Case Reports: Intraoperative Migratory Retinal Venous Thrombus in Proliferative Diabetic Retinopathy

Overview

Journal Front Med (Lausanne)

Specialty General Medicine

Date 2024 Sep 24

PMID 39314228

Authors

Danni Lyu

Huan Liu

Yijiong Fang

Yao Wang

Affiliations

Soon will be listed here.

Abstract

Purpose: This study aimed to study the characteristics, possible causes, and clinical implications of intraoperative migratory retinal venous thrombus in proliferative diabetic retinopathy (PDR).

Cases: Two middle-aged Chinese patients with diabetes mellitus presented with blurred vision and were diagnosed with PDR and tractional retinal detachment (TRD). An interesting phenomenon was observed during pars plana vitrectomy in both patients. Movement of tiny white thrombi and interruption of blood flow were observed in a branch of the central retinal vein when the vein was pulled at the time of fibrovascular membrane delamination and disappeared with the elimination of retinal traction after finishing the process of delamination. Laboratory studies revealed abnormal erythrocyte sedimentation rate, fibrinogen, D-dimer, international normalized ratio, and IgA anti-β2-glycoprotein I in one patient and elevated fibrinogen and IgA anticardiolipin in the other. Follow-up examinations at 1 week, 1, 3, and 6 months postoperatively showed good prognosis. Fluorescein fundus angiography at 1 month postoperatively showed neither embolus sign nor prolonged venous filling time in both patients.

Discussion: Local blood stasis of the retinal vein persistently dragged by the fibrovascular membrane may result in thrombogenesis, and traction of the retina during the delamination process may lead to the movement of thrombi. On the other hand, endothelial injury and disordered local blood stasis during delamination may also activate the biological coagulation process and instant thrombus formation. As well, antiphospholipid antibodies may also be a risk factor of ocular thrombogenesis.

Conclusion: This study provides the first videos recording migratory thrombus in terminal vessels, which indicates that fibrovascular membrane in PDR can lead to thrombogenesis due to dragging and hemostasis of the involved retinal vein. PDR patients with fibrovascular membranes may benefit from early relief of vascular traction through fibrovascular membrane delamination.

References

Su Y, Chen J, Dong Z, Zhang Y, Ma R, Kou J . Procoagulant Activity of Blood and Endothelial Cells via Phosphatidylserine Exposure and Microparticle Delivery in Patients with Diabetic Retinopathy. Cell Physiol Biochem. 2018; 45(6):2411-2420. DOI: 10.1159/000488228. View

Matsubara Y, Murata M, Maruyama T, Handa M, Yamagata N, Watanabe G . Association between diabetic retinopathy and genetic variations in alpha2beta1 integrin, a platelet receptor for collagen. Blood. 2000; 95(5):1560-4. View

Frangieh G, Green W, Finkelstein D . Histopathologic study of nine branch retinal vein occlusions. Arch Ophthalmol. 1982; 100(7):1132-40. DOI: 10.1001/archopht.1982.01030040110020. View

Jefferies P, Clemett R, Day T . An anatomical study of retinal arteriovenous crossings and their role in the pathogenesis of retinal branch vein occlusions. Aust N Z J Ophthalmol. 1993; 21(4):213-7. DOI: 10.1111/j.1442-9071.1993.tb00959.x. View

Fujisawa T, Ikegami H, Yamato E, Kawaguchi Y, Ueda H, Shintani M . Association of plasma fibrinogen level and blood pressure with diabetic retinopathy, and renal complications associated with proliferative diabetic retinopathy, in Type 2 diabetes mellitus. Diabet Med. 1999; 16(6):522-6. DOI: 10.1046/j.1464-5491.1999.00111.x. View

Marcinkowska A, Cisiecki S, Rozalski M . Platelet and Thrombophilia-Related Risk Factors of Retinal Vein Occlusion. J Clin Med. 2021; 10(14). PMC: 8306401. DOI: 10.3390/jcm10143080. View

Chen Z, Chen B, Hu P, Liu H, Zheng D . A preliminary observation on rod cell photobiomodulation in treating diabetic macular edema. Adv Ophthalmol Pract Res. 2023; 2(2):100051. PMC: 10577862. DOI: 10.1016/j.aopr.2022.100051. View

Antonetti D, Klein R, Gardner T . Diabetic retinopathy. N Engl J Med. 2012; 366(13):1227-39. DOI: 10.1056/NEJMra1005073. View

Lima Cabrita F, Foster C . Anticardiolipin antibodies and ocular disease. Ocul Immunol Inflamm. 2005; 13(4):265-70. DOI: 10.1080/09273940490912434. View

10.

Trope G, Lowe G, Ghafour I, Foulds W, Forbes C . Blood viscosity in proliferative diabetic retinopathy and complicated retinal vein thrombosis. Trans Ophthalmol Soc U K (1962). 1983; 103 ( Pt 1):108-10. View

11.

Yau J, Lee P, Wong T, Best J, Jenkins A . Retinal vein occlusion: an approach to diagnosis, systemic risk factors and management. Intern Med J. 2009; 38(12):904-10. DOI: 10.1111/j.1445-5994.2008.01720.x. View

12.

Boeri D, Maiello M, Lorenzi M . Increased prevalence of microthromboses in retinal capillaries of diabetic individuals. Diabetes. 2001; 50(6):1432-9. DOI: 10.2337/diabetes.50.6.1432. View

13.

Zhao H, Zhang L, Liu L, Li C, Song W, Pang Y . Blood Levels of Glycated Hemoglobin, D-Dimer, and Fibrinogen in Diabetic Retinopathy. Diabetes Metab Syndr Obes. 2021; 14:2483-2488. PMC: 8180300. DOI: 10.2147/DMSO.S309068. View

14.

Qian J, Jiang Y . Decreased prothrombin time after intravitreal bevacizumab in the early period in patients with proliferative diabetic retinopathy. Acta Ophthalmol. 2011; 89(4):e332-5. DOI: 10.1111/j.1755-3768.2011.02151.x. View

15.

Zhao J, Sastry S, Sperduto R, Chew E, Remaley N . Arteriovenous crossing patterns in branch retinal vein occlusion. The Eye Disease Case-Control Study Group. Ophthalmology. 1993; 100(3):423-8. DOI: 10.1016/s0161-6420(93)31633-7. View

16.

Vinik A, Erbas T, Park T, Nolan R, Pittenger G . Platelet dysfunction in type 2 diabetes. Diabetes Care. 2001; 24(8):1476-85. DOI: 10.2337/diacare.24.8.1476. View

17.

Tang Z, Zhao M, Li C, Wang Y, Peng S . Polyaspartoyl.l-arginine inhibits platelet aggregation through stimulation of NO release from endothelial cells. Eur J Pharmacol. 2008; 588(1):41-6. DOI: 10.1016/j.ejphar.2008.04.012. View

18.

Hernandez J, Sanles I, Perez-Montes R, Martinez-Taboada V, Olmos J, Salmon Z . Antiphospholipid syndrome and antiphospholipid antibody profile in patients with retinal vein occlusion. Thromb Res. 2020; 190:63-68. DOI: 10.1016/j.thromres.2020.04.005. View

19.

OMahoney P, Wong D, Ray J . Retinal vein occlusion and traditional risk factors for atherosclerosis. Arch Ophthalmol. 2008; 126(5):692-9. DOI: 10.1001/archopht.126.5.692. View

20.

Ceglowska K, Nowomiejska K, Kiszka A, Koss M, Maciejewski R, Rejdak R . Bilateral Macular Roth Spots as a Manifestation of Subacute Endocarditis. Case Rep Ophthalmol Med. 2016; 2015:493947. PMC: 4709653. DOI: 10.1155/2015/493947. View