Risk of Adverse Systemic Events in Retinal Vein Occlusion.

Purpose: Conflicting data exists on whether central and branch retinal vein occlusion (CRVO and BRVO) are linked to systemic adverse events. This study examines this association using the TriNetX US Collaborative Network, encompassing more than 110 million patients.

Design: Retrospective population-based cohort design.

Subjects and controls: CRVO and BRVO cohorts were compared to control cataract cohorts and between high and low-intensity treatment defined by ≥10 compared to ≤5 anti-vascular endothelial growth factor (anti-VEGF) injections.

Methods: This study used deidentified data from a national database (2006-2024), using International Classification of Diseases 10 codes for CRVO and BRVO. Patients were propensity score matched on demographics, medications, and comorbidities. Risk ratios were generated for systemic events in CRVO and BRVO patients compared to controls, and between patients with high and low-intensity treatment.

Main outcome measures: Risk ratios (RRs) and 95% confidence intervals (CIs) of death, myocardial infarction (MI), hemorrhagic stroke, ischemic stroke, and carotid disease.

Results: CRVO was associated with increased risk of death (RR 1.30; 95% CI 1.26-1.35), MI (RR 1.24; 1.16-1.32), hemorrhagic stroke (RR 1.35; 1.21-1.51), ischemic stroke (RR 1.49; 1.4-1.59), and carotid disease (RR 1.69; 1.59-1.79). BRVO was associated with increased risk of death (RR 1.27; 1.23-1.32), MI (RR 1.39; 1.30-1.49), hemorrhagic stroke (RR 1.57; 1.41-1.75), ischemic stroke (RR 1.66; 1.56-1.77), and carotid disease (RR 1.67; 1.57-1.77). CRVO with high-intensity treatment was associated with increased risk of MI (RR 1.47; 1.12-1.93) compared to low-intensity CRVO treatment, but there were no significant differences in risk of death (RR 0.98; 0.86-1.11), hemorrhagic stroke (RR 1.00; 0.63-1.58), ischemic stroke (RR 1.31; 1.03-1.66), or carotid disease (RR 1.34; 1.06-1.70). For BRVO with high compared to low-intensity treatment, no significant differences in rates of death (RR 1.12; 0.96-1.31), MI (RR 1.30; 0.93-1.81), hemorrhagic stroke (RR 0.96; 0.60-1.53), ischemic stroke (RR 1.05; 0.80-1.38), or carotid disease (RR 1.17; 0.85-1.60) were identified.

Conclusions: CRVO and BRVO are associated with increased risk of death, MI, hemorrhagic stroke, ischemic stroke, and carotid disease. High-intensity treatment of CRVO may be associated with increased risk of MI. These results from this dataset demonstrate the importance of systemic evaluation after RVO.