title: Retinal vascular occlusion: a window to diagnosis of familial and acquired thrombophilia and hypofibrinolysis, with important ramifications for pregnancy outcomes.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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).
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors: Cholesterol, Metabolism, and Thrombosis Center, Jewish Hospital of Cincinnati.
authors: Stephan G
authors: SG
authors: Dixon
authors: Cholesterol, Metabolism, and Thrombosis Center, Jewish Hospital of Cincinnati.
authors: Carl T
authors: CT
authors: Bruce
authors: Cholesterol, Metabolism, and Thrombosis Center, Jewish Hospital of Cincinnati.
authors: Charles J
authors: CJ
authors: Glueck
authors: Cincinnati Eye Institute; Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors: Robert A
authors: RA
authors: Sisk
authors: Cincinnati Eye Institute; Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors: Robert K
authors: RK
authors: Hutchins
authors: Cholesterol, Metabolism, and Thrombosis Center, Jewish Hospital of Cincinnati.
authors: Vybhav
authors: V
authors: Jetty
authors: Cholesterol, Metabolism, and Thrombosis Center, Jewish Hospital of Cincinnati.
authors: Ping
authors: P
authors: Wang
keywords: retinal artery occlusion; retinal vascular occlusion; retinal vein occlusion; thrombophilia