Recommendations for systemic diagnosis and management in clinical practice guidelines for retinal vein occlusion (RVO)

Galvez-Olortegui, Jose; Burgueño-Montañes, Carmen; Zavaleta-Mercado, Miguel; Galvez-Olortegui, Tomas

doi:10.1016/j.rceng.2023.07.002

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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">2</a> guideline is the only CPG published in the last 5 years (RCO-2022, EURETINA-2019<a class="elsevierStyleCrossRef" href="#bib0015">3</a> and PPP-2019<a class="elsevierStyleCrossRef" href="#bib0020">4</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">5</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">6</a> but is not considered by other updated CPGs.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">6</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">2</a>Lastly, we concur regarding the need for immediate referral to the primary care (as recommended by the CPG<a class="elsevierStyleCrossRefs" href="#bib0010">2–4</a>) or internal medicine physician, and the use of multidisciplinary care programs.Conflicts of interestThe authors declare that they do not have any conflicts of interest." "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. Guirado-Torrecillas" 1 => "V. Salazar-Rosa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rce.2023.01.002" "Revista" => array:6 [ "tituloSerie" => "Rev Clín Esp" "fecha" => "2023" "volumen" => "223" "paginaInicial" => "96" "paginaFinal" => "97" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36669742" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Retinal Vein Occlusion (RVO) Guidelines" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Royal College of Ophthalmologists" ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Libro" => array:2 [ "fecha" => "2022" "editorial" => "Royal College of Ophthalmologists" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "https://www.rcophth.ac.uk/resources-listing/retinal-vein-occlusion-rvo-guidelines/" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidelines for the management of retinal vein occlusion by the European Society of Retina Specialists (EURETINA)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "U. Schmidt-Erfurth" 1 => "J. Garcia-Arumi" 2 => "B.S. Gerendas" 3 => "E. Midena" 4 => "S. Sivaprasad" 5 => "R. Tadayoni" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000502041" "Revista" => array:6 [ "tituloSerie" => "Ophthalmologica" "fecha" => "2019" "volumen" => "242" "paginaInicial" => "123" "paginaFinal" => "162" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31412332" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Retinal Vein Occlusions Preferred Practice Pattern®" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.J. Flaxel" 1 => "R.A. Adelman" 2 => "S.T. Bailey" 3 => "A. Fawzi" 4 => "J.I. Lim" 5 => "G.A. Vemulakonda" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ophtha.2019.09.029" "Revista" => array:5 [ "tituloSerie" => "Ophthalmology" "fecha" => "2020" "volumen" => "127" "paginaInicial" => "288" "paginaFinal" => "320" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antithrombotic treatment for retinal vein occlusion: A systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Valeriani" 1 => "F. Paciullo" 2 => "A. Porfidia" 3 => "P. Pignatelli" 4 => "M. Candeloro" 5 => "M. Di Nisio" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jtha.2022.10.003" "Revista" => array:6 [ "tituloSerie" => "J Thromb Haemost" "fecha" => "2023" "volumen" => "21" "paginaInicial" => "284" "paginaFinal" => "293" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36700511" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2015 Guía 5. Manejo de las oclusiones venosas de la retina" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F. Gómez-Ulla" 1 => "M.J. Abraldes" ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Libro" => array:3 [ "titulo" => "Guías de Práctica Clínica de la SERV" "fecha" => "2021" "editorial" => "Sociedad Española de Retina y Vítreo" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "www.serv.es" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22548874/0000022300000008/v2_202404080905/S2254887423000887/v2_202404080905/en/main.assets" "Apartado" => array:4 [ "identificador" => "71813" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Correspondence" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22548874/0000022300000008/v2_202404080905/S2254887423000887/v2_202404080905/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887423000887?idApp=WRCEE"]

Revista Clínica Española (English Edition)

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Revista Clínica Española published its first issue in 1940 and is the body of expression of the Spanish Society of Internal Medicine (SEMI).
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Vol. 223. Issue 8.

Pages 520-521 (October 2023)

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