Editorial
Retinal vein occlusion, a great unknown and a challenge in venous thromboembolic disease
Trombosis venosa retiniana, una gran desconocida y un reto en la enfermedad tromboembólica venosa
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(B) Scatter plot and nonparametric regression curves of the mean LVEF increases highlighting LVEF increase ≥5% (blue line) compared to the initial LVEF and distinguishing between subjects who did and did not present with the event. The following statistical significance levels of LVEF ≥5% are shown in the groups FEVI <50% (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.022) and FEVI ≥50% (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1). (C) The same as Figure B, but with final LVEF over initial LVEF. (D) Multivariate logistic regression model showing the selected variables that are predictors of LVEF improvement greater than 5% in the depressed LVEF, the odds ratio (OR), and their 95% confidence interval. (E) ROC curve and predictive value of the logistic regression model (AUC<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.85).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.M. Salvador-Casabón, D. Grados-Saso, I. Lacambra-Blasco, I. Giménez-López, J.I. Pérez-Calvo" "autores" => array:5 [ 0 => array:2 [ "nombre" => "J.M." "apellidos" => "Salvador-Casabón" ] 1 => array:2 [ "nombre" => "D." "apellidos" => "Grados-Saso" ] 2 => array:2 [ "nombre" => "I." "apellidos" => "Lacambra-Blasco" ] 3 => array:2 [ "nombre" => "I." "apellidos" => "Giménez-López" ] 4 => array:2 [ "nombre" => "J.I." "apellidos" => "Pérez-Calvo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256522001357" "doi" => "10.1016/j.rce.2022.10.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256522001357?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887422001060?idApp=WRCEE" "url" => "/22548874/0000022300000002/v2_202311091405/S2254887422001060/v2_202311091405/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Retinal vein occlusion, a great unknown and a challenge in venous thromboembolic disease" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "96" "paginaFinal" => "97" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "L. Guirado-Torrecillas, V. Salazar-Rosa" "autores" => array:2 [ 0 => array:3 [ "nombre" => "L." "apellidos" => "Guirado-Torrecillas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "V." 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Indeed, its incidence is likely progressively increasing due to population aging, the comorbidity associated with this disease, more sensitive radiological diagnostic techniques, the recent SARS-CoV-2 pandemic, and the more sedentary lifestyle many lead nowadays. It also has a great degree of associated morbidity and mortality, even more so when it is not promptly diagnosed and adequate treatment is therefore not received.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Retinal vein occlusion (RVO) is considered venous thrombosis in an unusual site. This disease is one of the great unknowns and causes the most controversy when it comes to proposing treatment. It is the second most common cause of vision loss after diabetic retinopathy. It affects approximately 16 million people worldwide with a mean age of 60 years and no differences between the sexes.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The pathogenesis of RVO is not well known, although it appears that age has proven to be a crucial factor, given that the vast majority of patients are older than 50 years and its incidence increases with age. A great peculiarity that makes this disease a special, controversial entity is the fact that it is related to classic cardiovascular risk factors rather than habitual risk factors for VTD,<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> in particular hypertension, which is present in more than 50% of patients with RVO and is thus considered the most important risk factor. For this same reason, there are discrepancies when proposing the most adequate treatment.</p><p id="par0020" class="elsevierStylePara elsevierViewall">When approaching patients with RVO, two aspects must be considered: the first is adequate clinical management and the importance of referring these patients for a meticulous assessment of classic cardiovascular risk factors, local risk factors, and other situations of hypercoagulability, such as hyperhomocysteinemia, antiphospholipid syndrome, and thrombophilias; the latter are a point of controversy. At present, there is no recommendation for routinely conducting a thrombophilia study except for in young patients with no cardiovascular risk factors or those who have bilateral RVO.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Given the above, it seems reasonable that all patients with RVO be diagnosed via a fluorescein angiogram by an ophthalmologist and, afterwards, be referred for a consultation with the internal medicine clinic in order to conduct an adequate assessment and to propose systemic treatment<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> in the event it is indicated.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Emphasis should be placed on the importance of long-term follow-up to ensure the optimal control and treatment of cardiovascular risk factors as well as probable diseases related to RVO such as, for example, atrial fibrillation (as demonstrated in the article on the Valdecilla Cohort published in this issue)<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> or cerebrovascular disease.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> In this way, the probable systemic damage associated with RVO or uni- or bilateral recurrences of it can be prevented.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Another important aspect is systemic treatment. At present, there is no clear, definitive evidence on optimal treatment, probably due to a lack of higher-quality studies and the small number of patients, which may one of the fundamental causes. In general, there are no recommendations based on high quality evidence for systemic anticoagulant or antiplatelet treatment, according to the clinical practice guidelines of the Royal College of Ophthalmologists.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> However, some authors do advocate for the consensus-based recommendation of using of low-molecular-weight heparin (LMWH) at therapeutic doses during the first week followed by intermediate doses of LMWH for one to three months versus the use of aspirin or no treatment in patients with recent-onset RVO (15–30 days) with low bleeding risk and no local risk factors (hypermetropia or glaucoma).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Antithrombotic therapy is absolutely contraindicated in patients with small, isolated retinal hemorrhage. Long-term antiplatelet therapy is reserved for the primary prevention of cardiovascular disease in patients with RVO with high or very high cardiovascular risk.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Given the lack of reliable scientific evidence and high-quality recommendations, the importance of the registry of patients with RVO should be strongly emphasized in order to conduct studies and research that may clarify the existing questions about the most suitable management and its treatment and prevention.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:3 [ "etiqueta" => "1" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Dr. Vladimir Salazar-Rosa, coauthor of this editorial, passed away during the production process of the article.</p>" "identificador" => "fn0005" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary arterial thrombosis in COVID-19 with fatal outcome: results from a prospective, single-center, clinicopathologic case series" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.F. 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| Year/Month | Html | Total | |
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| 2023 September | 1 | 0 | 1 |
| 2023 March | 8 | 5 | 13 |
| 2023 February | 1 | 0 | 1 |
