Correspondence
Recommendations for systemic diagnosis and management in clinical practice guidelines for retinal vein occlusion (RVO)
Recomendaciones de diagnóstico y manejo sistémico en las guías de práctica clínica de la oclusión venosa retiniana (OVR)
Jose Galvez-Olorteguia,b,
, Carmen Burgueño-Montañesa,b, Miguel Zavaleta-Mercadoa,c, Tomas Galvez-Olorteguia,d,e
Corresponding author
a Unidad de Oftalmología Basada en Evidencias (Oftalmoevidencia), Scientia Clinical and Epidemiological Research Institute, Trujillo, Peru
b Servicio de Oftalmología, Hospital Universitario Central de Asturias, Oviedo, Spain
c Instituto de Investigaciones Oftalmológicas y Ciencias Visuales Avanzadas Zavaleta Mercado (Innovaz), Oruro, Bolivia
d Centro de Excelencia en Glaucoma, Clinica GO-Vision, Lima, Peru
e Departamento de Oftalmología, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru
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As the authors described, RVO is related to diverse systemic risk factors, predominantly cardiovascular, for which there is no clear consensus among the various clinical practice guidelines (CPG). The Royal College of Ophthalmologists (RCO)<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> guideline is the only CPG published in the last 5 years (RCO-2022, EURETINA-2019<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and PPP-2019<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>) that included a haematologist in the development team, and which associated RVO with peripheral vascular disease. Similarly, none of the CPGs (RCO, EURETINA o PPP) routinely recommend ruling out antiphospholipid syndrome, hyperhomocysteinemia, thrombophilia testing, or anticoagulant therapy indications (RCO: insufficient evidence, EURETINA/PPP: not reported), although recent evidence may suggest the use of antithrombotic therapy<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and recommend its use, as Dr. Guirado and Dr. Salazar mentioned. The recommendation from the authors of the editorial for bilateral RVO are based on the recommendations from GPC-SERV-2015 (updated 2021),<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> but is not considered by other updated CPGs.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We think that angiographic diagnosis of RVO presents both logistical limitations (duration) and clinical limitations (polymorbid patients, many with kidney damage), and do not recommend it during the acute phase (obscuring effect of the blood).<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In practice, the diagnosis is clinical (eye fundus), and monitoring and assessments are performed with optical coherence tomography (OCT); angiography-OCT (non-invasive) or angiography with fluorescein are useful in evaluating the lack of retinal perfusion in cases of ischemic RVO.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Lastly, we concur regarding the need for immediate referral to the primary care (as recommended by the CPG<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a>) or internal medicine physician, and the use of multidisciplinary care programs.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect1005">Conflicts of interest</span><p id="par1280" class="elsevierStylePara elsevierViewall">The authors declare that they do not have any conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Trombosis venosa retiniana, una gran desconocida y un reto en la enfermedad tromboembólica venosa" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. 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