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. 2020 Feb 28;99(9):e19319. doi: 10.1097/MD.0000000000019319

Diabetes mellitus as a risk factor for retinal vein occlusion

A meta-analysis

Yun Wang a, Shanjun Wu a, Feng Wen a, Qixin Cao b,∗
Editor: Ediriweera Desapriya
PMCID: PMC7478649  PMID: 32118761

Supplemental Digital Content is available in the text

Keywords: diabetes mellitus, meta-analysis, retinal vein occlusion

Abstract

Retinal vein occlusion (RVO) is the second most common etiology for vision loss. There is contrasting evidence on the association between diabetes mellitus (DM) and the risk of RVO. We performed a meta-analysis of published articles before October 31, 2019, to estimate a pooled odds ratio for the association between DM and RVO, including central and branch RVO by a fixed or random effects model. We identified 37 publications from 38 studies (1 publication was from 2 studies), published between 1985 and 2019. In total, 148,654 cases and 23,768,820 controls were included in this meta-analysis. The results of pooled analysis for all 37 publications (or 38 studies) showed a significant association between DM and the risk of RVO (OR = 1.68, 95% CI: 1.43–1.99). Subgroup analysis indicated that DM was significantly associated with CRVO (OR = 1.98, 95% CI: 1.29–3.03, I2 = 67.9%), but not significantly associated with BRVO (OR = 1.22, 95% CI: 0.95–1.56, I2 = 64.1%). In conclusion, the result of present meta-analysis suggested that DM is a risk factor for RVO. More well-designed studies on the relationship between RVO and DM should be undertaken in the future.

1. Introduction

Retinal vein occlusion (RVO) is the second most common etiology for vision loss resulting from retinal vascular disorder.[1] RVO exists as 2 subtypes: central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO). A recent analysis revealed that approximately 16 million people worldwide are affected by BRVO.[2] BRVO may result from compression of a branch retinal vein by an adjacent arteriosclerosis retinal artery. Although CRVO shows low prevalence compared to BRVO, it is associated with a worse visual prognosis. CRVO is typically caused by thrombus formation near the lamina cribrosa[1,3] and frequently leads to devastating complications such as neovascular glaucoma.[4]

Systemic condition such as hypertension (HTN), dyslipidemia, diabetes mellitus (DM), and heart diseases increase the risk for endothelial damage or abnormal blood flow; thus, they are associated with RVO.[5] DM, with a prevalence of 2.8% in 2000 and estimated prevalence rate of 4.4% in 2030,[6] is an increasingly severe epidemic health problem globally related with serious acute and chronic complications, resulting from the changing lifestyle and aging population.[7]

Components of metabolic syndrome as risk factors for RVO have been controversial with only some prior studies showing an association between DM and RVO.[8–14] Therefore, this meta-analysis was could determine DM as a possible risk factor.

2. Materials and methods

The present study involved reviewing of issued studies under the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines, and thus, ethical approval was not required.

2.1. Search strategy and study selection

The systematic review was performed by searching databases of PubMed, Web of Science, Scopus, and Cochrane Library to identify relevant studies with the following keywords DM and RVO, and the last search was updated on October 31, 2019. Both Medical Subject Headings and free text terms for key words were used. Detailed search strategies are presented in Supplementary Table 1. The reference lists of papers of interest, and published review articles were also explored to retrieve potentially additional studies. Duplicate publications were included only once. Inclusion criteria of the studies were as follows:

  • (1)

    clear information of RVO confirmation and of included patients and controls;

  • (2)

    control groups without RVO; and

  • (3)

    the number of individuals with DM in RVO cases and controls.

Exclusion criteria were as follows:

  • (1)

    case reports, laboratory studies, letters, reviews, or expert opinions;

  • (2)

    studies with overlapping or duplicate data; and

  • (3)

    lack of enough cases (less than 10) with any form of RVO.

2.2. Data extraction and quality assessment

Two investigators conducted the systematic search and extracted data independently by the name of the first author, year of publication, country/region, races, study period, study design, total number of RVO patients and control subjects, RVO type, DM patients, age (mean or median) of RVO patients and control cases. The quality of the included studies was evaluated by using the Newcastle–Ottawa Scale (NOS).[15] The NOS has a minimum score of zero and a maximum score of nine. All included studies were regarded as low, moderate, and high quality based on NOS scores of 0 to 3, 4 to 6, and 7 to 9, respectively.[16] Any discrepancy was resolved by consensus, and if needed, by consultation with the third author.

2.3. Statistical analysis

The results were evaluated as odds ratios (ORs) for each included study. ORs and 95% confidence intervals (CIs) were obtained directly or calculated from each publication. The heterogeneity of pooled OR was estimated by Higgins I-squared (I2) statistic. If heterogeneity existed (I2 greater than 50%), a random-effects model was applied; otherwise, a fixed-effects model was conducted.[17,18] Egger linear regression and Begg funnel plot test were applied to evaluate publication bias and a P < .05 was considered significant. Leave-one-out sensitivity analysis was applied to confirm the outcomes’ credibility of this meta-analysis. All statistical analyses were performed by STATA software version 12.0 (STATA Corporation, College Station, TX) and all P values were 2-sided.

3. Results

3.1. Study characteristics

The process of detailed screening is shown in Figure 1. We identified 37 publications[8–12,14,19–48] from 38 studies (1 publication[49] was from 2 studies: Beaver Dam Eye Study and Blue Mountains Eye Study), published between 1985 and 2019, according to the inclusion and exclusion criteria. The characteristics of all the included studies and their quality based on the NOS score are demonstrated in Table 1. In total, 148,654 cases and 23,768,820 controls were included in this meta-analysis. Among them, 1123 cases were CRVO, 4842 cases were BRVO, and 142,689 cases were RVO.

Figure 1.

Figure 1

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Methodological flow diagram of the meta-analysis.

Table 1.

Characteristics of all the included studies.

3.1.

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3.2. Meta-analysis

The results of pooled analysis for all 37 publications showed a significant association between DM and the risk of RVO (OR = 1.68, 95% CI: 1.43–1.99) (Fig. 2) with significant heterogeneity across the studies (I2 = 96.6%). In the subgroup analysis by type of RVO, the results indicated that DM was a risk factor for the CRVO group (OR = 1.98, 95% CI: 1.29–3.03, I2 = 67.9%) and mix group (OR = 1.94, CI: 1.59–2.38, I2 = 96.8%), but not significantly associated with BRVO group (OR = 1.22, 95% CI: 0.95–1.56, I2 = 64.1%). However, in subgroup analysis by study design, DM was associated with increased risk of RVO in both case-control studies (OR = 1.58, 95% CI: 1.27–1.96, I2 = 63.9%) and cohort studies (OR = 2.01, 95% CI: 1.49–2.71, I2 = 99.2%). Subgroup analysis by country showed association between DM and the risk of RVO in US (OR = 1.4, 95% CI: 1.01–1.94, I2 = 78.4%), Turkey (OR = 2.09, 95% CI: 1.48–2.93, I2 = 29.3%), and Italy (OR = 2.16, 95% CI: 1.22–3.83, I2 = 56.8%). On the basis of sample size (studies with less than 1000 subjects were classified as “Small”, studies between 1000 and 10,000 subjects as “Middle”, and with more than 10,000 subjects as “Large”), DM was a risk factor in the Small group (OR = 1.52, 95% CI: 1.14–2.03, I2 = 61.8%), Middle group (OR = 1.72, 95% CI: 1.35–2.17, I2 = 50.7%), and Large group (OR = 2.35, 95% CI: 1.66–3.32, I2 = 99.7%). As per the publication year, the analysis showed that DM was not a risk factor in studies published before 2000 (OR = 1.18, 95% CI: 0.83–1.69, I2 = 53.8%) as well as published between 2000 and 2010 (OR = 1.47, 95% CI: 0.99–2.19, I2 = 53.6%), however, DM is associated with the risk of RVO in studies published after 2010 (OR = 2.07, 95% CI: 1.67–2.58 I2 = 98.3%). Subgroup analysis based on NOS score showed a significant association between DM and increased risk of RVO in the moderate quality (OR = 2.13, 95% CI: 1.68–2.72, I2 = 98.5%) and high-quality groups (OR = 1.4, 95% CI: 1.12–1.74, I2 = 51.8%).

Figure 2.

Figure 2

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Forest plot of the risk estimates of the association between diabetes mellitus and retinal vein occlusion in the overall analysis.

3.3. Publication bias and sensitivity analysis

Begg funnel plot and Egger linear regression test were evaluated for publication bias. In all included studies, the results did not indicate any evidence of bias (P = .085) (Fig. 3, Table 2). However, there was publication bias in the Italy group analysis (P = .006, Table 2) and studies published before 2000 (P = .021, Table 2). We used the sequential omission of each individual study to check if any single study impacted the results. Figure 4 shows that the result was not affected by each individual study and this indicated the stability of the results in the overall analysis.

Figure 3.

Figure 3

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Funnel plot evaluating the association between diabetes mellitus and retinal vein occlusion in the overall analysis.

Table 2.

The results of meta-analysis.

3.3.

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Figure 4.

Figure 4

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Leave-one-out sensitivity analyses estimating the association between diabetes mellitus and retinal vein occlusion in the overall analysis.

4. Discussion

RVO is the second most common retinal vascular disorder and a relatively common and frequent cause of visual loss, mainly in elderly patients, resulting from macularedema and retinal ischemia.[50] Although it was first recognized over a century ago, the exact pathogenesis remains unclear. The risk factor for RVO is further connected with systemic conditions such as HTN, arteriosclerosis, DM, hyperlipidemia (HLD), vascular cerebral stroke, blood hyperviscosity, and thrombophilia.[51] Early in 2008, O’Mahoney et al[52] concluded that DM is a risk factor for RVO in adults based on the analysis of 2877 RVO cases and 13,225 controls from 20 studies. Since then, more studies about the relationship between RVO and DM were issued that may significantly change their conclusion. Thus, new analysis was necessary.

This meta-analysis involving 148,654 cases with RVO and 23,768,820 controls supported that individuals with DM were positively related with an increased risk of RVO. Compared with the previous meta-analysis,[52] the number of included studies was more than one-fold in this study with multi-fold cases and controls. In addition, we conducted subgroup analyses based on several factors (such as country and NOS score), which were not conducted by O’Mahoney et al. Thus, this study provides more accuracy about the relationship between DM and RVO.

In the subgroup analysis by type of RVO, we found no association between DM and the risk of BRVO, but DM was a risk factor for the CRVO group and mix group. Previously, Pinna et al[28] found that the prevalence rate of DM was lower in the BRVO group (12.2%) than in the control group (15%). However, Demir et al[44] and Christodoulou et al[37] indicated that the prevalence rate of DM was higher in the BRVO group (24% and 16.7%, respectively) than in the control group (14% and 2.4%, respectively). This meta-analysis included more studies, which can strengthen the statistical power. Notably, the present study missed several BRVO data because 22 included studies (mix group) only included RVO data. Thus, we should be cautioned about the relationship between DM and BRVO, with more future studies suggested. Studies published after 2010 that showed association between DM and risk of RVO might have used more accurate methods and thus provided a more representative case-control study.

Significant heterogeneity was found in the overall analysis. When data were pooled into subgroup analyses, the heterogeneity decreased in some groups. Further analysis showed 2 studies[38,39] affected heterogeneity. Both studies were population based cohort studies including 137,541 samples and 23,149,403 samples, respectively. After excluding both studies, the I2 decreased to 61.7% and results did not change. Moreover, we used the sequential omission of each individual study and the result was not affected by each individual study, thus indicating the stability of the results.

Our study has several concerning limitations. First, the studies included in this meta-analysis were all published in English, the language bias being inevitable. Second, we could not conduct subgroup analysis based on other contributing clinical factors (such as HTN and HLD) because of insufficient data. Finally yet importantly, only published studies with available data were included, and the unpublished data mat thus influence the conclusions.

In conclusion, the result of present meta-analysis suggested that DM is a risk factor for RVO. Considering these limitations listed above, more well-designed studies on the relationship between RVO and DM should be undertaken in the future.

Author contributions

Conceptualization: Yun Wang, Qixin Cao.

Data curation: Yun Wang, Shanjun Wu, Feng Wen, Qixin Cao.

Investigation: Shanjun Wu, Feng Wen.

Methodology: Yun Wang, Feng Wen, Qixin Cao.

Software: Yun Wang, Shanjun Wu, Feng Wen, Qixin Cao.

Validation: Shanjun Wu, Qixin Cao.

Writing – original draft: Yun Wang, Shanjun Wu, Feng Wen.

Writing – review & editing: Qixin Cao.

Supplementary Material

Supplemental Digital Content
medi-99-e19319-s001.docx (16.6KB, docx)

Footnotes

Abbreviations: BRVO = branch retinal vein occlusions, CRVO = central retinal vein occlusion, DM = diabetes mellitus, HTN = hypertension, I2 = I-squared, OR = odds ratio, RVO = retinal vein occlusion.

How to cite this article: Wang Y, Wu S, Wen F, Cao Q. Diabetes mellitus as a risk factor for retinal vein occlusion: A meta-analysis. Medicine. 2020;99:9(e19319).

YW, SW, and FW contributed equally to this work and should be considered as co-first authors.

This work was supported by Huzhou Public Welfare Application Research Project (Grant number: 2019GYB69).

References

  • [1].Prisco D, Marcucci R. Retinal vein thrombosis: risk factors, pathogenesis and therapeutic approach. Pathophysiol Haemost Thromb 2002;32:308–11. [DOI] [PubMed] [Google Scholar]
  • [2].Rogers S, McIntosh RL, Cheung N, et al. The prevalence of retinal vein occlusion: pooled data from population studies from the United States, Europe, Asia, and Australia. Ophthalmology 2010;117:313–90. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [3].Hayreh SS. Prevalent misconceptions about acute retinal vascular occlusive disorders. Prog Retin Eye Res 2005;24:493–519. [DOI] [PubMed] [Google Scholar]
  • [4].Chan CK, Ip MS, Vanveldhuisen PC, et al. SCORE Study report #11: incidences of neovascular events in eyes with retinal vein occlusion. Ophthalmology 2011;118:1364–72. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [5].Stem MS, Talwar N, Comer GM, et al. A longitudinal analysis of risk factors associated with central retinal vein occlusion. Ophthalmology 2013;120:362–70. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [6].Wild S, Roglic G, Green A, et al. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004;27:1047–53. [DOI] [PubMed] [Google Scholar]
  • [7].Vigneri P, Frasca F, Sciacca L, et al. Diabetes and cancer. Endocr Relat Cancer 2009;16:1103–23. [DOI] [PubMed] [Google Scholar]
  • [8].Johnston RL, Brucker AJ, Steinmann W, et al. Risk factors of branch retinal vein occlusion. Arch Ophthalmol 1985;103:1831–2. [DOI] [PubMed] [Google Scholar]
  • [9].Appiah AP, Greenidge KC. Factors associated with retinal-vein occlusion in Hispanics. Ann Ophthalmol 1987;19:307–9. 312. [PubMed] [Google Scholar]
  • [10].Elman MJ, Bhatt AK, Quinlan PM, et al. The risk for systemic vascular diseases and mortality in patients with central retinal vein occlusion. Ophthalmology 1990;97:1543–8. [DOI] [PubMed] [Google Scholar]
  • [11].Rath EZ, Frank RN, Shin DH, et al. Risk factors for retinal vein occlusions. A case-control study. Ophthalmology 1992;99:509–14. [DOI] [PubMed] [Google Scholar]
  • [12].Sekimoto M, Hayasaka S, Setogawa T. Type of arteriovenous crossing at site of branch retinal vein occlusion. Jpn J Ophthalmol 1992;36:192–6. [PubMed] [Google Scholar]
  • [13].Risk factors for branch retinal vein occlusion. The Eye Disease Case-control Study Group. Am J Ophthalmol 1993;116:286–96. [PubMed] [Google Scholar]
  • [14].Risk factors for central retinal vein occlusion. The Eye Disease Case-Control Study Group. Arch Ophthalmol 1996;114:545–54. [PubMed] [Google Scholar]
  • [15].Wells GA, Tugwell P, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Ottawa Health Research Institute Web site 2015. [Google Scholar]
  • [16].Montazeri Z, Nyiraneza C, El-Katerji H, et al. Waterpipe smoking and cancer: systematic review and meta-analysis. Tob Control 2017;26:92–7. [DOI] [PubMed] [Google Scholar]
  • [17].DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986;7:177–88. [DOI] [PubMed] [Google Scholar]
  • [18].Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 1959;22:719–48. [PubMed] [Google Scholar]
  • [19].Timmerman EA, de Lavalette VW, van den Brom HJ. Axial length as a risk factor to branch retinal vein occlusion. Retina 1997;17:196–9. [DOI] [PubMed] [Google Scholar]
  • [20].Simons BD, Brucker AJ. Branch retinal vein occlusion. Axial length and other risk factors. Retina 1997;17:191–5. [DOI] [PubMed] [Google Scholar]
  • [21].Salomon O, Moisseiev J, Rosenberg N, et al. Analysis of genetic polymorphisms related to thrombosis and other risk factors in patients with retinal vein occlusion. Blood Coagul Fibrinolysis 1998;9:617–22. [DOI] [PubMed] [Google Scholar]
  • [22].Marcucci R, Bertini L, Giusti B, et al. Thrombophilic risk factors in patients with central retinal vein occlusion. Thromb Haemost 2001;86:772–6. [PubMed] [Google Scholar]
  • [23].Kadayifcilar S, Ozatli D, Ozcebe O, et al. Is activated factor VII associated with retinal vein occlusion? Br J Ophthalmol 2001;85:1174–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [24].Yaghoubi GH, Madarshahian F, Mosavi M. Hyperhomocysteinaemia: risk of retinal vascular occlusion. East Mediterr Health J 2004;10:633–9. [PubMed] [Google Scholar]
  • [25].Yildirim C, Yaylali V, Tatlipinar S, et al. Hyperhomocysteinemia: a risk factor for retinal vein occlusion. Ophthalmologica 2004;218:102–6. [DOI] [PubMed] [Google Scholar]
  • [26].Weger M, Renner W, Steinbrugger I, et al. Role of thrombophilic gene polymorphisms in branch retinal vein occlusion. Ophthalmology 2005;112:1910–5. [DOI] [PubMed] [Google Scholar]
  • [27].Gumus K, Kadayifcilar S, Eldem B, et al. Is elevated level of soluble endothelial protein C receptor a new risk factor for retinal vein occlusion? Clin Exp Ophthalmol 2006;34:305–11. [DOI] [PubMed] [Google Scholar]
  • [28].Pinna A, Carru C, Solinas G, et al. Glucose-6-phosphate dehydrogenase deficiency in retinal vein occlusion. Invest Ophthalmol Vis Sci 2007;48:2747–52. [DOI] [PubMed] [Google Scholar]
  • [29].Leoncini G, Bruzzese D, Signorello MG, et al. Platelet activation by collagen is increased in retinal vein occlusion. Thromb Haemost 2007;97:218–27. [PubMed] [Google Scholar]
  • [30].Koizumi H, Ferrara DC, Brue C, et al. Central retinal vein occlusion case-control study. Am J Ophthalmol 2007;144:858–63. [DOI] [PubMed] [Google Scholar]
  • [31].Di Capua M, Coppola A, Albisinni R, et al. Cardiovascular risk factors and outcome in patients with retinal vein occlusion. J Thromb Thrombolysis 2010;30:16–22. [DOI] [PubMed] [Google Scholar]
  • [32].Bertelsen M, Linneberg A, Rosenberg T, et al. Comorbidity in patients with branch retinal vein occlusion: case-control study. BMJ 2012;345:e7885. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [33].Capua MD, Minno MN, Guida A, et al. Coronary artery disease, cerebral non-fatal ischemic stroke in retinal vein occlusion: an 8-yr follow-up. Nutr Metab Cardiovasc Dis 2012;22:23–7. [DOI] [PubMed] [Google Scholar]
  • [34].Giannaki K, Politou M, Rouvas A, et al. Retinal vein occlusion: genetic predisposition and systemic risk factors. Blood Coagul Fibrinolysis 2013;24:279–83. [DOI] [PubMed] [Google Scholar]
  • [35].Newman-Casey PA, Stem M, Talwar N, et al. Risk factors associated with developing branch retinal vein occlusion among enrollees in a United States managed care plan. Ophthalmology 2014;121:1939–48. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [36].Fernandez-Vega B, Alvarez L. Association study of high-frequency variants of MTHFR gene with retinal vein occlusion in a Spanish population 2019;40:342–9. [DOI] [PubMed] [Google Scholar]
  • [37].Christodoulou A, Bagli E, Gazouli M, et al. Genetic polymorphisms associated with the prevalence of retinal vein occlusion in a Greek population. Int Ophthalmol 2019;39:2637–48. [DOI] [PubMed] [Google Scholar]
  • [38].Kim J, Lim DH, Han K, et al. Retinal vein occlusion is associated with low blood high-density lipoprotein cholesterol: a nationwide cohort study. Am J Ophthalmol 2019;205:35–42. [DOI] [PubMed] [Google Scholar]
  • [39].Chen YY, Yen YF, Lin JX, et al. Risk of ischemic stroke, hemorrhagic stroke, and all-cause mortality in retinal vein occlusion: a nationwide population-based cohort study. J Ophthalmol 2018;2018:8629429. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [40].Christiansen CB, Torp-Pedersen C, Olesen JB, et al. Risk of incident atrial fibrillation in patients presenting with retinal artery or vein occlusion: a nationwide cohort study. BMC Cardiovasc Disord 2018;18:91. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [41].Schwaber EJ, Fogelman N, Sobol EK, et al. Associations with retinal vascular occlusions in a diverse, urban population. Ophthalmic Epidemiol 2018;25:220–6. [DOI] [PubMed] [Google Scholar]
  • [42].Thapa R, Bajimaya S, Paudyal G, et al. Prevalence, pattern and risk factors of retinal vein occlusion in an elderly population in Nepal: the Bhaktapur retina study. BMC Ophthalmol 2017;17:162. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [43].Szigeti A, Ecsedy M, Schneider M, et al. Stromal cell-derived factor 1 polymorphism in retinal vein occlusion. PLoS One 2016;11:e0166544. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [44].Demir S, Ortak H, Benli I, et al. Genetic association between arterial stiffness-related gene polymorphisms in BRVO and CRVO patients in a Turkish population. Retina 2015;35:2043–51. [DOI] [PubMed] [Google Scholar]
  • [45].Kutluturk I, Karagoz A, Bezgin T, et al. Relationship between angiotensin I-converting enzyme insertion/deletion gene polymorphism and retinal vein occlusion. Thromb J 2014;12:17. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [46].Weger M, Steinbrugger I, Renner W, et al. Role of the vitamin K epoxide reductase complex subunit 1 (VKORC1) -1639G>A gene polymorphism in patients with retinal vein occlusion. Curr Eye Res 2013;38:1278–82. [DOI] [PubMed] [Google Scholar]
  • [47].Ortak H, Demir S, Ates O, et al. Association of MMP2-1306C/T and TIMP2G-418C polymorphisms in retinal vein occlusion. Exp Eye Res 2013;113:151–5. [DOI] [PubMed] [Google Scholar]
  • [48].Chan EW, Wong TY, Liao J, et al. Branch retinal vein occlusion and optic nerve head topographic parameters: the Singapore Indian eye study. Br J Ophthalmol 2013;97:611–6. [DOI] [PubMed] [Google Scholar]
  • [49].Cugati S, Wang JJ, Knudtson MD, et al. Retinal vein occlusion and vascular mortality: pooled data analysis of 2 population-based cohorts. Ophthalmology 2007;114:520–4. [DOI] [PubMed] [Google Scholar]
  • [50].Hayreh SS, Zimmerman MB. Branch retinal vein occlusion: natural history of visual outcome. JAMA Ophthalmol 2014;132:13–22. [DOI] [PubMed] [Google Scholar]
  • [51].Zhou JQ, Xu L, Wang S, et al. The 10-year incidence and risk factors of retinal vein occlusion: the Beijing eye study. Ophthalmology 2013;120:803–8. [DOI] [PubMed] [Google Scholar]
  • [52].O’Mahoney PR, Wong DT, Ray JG. Retinal vein occlusion and traditional risk factors for atherosclerosis. Arch Ophthalmol 2008;126:692–9. [DOI] [PubMed] [Google Scholar]

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Supplementary Materials

Supplemental Digital Content
medi-99-e19319-s001.docx (16.6KB, docx)

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