Retinal Vein Occlusion. Trombosis de Vena retiniana
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Transcript of Retinal Vein Occlusion. Trombosis de Vena retiniana
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Trombosis Venosa
Retiniana
¿ el patito feo de las trombosis ?
Dr. Vladimir Rosa Salazar.!Unidad de Corta Estancia/Trombosis.!Servicio de Medicina Interna.!Hospital Clínico Universitario Virgen de la Arrixaca. Murcia.!
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“¿Papa como se cura la trombosis del ojo?”
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Trombosis Venosa
Retiniana
= Patito feo
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Varón de 55 años con trombosis venosa retiniana.
¿Anticoagularían ustedes a este paciente aunque fuera
por unos meses?!
http://xforumetv.shmedical.es/rss/votaciones/grafica/varon-de-55-anos-con-trombosis-venosa-retiniana-anticoagularian-ustedes-a-este-paciente-aunque-fuera-por-unos-meses
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www.themegallery.com
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30 TVR
51.000 pacientes
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WANTED
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Trombosis de Vena Retiniana
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! Miembros superiores.!! Senos venosos cerebrales.!! Territorio esplácnico.!
! Vena esplénica.!! Vena porta.!! Vena mesentérica superior.!! Vena mesentérica inferior.!
! Vena retiniana (TVR).!
Semin Hematol 2011;48:264-70.
Trombosis en lugares inusuales
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! Causa común pérdida visual.
! 2ª causa retinopatía vascular.!
! Prevalencia 0.1-0.4%.
! =
Retina 2013;33:901-10. N Engl J Med 2010;363:2135-44.
Ophthalmology 2010;117:313-19.
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! Vena central.
! Vena hemicentral.
! Vena tributaria.
Retina 2013;33:901-10. N Engl J Med 2010;363:2135-44.
Ophthalmology 2010;117:313-19.
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! Morbilidad: Ceguera. ! Edema macular.!! Isquemia macular.!! Glaucoma neovascular.!
! Tratamiento: ! Local.!! Sistémico.!
Retina 2013;33:901-10. N Engl J Med 2010;363:2135-44.
Ophthalmology 2010;117:313-19.
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Obstrucción !de vena central !
de la retina!
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Obstrucción !de vena tributaria !
de la retina!
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Obstrucción !de
hemirretina!
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Arteriopatía
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Fisiopatología Compresión
Cambios en la pared del vaso
Mediadores
Alteración barrera retina-sangre
Hipoxia
Localización Cruces A-V
Lámina cribosa
Intima Endotelio
Flujo
IL-6 VEGF
Incremento permeabilidad vascular
Edema macular vasogénico
Disminución agudeza visual
Retina 2013;33:901-10. N Engl J Med 2010;363:2135-44.
Current Eye Research 2008;33:111-31.
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! Edad.!! Arterioesclerosis.!
! HTA. ! DM.!! Dislipemia.!! Tabaquismo.!
! Ateromatosis carotídea.!! Estrógenos.!! Trombofilias.!! Neoplasias hematológicas.!! Glaucoma.!
Factores predisponentes
N Engl J Med 2010;363:2135-44. Current Eye Research 2008;33:111-31.
J Thromb Thrombolysis 2010;30:16-22.
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Pronóstico
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! 6 Estudios. ! 549 pacientes. ! " de riesgo cardiovascular. ! Riesgo intemedio. ! Hombres fumadores.
Khan et al. Can J Ophthalmol 2013;48:40-45.
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Bertelsen et al. Ophthalmology 2013.
! 439 TVCR. ! 2195 controles. ! 5 años de seguimiento. ! " de mortalidad total, (HR 1.45). ! " de eventos vasculares.
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www.themegallery.com
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Artículos de mayor impacto
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Rodriguez et al. Med Clin (Barc) 2010;134:95-100.
Factores de riesgo vascular y enfermedad obstructiva microvascular de la retina
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! Estudio retrospectivo EEUU.!! TVR en anticoagulados vs TVR sin
anticoagulación. ! Seguimiento: 16 meses.!
! AV y perfusión: similares.
Mruthyunjaya et al. Retina 2006;26:285-291.
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Quresh et al. Ophthalmology 2007;114:507-19.
Interventions for Central Retinal Vein Occlusion. An Evidence-Based Systematic Review
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Janssen et al. Thromb Haemost 2005;93:1021-26.
Retinal vein occlusion: a form of venous thrombosis or complication of atherosclerosis? Meta-analysis of thrombophilic factors
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Low molecular weight heparin for the treatment of retinal vein occlusion: a systematic review and meta-analysis of randomized trials
Lazo-Langner et al. Haematologica 2010;95:1587-93.
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Lazo-Langner et al. Haematologica 2010;95:1587-93.
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Interim Guidelines for Management of Retinal Vein Occlusion. London: The Royal College of Ophthalmologists, December 2010.
BMJ 2012;344:e499.
No recomiendan el uso de AAS, a menos que exista otra razón para indicarla!
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Pacientes TVR
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Pacientes TVR
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Pacientes TVR
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Pacientes TVR
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Pacientes TVR
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TVR (n) Controles (n) p
Dislipemia 20 (40%) 7 (14%) 0.003
Colesterol 204±35 167±36 <0.001
Triglicéridos 173±137 100±44 0.001
LDL (n=40) 120±34 83±21 0.02
Hemoglobina 14.5±4.1 12.8±1.4 <0.001
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! Valoración sistémica. ! Identificar y tratar FRCV. ! Homocisteína y SAF. ! ¿Estudio de trombofilia?. ! ¿Tratamiento sistémico?. ! ¿Anticoagulación?. ! ¿AAS?. ! ¿HBPM?.
! RIETE.
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“Sólo
Platón
sé que no sé nada….”
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