Retinal vein occlusion, a great unknown and a challenge in venous thromboembolic disease

Guirado-Torrecillas, L.; Salazar-Rosa, V.

doi:10.1016/j.rceng.2023.01.001

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Guirado-Torrecillas, V. Salazar-Rosa" "autores" => array:2 [ 0 => array:3 [ "nombre" => "L." "apellidos" => "Guirado-Torrecillas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "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">1</a>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.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">2,3</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.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">4,5</a>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">6</a> in the event it is indicated.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">7</a> or cerebrovascular disease.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> In this way, the probable systemic damage associated with RVO or uni- or bilateral recurrences of it can be prevented.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">9</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">10</a>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.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." "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:3 [ "etiqueta" => "1" "nota" => "Dr. Vladimir Salazar-Rosa, coauthor of this editorial, passed away during the production process of the article." 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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).
The journal fully endorses the goals of updating knowledge and facilitating the acquisition of key developments in internal medicine applied to clinical practice. Revista Clínica Española is subject to a thorough double blind review of the received articles written in Spanish or English. Ten issues are published each year, including mostly originals, reviews and consensus documents.

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Current Contents / Clinical Medicine , JCR / SCI-Expanded, Index Medicus / Medline y Excerpta Medica / EMBASE

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Impact factor

The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two preceding years.

© Clarivate Analytics, Journal Citation Reports 2022

Impact factor 2023

2.3

Citescore

CiteScore measures average citations received per document published.

Citescore 2023

0.7

SJR

SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact.

SJR 2023

0.162

SNIP

SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field.

SNIP 2023

0.211

View more metrics

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Journal Information

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Vol. 223. Issue 2.

Pages 96-97 (February 2023)

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