revealed that high Lp(a), DM, and FV (Leiden) were the main predictive components, with odds ratios 16.88 (p=0.012), 5.78 (p=0.022) and 4.44 (p=0.033), respectively.


CONCLUSIONS
Based on our results it appears that thrombophilia is likely to contribute to the development of NAION besides vascular damage due to the presence of cardiovascular risk factors. Further data are needed, however, to justify the suggested use of secondary prophylaxis using anticoagulant/antiplatelet therapy.
Nagy
Valeria
V
Department of Ophthalmology, University of Debrecen, Medical and Health Science Center, 4012 Debrecen, Hungary. vnagy@jaguar.dote.hu
Steiber
Zita
Z
Takacs
Lili
L
Vereb
Gyorgy
G
Berta
Andras
A
Bereczky
Zsuzsanna
Z
Pfliegler
Gyorgy
G
D000368:Aged; D001779:Blood Coagulation Factors / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000150:complications; D016022:Case-Control Studies; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D017270:Lipoprotein(a) / Q000097:blood; D008297:Male; D008875:Middle Aged; D018917:Optic Neuropathy, Ischemic / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D019851:Thrombophilia / Q000097:blood / Q000150:complications / Q000175:diagnosis*
D001779:Blood Coagulation Factors; D017270:Lipoprotein(a)