J Korean Ophthalmol Soc.  2017 Mar;58(3):352-357. 10.3341/jkos.2017.58.3.352.

Central Retinal Vein Occlusion in Young Healthy Patients and the Role of Thrombophilia in Pathogenesis

• Lee YM
• Lee MW

• KMID: 2371919
• DOI: http://doi.org/10.3341/jkos.2017.58.3.352

Abstract

PURPOSE
We report two young patients who developed central retinal vein occlusion (CRVO) without any systemic disease, and various thrombophilia tests were performed to determine the etiology.
CASE SUMMARY
Two young patients, a 22-year-old female and a 23-year-old male, who had acute vision loss were diagnosed with nonischemic CRVO via fluorescein angiography. They had no other disease and no common risk factors for CRVO. We performed various tests to determine the thrombophilic risk factors and discovered a transient decrease in protein S antigen and protein C antigen in the female and male patients, respectively.
CONCLUSIONS
CRVO in young patients without systemic disorders may have different mechanisms in the pathology and thus additional laboratory tests to determine thrombophilic disorders are necessary.

Keyword

Central retinal vein occlusion; Protein C deficiency; Protein S deficiency; Thrombophilic disorder

MeSH Terms

Female
Fluorescein Angiography
Humans
Male
Pathology
Protein C
Protein C Deficiency
Protein S
Protein S Deficiency
Retinal Vein*
Risk Factors
Thrombophilia*
Young Adult
Protein C
Protein S

Figure

• 

  Figure 1 Color fundus photograph, fluorescein angiography (FAG), and optical coherence tomography (OCT) from right eye of a 23-year-old woman with central retinal vein occlusion and transient decrease in Protein S antigen. Color fundus photograph presented dilated retinal veins, flame-shaped hemorrhages in inferior area, multiple cotton-wool spots, and mild disk elevation (A ). FAG demonstrated disc hyperemia, leakage from retinal vein, macular edema and blocked hypofluorescence compatible with the hemorrhages (B). OCT demonstrated a significant macular edema with subretinal fluid (C) and bevacizumab was injected into vitreous at once. Following fundus photography (D) and FAG (E) of the same patient after 15 months later returned to normal. The macular edema had resorbed completely and visual acuity was also restored (F).

• 

  Figure 2 Color fundus photograph, fluorescein angiography (FAG), and optical coherence tomography (OCT) from right eye of a 22-year-old man with central retinal vein occlusion and transient decrease in Protein C antigen. Fundus photograph presented dilated retinal veins, flame-shaped retinal hemorrhages in 4 quadrant, and mild disk elevation (A). FAG demonstrated mild disc hyperemia, leakage from retinal vein, and blocked hypofluorescence compatible with the hemorrhages (B). OCT demonstrated nearly normal macular structure (C). Following fundus photography (D) and FAG (E) of the same patient after 15 months showing that almost retinal hemorrhage was absorbed but vessel tortuosity, small amount of retinal and disc hemorrhage, and leakage from capillary remained. The macula had maintained normal structure in following OCT (F) and the best corrective visual acuity was 1.0.

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