RISK FACTORS FOR RETINAL VENOUS OCCLUSIVE DISORDERS IN YOUNGER PATIENTS.

* Dr. G. V. Prasad MD 1 and Dr. Ch. Ramakrishna MBBS 2 . 1. Civil Surgeon, Department of Ophthalmology, Andhra Medical College, Visakhapatnam. 2. Junior Resident, Department of Ophthalmology, Andhra Medical College, Visakhapatnam. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History


Systemic Risk Factors:
Age, Hypertension, Hyperlipidemia, Diabetes Mellitus, Oral contraceptive Pill usage, smoking, Thrombophilias (Hyperhomocystinemia, Antiphospholipid antibody syndrome, Factor V Leiden Mutation), Myeloproliferative disorders, Dehydration, Chronic Renal Failure The purpose of this study was to evaluate the various systemic risk factors for retinal venous occlusive disorders in younger patients below the age of 51 years.

Materials and Methods:-
The study was conducted at Retina Clinic, Department of Ophthalmology, Government Regional Eye Hospital, Andhra Medical College, Visakhapatnam from August 2017 to January 2018.

Exclusion Criteria:
Retinal Venous occlusions diagnosed in people above the age of 50 years were excluded from the study.
Patients satisfying the inclusion criteria were recruited for the study. Informed consent was taken from every participant. Identification data like Name, Age, Sex, Address, and Occupation were collected. A detailed history pertaining to the ocular complaint and history of any associated systemic illnesses was recorded. Best corrected Visual acuity of the patient was recorded in both the eyes using Snellen's Chart. A detailed Ocular Examination was done which included Slit lamp Examination of the Anterior Segment followed by Examination of the Posterior Segment with 78D lens and Slit Lamp Biomicroscopy as well as Indirect Ophthalmoscopy. Intraocular pressure (IOP) was measured with Goldmann'sApplanation Tonometer prior to pupillary dilatation. A thorough Systemic Examination was done which included recording of the vital data-Pulse Rate and Blood Pressure, followed by auscultation of Cardiovascular and Respiratory systems followed by palpation of abdomen for any Organomegaly. A diagnosis of retinal venous occlusion was made based on clinical examination of Fundus with 78D lens with slit lamp and Indirect Ophthalmoscopy.
All the participants diagnosed with retinal venous occlusion were subjected to the following investigations:
Of the various systemic risk factors studied for association with retinal Venous Occlusions, Hyperhomocystinemia was found in the majority of the patients. 20 cases out of 25 had elevated Plasma Homocysteine levels accounting for 80% of the study population. The second most common risk factor in our study was found to be Systemic Hypertension. Systemic Hypertension was present in 16 participants accounting for 64% of the cases. The mean Systolic Blood Pressure was 133.76mm of Hg and the mean Diastolic Blood Pressure was 87.04 mm of Hg. Hyperlipidemia was the third most common risk factor found to be associated with Retinal Venous occlusion in our study. 13 participants had Hyperlipidemia accounting for 52% of the cases. 10 patients had elevated Serum Total cholesterol and 3 patients had reduced Serum HDL cholesterol. Diabetes Mellitus was the fourth common risk factor in our study. 9 participants suffered from Diabetes mellitus accounting for 36% of the study population ( Figure:3)( Table-1).

Conclusion:-
Our study shows that Hyperhomocystinemia, Systemic Hypertension, Hyperlipidemia and Diabetes mellitus were significant risk factors associated with Retinal Venous Occlusive Disorders in the younger patients below the age of 51 years. Hence, investigating for these systemic risk factors and taking appropriate corrective measures for these detected abnormalities in young patients diagnosed with retinal venous occlusive disorders will help in preventing the occurrence of future ocular as well as systemic vaso-occlusive events and thereby help in reducing morbidity and mortality. Hypertension, Hyperlipidemia and Diabetes Mellitus are lifestyle disorders which can be prevented by making modifications in our lifestyle as a form of primordial prevention. Hence emphasizing the role of lifestyle modifications on the younger population will definitely help in prevention of occurrence of ocular as well as systemic vaso-occlusive disorders.