METHODS: Measures of
thrombophilia-hypofibrinolysis were obtained in 132 CRVO cases, 15 CRAO cases, and 17 AF cases. Cases were compared to 105 healthy control subjects who did not differ by race or sex and were free of any ophthalmologic disorders. All
cardiovascular disease (CVD) risk factors were compared to healthy general populations.
MAIN OUTCOME MEASURES: CRVO cases were more likely than controls to have high
homocysteine (odds ratio [OR] 8.64, 95% confidence intervals [CI]: 1.96-38), high anticardiolipin
immunoglobulin M (
IgM; OR 6.26, 95% CI: 1.4-28.2), and high
Factor VIII (OR 2.47, 95% CI: 1.31-7.9). CRAO-AF cases were more likely than controls to have high
homocysteine (OR 14, 95% CI: 2.7-71.6) or the
lupus anticoagulant (OR 4.1, 95% CI: 1.3-13.2). In four of 77 women with CRVO (two found to have high
homocysteine, two with inherited high
Factor XI), CRVO occurred after starting
estrogen-
progestins,
estrogen-
testosterone, or
estrogen agonists. In one of eight women with CRAO found to have high
anticardiolipin antibody IgG, CRAO occurred after starting
conjugated estrogens, and AF occurred after starting
conjugated estrogens in one of eleven women with AF (inherited
protein S deficiency).
Therapy for medians of 21 months (CRVO) and 6 months (CRAO-AF) was 5 mg
folic acid, 100 mg B6, and 2000 mcg/day B12 normalized
homocysteine in 13 of 16 (81%) CRVO cases and all five CRAO-AF cases with pretreatment
hyperhomocysteinemia. The CRVO cases had an excess of
hypertension; CRAO-AF cases had an excess of
type 2 diabetes and
hypertension.
CONCLUSION: