Background—This randomized controlled trial evaluated clinical durability of Zilver PTX, a paclitaxel-coated drug-eluting stent (DES), for femoropopliteal artery lesions. Outcomes compare primary D...

https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.115.016900

Durable Clinical Effectiveness With Paclitaxel-Eluting Stents in the Femoropopliteal Artery: 5-Year Results of the Zilver PTX Randomized Trial

The introduction of intravitreal antivascular endothelial growth factor (VEGF) therapy for neovascular age-related macular degeneration (AMD) has not only improved the quality of life for our patients but also raised the bar for what we consider effective treatment for this disease.1,2 Fortunately,

Do we need a new classification for choroidal neovascularization in age-related macular degeneration?

Retinal artery occlusion: associated systemic and ophthalmic abnormalities.

Background/Purpose:Retinal vein occlusion is the second most common retinal vascular disorder after diabetic retinopathy and is considered to be an important cause of visual loss. In this review, the purpose is to make an update of the literature about the classification, epidemiology, pathogenesis,

Branch retinal vein occlusion: epidemiology, pathogenesis, risk factors, clinical features, diagnosis, and complications. An update of the literature.

Previous studies have shown an increased risk of retinal vein occlusion (RVO) in patients with hypertension, hypercholesterolemia and diabetes mellitus.Literature on the association between thrombophilic factors and RVO consists of small studies and case reports. The objective was to determine the relationship between thrombophilic risk factors and RVO. Thrombophilic risk factors analyzed were hyperhomocysteinemia, MTHFR gene mutation, factor V Leiden mutation, protein C and S deficiency, antithrombin deficiency, prothrombin gene mutation, anticardiolipin antibodies and lupus anticoagulant. For all currently known thrombophilic risk factors odds ratios for RVO were calculated as estimates of relative risk. The odds ratios were 8.9 (95% CI 5.7 –13.7) for hyperhomocysteinemia, 3.9 (95% CI 2.3 – 6.7) for anticardiolipin antibodies, 1.2 (95% CI 0.9 –1.6) for MTHFR, 1.5 (95% CI 1.0 – 2.2) for factorV Leiden mutation and 1.6 (95% CI 0.8 – 3.2) for prothrombin gene mutation. In conclusion, regarding thrombophilic risk factors and RVO there is only evidence for an association with hyperhomocysteinemia and anticardiolipin antibodies, factors that are known as risk factors for venous thrombosis as well as for arterial vascular disease.The minor effect of factor V Leiden mutation and the protrombin gene mutation (risk factors for venous thrombosis only) suggests that atherosclerosis might be an important factor in the development of CRVO.

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Retinal vein occlusion: a form of venous thrombosis or a complication of atherosclerosis? A meta-analysis of thrombophilic factors.

Association of complement factor H Y402H gene polymorphism with different subtypes of exudative age-related macular degeneration.

Role of thrombophilic gene polymorphisms in branch retinal vein occlusion.

Background: Elevated plasma homocyst(e)ine is a major risk factor for venous thrombosis and cardiovascular disease. Homozygosity for the MTHFR C677T mutation and low plasma folate levels increase plasma homocyst(e)ine concentrations. The aim of this retrospective case–control study was to investigate a possible association between hyperhomocyst(e)inemia and central retinal vein occlusion. Methods: Our study included 78 consecutive patients with central retinal vein occlusion and 78 control subjects, matched for age and sex. High-performance liquid chromatography (HPLC) with fluorescence detection was used to determine fasting plasma homocyst(e)ine concentrations. Plasma folate and vitamin B12 levels were determined by immunological assays. Genotyping for the MTHFR C677T mutation was performed by polymerase chain reaction (PCR). Results: Hyperhomocyst(e)inemia was defined by the 95th percentile of plasma homocyst(e)ine concentrations in the control group (=14.83 µmol/l). Thus 16 patients with central retinal vein occlusion were diagnosed as hyperhomocyst(e)inemic, compared with three control subjects (P=0.001). The odds ratio of hyperhomocyst(e)inemia for central retinal vein occlusion was 5.29 (95% CI 1.33–21.13). Mean plasma folate levels were significantly lower in patients than in controls (3.94±1.94 ng/ml vs. 5.69±2.09 ng/ml; P<0.001). Distribution of MTHFR C677T genotypes did not significantly differ between the two groups. Conclusions: Our study suggests that hyperhomocyst(e)inemia, but not the MTHFR C677T mutation, is associated with central retinal vein occlusion.

Hyperhomocyst(e)inemia and MTHFR C677T genotypes in patients with central retinal vein occlusion.

Hyperhomocyst(e)inemia, but not methylenetetrahydrofolate reductase C677T mutation, as a risk factor in branch retinal vein occlusion

PURPOSE Increased plasma homocysteine levels have been found in patients with primary open angle glaucoma (POAG) and glaucoma secondary to pseudoexfoliation syndrome (PEXG). A common polymorphism of the methylenetetrahydrofolatereductase (MTHFR 677C>T) leads to moderately elevated plasma homocysteine levels particularly under conditions of impaired folate status. It was the aim of this study to investigate a hypothesized association between this polymorphism and the presence of either POAG or PEXG. METHODS The present retrospective case-control study included a total of 553 participants comprising 204 patients with POAG, 138 patients with PEXG, and 211 control subjects. Genotyping for the MTHFR 677C>T polymorphism was performed by polymerase chain reaction (PCR). RESULTS No significant difference in the genotype distribution of the MTHFR 677C>T polymorphism was found between control subjects and patients with POAG or PEXG. The prevalence of the MTHFR 677TT genotype was 6.9% in patients with POAG, 11.6% in patients with PEXG, and 9.5% in control subjects. CONCLUSIONS The present data suggest that the MTHFR 677C>T polymorphism itself is not a major genetic risk factor for POAG and PEXG in a central European population.

/pdf/methylenetetrahydrofolatereductase-mthfr-677c-t-polymorphism-5epu19onzi.pdf

Werner Temmel

Papers

Association of complement factor H Y402H gene polymorphism with different subtypes of exudative age-related macular degeneration.

Role of thrombophilic gene polymorphisms in branch retinal vein occlusion.

Hyperhomocyst(e)inemia and MTHFR C677T genotypes in patients with central retinal vein occlusion.

Hyperhomocyst(e)inemia, but not methylenetetrahydrofolate reductase C677T mutation, as a risk factor in branch retinal vein occlusion

Methylenetetrahydrofolatereductase (MTHFR) 677C>T polymorphism and open angle glaucoma.