Background: Retinal vein occlusion (RVO) has been associated with incident cardiovascular events and mortality in observational studies, but the results have not been consistent. In this systematic review and meta-analysis, we investigate the association of baseline RVO with subsequent development of cardiovascular events and mortality.

Methods: Eligible English-language peer-viewed cohort studies in PUBMED and EMBASE were identified from inception to November 2017. Exposure of interest was baseline RVO (branch, hemi-retinal, or central). Outcomes of interest were stroke (fatal and nonfatal), myocardial infarction, heart failure, peripheral arterial disease (PAD), cardiovascular mortality, and all-cause mortality. Risk estimates from individual studies were pooled using a random-effects model and results are presented as risk ratios (RR) and 95% confidence intervals (CI).

Results: Fifteen longitudinal cohort studies consisting of 474,466 patients (60,069 with RVO, 414,397 without RVO) were included. RVO increased risk of stroke (RR, 1.45; 95% CI, 1.31-1.61), myocardial infarction (RR, 1.26; 95% CI, 1.17-1.37), heart failure (RR, 1.53; 95% CI, 1.22-1.92), PAD (RR, 1.26; 95% CI, 1.09-1.46), and all-cause mortality (RR, 1.36; 95% CI, 1.02-1.81), but did not increase risk of cardiovascular mortality (RR, 1.78; 95% CI, 0.70-4.48).

Conclusions: Patients who develop RVO are at increased risk for stroke, myocardial infarction, heart failure, PAD, and all-cause mortality. Immediate referral for cardiovascular evaluation and intervention is crucial in patients diagnosed with RVO.