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2015 ; 6
(3
): 462-8
Nephropedia Template TP
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English Wikipedia
Combined Central Retinal Artery and Vein Occlusion Associated with Factor V
Leiden Mutation and Treated with Hyperbaric Oxygen
#MMPMID26955350
Lemos JA
; Teixeira C
; Carvalho R
; Fernandes T
Case Rep Ophthalmol
2015[Sep]; 6
(3
): 462-8
PMID26955350
show ga
BACKGROUND: Combined central retinal artery occlusion (CRAO) and central retinal
vein occlusion (CRVO) is an uncommon retinal vascular disease which causes sudden
visual acuity loss and is associated with poor prognosis and the development of
severe complications. We report a very rare case of combined CRAO and CRVO in a
patient with factor V Leiden (FVL) mutation (only 3 cases published). To our
knowledge, this is the first case of combined CRAO and CRVO treated with
hyperbaric oxygen therapy (HBOT). CASE AND RESULTS: A 49-year-old woman presented
with complaints of sudden loss of vision in her left eye (LE), with best
corrected visual acuity (BCVA) of 1/20. A complete ophthalmic evaluation with
fundus angiography showed combined CRAO and CRVO. The patient was urgently
treated with HBOT (she completed a total of 9 sessions in 7 days), with marked
visual acuity and angiographic improvement (BCVA of 10/10). Forty-five days
later, she developed a new LE CRVO, and BCVA decreased to 5/10 and later to <1/20
because of significant macular edema. A detailed investigation showed an abnormal
resistance to activated protein C, and a genetic study showed homozygosity for
FVL mutation. The patient was submitted to 3 monthly injections of 1.25 mg
bevacizumab. After 10 months, the patient is in a stable condition with BCVA of
6/10. CONCLUSIONS: Combined CRAO and CRVO in young adults should be investigated
thoroughly for embolic sources, thrombophilic disorders and local ocular
conditions. This is the first case of this severe disease that was treated with
HBOT, and the visual result was very good.