Retinal Vein Occlusion:

What is the appropriate Laboratory WOrkup?

Ana Maria Cunha Matias, MD USF GO Porto- Portugal

Background:
Retinal vein occlusion (RVO) is a common cause of vision loss and it is the second most common retinal vascular disease after diabetic
retinopathy. The pathogenesis of RVO is multifactorial in origin and not completely understood. It includes age as a major risk factor and a
combination of mechanical compression, atherosclerotic degenerative changes in vessel walls and hypercoagulable factors-
The most controversial question in RVO workup involves the utility and adequacy of laboratory testing.

Case description
History Complain:
Patient, female gender, fifty years old Several days of blurred vision that were
Type 1 Diabetic since her third decade followed by painless sudden loss of vision
Chronic Kidney disease (KDIGO 3 A) in the right eye
Unremarkable physical exam
Normal lipid panel + low tensional profile

The patient had a past history of bouts of circulating

antinuclear antibodies in a speckled pattern Typical funduscopic examination of flame
haemorrhages, haemorrhage wedge shaped, dot
and blot haemorrhages and dilated tortuous veins

 RVO has a prevalence of 1 to 2% in persons older than 40 years of age: affects 16 million persons worldwide.
 Bilateral RVOs is uncommon-occurring in about 5% of cases
 10% of recurrence of RVO in the same eye or in the other eye

Risk Factors
Local Systemic
Ocular hypertension Age, race, medications
Arteriovenous crossing Cardiovascular disease, Hypertension, diabetes mellitus,
Local arteriolar narrowing dyslipidaemia
Open angle glaucoma Ocular Inflammatory diseases and vasculitis
Hyperviscosity syndromes, Hypercoagulable states
Routine investigations
Complete blood count, renal profile, fasting serum levels of glucose and Hb1Ac, lipid profile, PT and APPT and ERS/ Serum electrophoresis
Additional investigations
Homocysteine levels, Levels of functional Protein C and Protein S, Antithrombin III levels, Factor V of Leiden, Prothrombin gene mutation
(G201210A)
Antinuclear Antibody, Lupus Anticoagulant, anticardiolipin antibodies, syphilis serology

History + ocular examination + preliminary tests

Patient > 60 years old+ Patient < 50 years old + no risk factors
isolated typical RVO Patient with abnormal test results or
Patient 50 - 60 years old bilateral RVO at presentation or
with a history of numerous RVOs or
past history of thrombotic events or
Extended laboratory study Decide according clinical family history of thrombotic events
not recommended judgement

Search for infectious, inflammatory or hypercoagulable cause Extended laboratory study is recommended
Bibliography:-Clinical Guidelines –Retinal Vein Occlusio (RVO) Guidelines The Royal College of Ophthalmologists. July 2015
-Retinal vein occlusion: Epidemiology, clinical manifestations, and diagnosis, in up-to-date; -Laboratory evaluation of hypercoagulable states in patients with central retinal vein occlusion who are less
than 56 years of age