Table 1:
Predominant associations for vein occlusions
| Patient group |
Hypertension |
Hyperlipidaemia |
Diabetes Mellitus |
No obvious cause |
Young patients less
than 50 years old |
25%
|
35%
|
3%
|
40%
|
Older patients over
50 years |
64%
|
34%
|
4-15%
|
21%
|
| Asian (from Indian subcontinent) |
64%
|
50%
|
29%
|
10.7%
|
| West Indian |
83%
|
33%
|
38%
|
8.3%
|
| Recurrent cases |
88%
|
47%
|
3%
|
6%
|
| Odd ratio |
1.8 - 2.5
|
|
1.6 - 2.1
|
|
m
m
Table 2:
Initial Medical Investigations for Patients Presenting with Retinal Vein
Occlusion
| ALL PATIENTS |
-
Full blood count and ESR or plasma viscosity
-
Urea, electrolytes, creatinine
-
Random blood glucose
-
Random cholesterol and HDL cholesterol+
-
Plasma protein electrophoresis
-
ECG+
-
Thyroid function
+ It is essential to record these
investigations for the Framingham equation
|
| MORE SPECIALISED TESTS ACCORDING
TO CLINICAL INDICATION |
-
Thrombophilia screen
-
Anti-cardiolipin antibody, lupus anticoagulant
-
C-reactive protein
-
Serum ACE
-
Auto-antibodies - rheumatoid factor
/ anti-nuclear / anti DNA / ANCA
-
Chest X-ray
-
Fasting homocystine level
|
m
m
Table 3:
Guide to diagnosis and targets for cardiovascular risk factors
Blood
pressure
(mm/Hg) |
Diagnosis of hypertension
> 140/ and, or > 90 sustained
Optimal blood pressure is < 140/85
Audit standard is < 150/<90 |
Cholesterol
(mmol/l) |
Primary prevention - (CHD risk >
15% or total CVD risk > 20% 10 year risk)* +, statin usually
required.
Secondary prevention target is <4.8
mmol/l, use of statin required |
| Diabetes
mellitus |
Diagnosis = fasting glucose > 7.0
mmol/l (multiple sampling)
Glycosylated haemoglobin target is
< 7%
Optimal blood pressure is <130/80
Audit standard is <140/<80 |
| Aspirin |
Indicated if CHD risk
> 15% 10 year* and (or CVD risk > 20%)+,in hypertensive patients,
providing satisfactory blood pressure control and no contra- indication
(peptic ulcer, allergy, history of haemorrhage e.g. recent haemorrhagic
stroke, or in the initial stages of a severe haemorrhagic retinal vein
occlusion) |
* Coronary Heart Disease
(CHD) and Total CardiovascularDisease (CVD) risk
calculated using the Framingham
Equation, either using chart, discs or
computerised programs (See Joint
British Guidelines and British Hypertension
Society guidelines).44,45,48,49
Variables required for the calculation
include random cholesterol, HDL cholesterol,systolic blood pressure levels,
and age, sex, the presence of diabetes mellitus,smoking, and the presence
of left ventricular hypertrophy on ECG.
+ British Hypertension Society guidelines
200449 |
|
