Associated antiphospholipid antibodies

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CRAO is also associated with elevated levels of antiphospholipid antibodies (APA).34-39 Among patients with systemic lupus erythematosus, persistently positive tests for APA, especially lupus anticoagulant and anticardiolipid antibody (aCL), characterise a subset of patients with thrombotic tendency.38 In particular, the presence of aCL has been found to be an independent risk factor for ischaemic stroke, especially among young patients,39 and an association between transient monocular blindness and elevated levels of APA, especially aCL, has been suggested (for review see Donders et al.40).

Figure 12.2 Branch retinal artery occlusion with impaction of two emboli in the artery. The retina shows an arcuate band of infarction

The primary antiphospholipid syndrome and factor V Leiden mutation, as well as other forms of thrombophilia, should be considered in the differential diagnosis of unexplained retinal vascular occlusions. The coexistence of severe thrombophilic disorders may carry a particularly high risk for thrombotic manifestations.41

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