Abstract
Two common causes of visual loss in idiopathic retinal vasculitis (RV) are retinal ischaemia and cystoid macular oedema. This study investigated whether thrombophilic factors are more prevalent in patients with ischaemic RV than non-ischaemic RV. Twenty patients with RV (10 ischaemic, 10 non-ischaemic) were prospectively recruited before starting systemic imniunosuppression. Twenty-one different haemostatic parameters were tested. Seventeen patients had at least one haemostatic abnormality. Three patients had low Protein S, one had low Protein C. Three patients had positive anticardiolipin antibody titres, 1 had poor fibrinolytic activity, 3 had raised fibrinogen levels. Ten patients had raised lipoprotein (a) levels. Fibrinogen levels were higher in the smokers (p = 0.02). Although all von Willebrand's factor levels were within the normal range, they were higher in the ischaemic group (p = 0.008), in which smoking was more prevalent. This study has shown a high prevalence of thrombophilic abnormalities in RV patients, and implicates smoking in the aetiology of ischaemic RV.
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References
Sanders MD . Duke Elder Lecture. Retinal arteritis, retinal vasculitis and autoimmune retinal vasculitis. Eye 1987;1:441–65.
Graham EM, Stanford MR, Sanders MD, Kasp E, Dumonde DC . A point prevalence study of 150 patients with idiopathic retinal vasculitis. I. Diagnostic value of ophthalmological features. Br J Ophthalmol 1989;73:714–21.
Lindop GDM, Percy-Robb IW, Walker ID . Disturbances of body fluids, haemostasis and the flow of blood. In: MacSween RNM, Whaley K, editors. Muir's textbook of pathology. 13th ed. London: Edward Arnold, 1992:92–3.
Chafa O, Fischer AM, Meriane F, Chellali T, Sternberg C, Otmani F, Benabadji M . Behçet syndrome associated with Protein S deficiency. Thromb Haemost 1992;67:1–3.
Pivetti-Pezzi P, Priori R, Caterinelli G, Meroni PL, Federici AB, Abdulaziz M, et al. Markers of vascular injury in Behçet's disease associated with retinal vasculitis. Ann Ophthalmol 1992;24:411–4.
Nelson ME, Talbot JF, Preston FE . Recurrent multiple-branch retinal arteriolar occlusions in a patient with Protein C deficiency. Graefes Arch Clin Exp Ophthalmol 1989;227:443–7.
Ririe DG, Cosgriff TM, Martin B . Central retinal vein occlusion in a patient with familial antithrombin III deficiency: case report. Ann Ophthalmol 1979;11:1841–5.
Golub BM, Sibony PA, Coller BS . Protein S deficiency associated with central retinal artery occlusion. Arch Ophthalmol 1990;108:918.
Favilla I, Stubbs K, Kowal L . Abnormal fibrinolysis in retinal vein occlusion. Am J Ophthalmol 1981;9:213–8.
Greven CM, Weaver RG, Owen J, Slusher MM . Protein S deficiency and bilateral branch retinal artery occlusion. Ophthalmology 1990;98:33–4.
Smith DB . Protein C deficiency: a cause of amaurosis fugax? J Neurol Neurosurg Psychiatry 1987;50:361–2.
Vine AK, Samama MM . The role of abnormalities in the anticoagulant and fibrinolytic systems in retinal vascular occlusions. Surv Ophthalmol 1993;37:283–92.
British Committee for Standards in Haematology. Guidelines on the investigation and management of thrombophilia. J Clin Pathol 1990;43:703–9.
Greaves M, Preston FE . Clinical and laboratory aspects of thrombophilia. In: Poller L, editor. Recent advances in blood coagulation, vol. 5. Edinburgh: Churchill Livingstone, 1990:119–40.
Miletich J, Sherman L, Broze G . Absence of thrombosis in subjects with heterozygous Protein C deficiency. N Engl J Med 1987;317:991–6.
Gladson CL, Sharrer I, Hach V, Beck KH, Griffin JH . The frequency of type I heterozygous Protein C deficiency in 141 unrelated young patients with venous thrombosis. Thromb Haemost 1988;59:18–22.
Watts MT, Greaves M, Clearin LG, Malia RG, Cooper SM . Antiphospholipid antibodies and ischaemic optic neuropathy. Lancet 1990;335:613–4.
Kleiner RC, Najarian LV, Schatten S, Jabs DA, Patz A, Kaplan HJ . Vaso-occlusive retinopathy associated with antiphospholipid antibodies (lupus anticoagulant retinopathy). Ophthalmology 1989;96:896–904.
Acheson JF, Gregson RC, Merry P, Schulenberg WE . Vaso-occlusive retinopathy in the primary antiphospholipid antibody syndrome. Eye 1991;5:48–55.
Asherson RA, Merry P, Acheson JF, Harris EN, Jabs DA, Hughes GRV . Antiphospholipid antibodies: a risk factor for occlusive ocular vascular disease. Ann Rheum Dis 1989;48:358–61.
Rabbani LE, Loscalzo J . Recent observation on the role of hemostatic determinants in the development of the atherothrombotic plaque. Atherosclerosis 1994;105:1–7.
Kostner GM, Avogaro P, Cozzolato G, et al. Lipoprotein a and the risk of myocardial infarction. Atherosclerosis 1981;38:51–61.
Ruggin ZM . von Willebrand factor and fibrinogen. Curr Opin Cell Biol 19393;5:989–96.
Blann AD, McCollum CN . Adverse influence of cigarette smoking on the endothelium. Thromb Haemost 1993;70:707–11.
Ernst E . Fibrinogen: an independent risk factor for cardiovascular disease. BMJ 1991;303:596–7.
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Palmer, H., Jurd, K., Hunt, B. et al. Thrombophilic factors in ischaemic and non-ischaemic idiopathic retinal vasculitis. Eye 9, 507–512 (1995). https://doi.org/10.1038/eye.1995.116
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DOI: https://doi.org/10.1038/eye.1995.116
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