Section 7 Ameliorate cardiovascular morbidity and mortality associated with retinal vein occlusion
Retinal vein occlusions are associated with an increase in vascular causes of
death (both cerebral and cardiac) in large prospective follow up studies.41,42
It is now proven that drug treatment of hypertension reduces the severity of its
complications, and additional therapy of aspirin in well controlled hypertensive
subjects given as a primary prevention reduces cardiovascular event rate.44
Recent trials of cholesterol lowering using statins have confirmed the beneficial
effect of this therapy with reduction of cardiovascular morbidity and mortality.44
Patients with rarer underlying conditions such as myeloma and inflammatory
disorders should be referred and managed by appropriate specialists.
Cardiovascular risk factors identified in patients with retinal vein
occlusion45should be managed according to the joint guidelines of the British
Hypertension Society, British Hyperlipidaemia Association and British Diabetic
Association.44 This approach should ameliorate adverse cardiovascular
outcomes for patients with retinal vein occlusion. Target levels for medical
management recommended by the joint societies and the recent British
Hypertension Society guidelines are shown in Table 3 and, unless a specific
contra-indication, aspirin, 75-150 mg daily is appropriate.

7.1 To prevent the recurrence of retinal vein occlusion
Several series have demonstrated that recurrence of retinal vein occlusion may occur in the affected eye or in the fellow eye in up to 15% of patients over a five year follow up period.40 Rates vary according to studies in differing countries
from 9 to 15%. In view of the poor potential visual outcome of patients with
recurrent retinal vein occlusion, this aspect has been studied, but not in controlled trials. Available data supports the concept that recurrence of retinal
vein occlusion may be reduced by medical treatments of underlying
cardiovascular risk factors with the addition of aspirin/persantin.42

7.2 The use of hormone replacement therapy following retinal vein occlusion
Although estrogen-containing HRT should not be commenced in those women
with retinal vein occlusion, continued use does not appear to be associated with
a higher rate of recurrence. Historically, HRT was contraindicated and
discontinued following central vein thrombosis. Following the work of the Eye
Disease Case-Control Study Group12and Kirwan and associates16, medical
practice showed a trend to continue HRT following retinal vein occlusion due
to the epidemiological evidence supporting HRT in the prevention of
cardiovascular disease. This policy has not lead to the potentially disastrous
visual outcome of recurrence of retinal vein occlusion in the fellow eye.
Currently, the decision about whether to continue HRT in a woman with retinal
vein occlusion should be made on a case by case basis. The decision should be
based on the woman’s individual case history, including the indication for HRT
use. The degree of residual visual impairment may influence the decision as a
recurrence in the fellow eye may have a potentially devastating visual outcome.
Further guidance may be obtained from the results of thrombophilia screening,
as this may provide an indicator of future risk. The current uncertainty about
the effects of HRT on cardiovascular risk and recent guidelines for the use of
HRT should also be considered.46

Introduction Methods used Risk factors CRVO
BRVO Medical treatment Cardiovascular problems Young patient
References. Tables Main index Main page.