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Analysis of Thrombophilic Risc Factors in Patients with Central Retinal Vein Occlusion (CRVO)
1Weinberger A. W. A., 2Frank R. D., 3Kunz D., 1Cordes A. K., 1Schrage N. F.,
1RWTH Aachen, Universitätsaugenklinik (Aachen)
2RWTH Aachen, Innere Medizin II, Nephrologie und Immunolgie (Aachen)
3RWTH Aachen, Institut für Klinische Chemie und Pathobiochemie, sowie Klinisch-Chemisches Zentrallaboratorium (Aachen)
Introduction: The risc of developing a thrombosis is mainly correlated to blood viscosity, velocity of blood flow (stasis) and smoothness of vascular walls. Thrombosis of the central retinal vein often leads to irreversible vision loss. Modern laboratory diagnostics allow the analysis of a variety of thrombophilic factors. Its usefulness is in discussion. In this study we analyzed these thrombophilic factors in a consecutive group of patients with CRVO.
Patients and Methods: Patients with CRVO with onset of symptoms less than 21 days who had not undergone hemodilution therapy were recruted from our outpatient center and compared to an age-matched control. We analyzed differential blood, ESR, CRP, fibrinogen, antithrombin III, factor VIII:C, APC-resistance, protein S, protein C, lupus anticoagulans, cardiolipin antibody, homocystein, and mutations of MTHFR, prothrombin and and factor V.
Results: Thirty-six patients could be included. Age ranged from 32 to 79 years (mean 62). As medical risk factors eighteen patients had arterial hypertension, six had diabetes, five had a known coronary heart disease. Ten patients had a history of cigarette smoking. Initial hematokrit was 0,428 (39-52), fibrinogen was increased in two patients, we did not observe an antithrombin III deficiency. Factor VIII:C was elevated in twenty-one patients, six of these patients had a moderate CRP elevation. The remaining thirteen patients with normal Factor VIII:C showed a moderate CRP increase in three patients. Increased APC-Resistence was found in three cases,we saw no protein C or protein S deficiency. We also did not observe anti-phospholipid antibodies. A mild homocysteinemia was seen in seven cases. MTHFR was found with homocygot mutations in three patients, no mutations were found for prothrombin and factor V.
Conclusions: We could identify a factor VIII:C elevation without acute phase reaction being associated with CRVO. Compared to an age matched control group the remaining factors were not significantly different. Prothrombin-mutations as well as protein S -elevation seem to be rare. The necessity of extensive thrombophilic screening is questionable.