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Abstract

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  2. Abstract
  3. Disclosure of Conflict of Interests
  4. References

See also Rehak M, Wiedemann P. Retinal vein thrombosis: pathogenesis and management. J Thromb Haemost 2010; 8: 1886–94; Ageno W, Squizzato A, Lazo-Langner A. Retinal vein thrombosis: pathogenesis and management: a rebuttal. This issue, pp 418–9.

We appreciate the interest and comments from Professor Ageno et al. about our review article ‘Retinal vein thrombosis: pathogenesis and management’ [1], in which we presented an overview of the pathogenesis and management of retinal vein occlusion (RVO). The purpose of such a review is to summarize the most important data and to provide clinical recommendations based on the currently best available level of evidence.

We agree that there is a rationale for the use of antiplatelet agents and anticoagulant drugs in the treatment of patients with RVO. For use of these treatment options, we have reflected the results of a study published by Squizzato et al. [2]. The authors concluded that ‘despite the limited evidence, the results of the few randomised controlled studies suggest that patients may benefit from antithrombotic treatment in the acute phase of the disease, and that low molecular weight heparins (LMWH) appear as the most effective agents’. They further wrote ‘however, it should be emphasized that no studies comparing LMWH with placebo or no treatments have been carried out. Thus, it is at this stage only possible to suggest a superiority of LMWH over comparator treatments, whereas no clear cut conclusions can be drawn on the potential benefits of the LMWH over no antithrombotic treatment’.

The meta-analysis of Lazo-Langer et al. [3] appeared following acceptance of our paper for publishing. These authors conducted a systematic review and meta-analysis of randomized trials (RCTs) evaluating the effect of LMWH on patients with RVO. Only three RCTs could be evaluated. The results of the meta-analysis suggest that the use of LMWH results in improved visual acuity 6 months after symptom onset and also in a 78% risk reduction of developing adverse ocular outcomes. However, a number of limitations preclude definitive conclusions from this study. First, the evaluated studies used different agents. The optimal low-molecular-weight heparin, dosing schedule and duration of treatment thus remain unknown. Whereas one study administered parnaparin for 3 months, the other two used dalteparin for only 20 days. Also, the authors of this study concluded that more studies are required before definitive recommendations can be made [3].

The data from these studies, however, could be used to design a larger prospective randomized study in which the dosing schedule and duration of treatment with LMWH in patients with RVO could be clarified.

Disclosure of Conflict of Interests

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  3. Disclosure of Conflict of Interests
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The authors state that they have no conflict of interest.

References

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  2. Abstract
  3. Disclosure of Conflict of Interests
  4. References