J Korean Ophthalmol Soc.  2008 Dec;49(12):2017-2020.

Central Retinal Artery Obstruction in Protein S Deficiency

• Lee SB
• Yun YJ
• Kim JY

Abstract

PURPOSE: To report a case of central retinal artery obstruction (CRAO) caused by protein S deficiency.
CASE SUMMARY
A 36-year-old man presented with acutely reduced visual acuity in the right eye. The patient had no other diseases such as diabetes mellitus or hypertension. The visual acuity was 20/20 in the right eye and light perception in the left eye. Afferent pupillary defect was observed in theleft eye. Fundus examination showed diffuse retinal opacification and a cherry-red spot at the macula. Thus the patient was diagnosed with CRAO in the left eye. There were no abnormal findings on routine hematologic tests including blood coagulation test. Protein C activity, antithrombin III activation, anticardiolipin antibody were within normal limits but protein S activity was decreased. Thus, the patient was diagnosed with CRAO with protein S deficiency.
CONCLUSIONS
Coagulation factors such as protein S need to be measuredin cases of CRAO in young patients without medical problems.

Keyword

Central retinal artery obstruction; Hypercoagulable state; Protein S

MeSH Terms

Adult
Antibodies, Anticardiolipin
Antithrombin III
Blood Coagulation Factors
Blood Coagulation Tests
Diabetes Mellitus
Eye
Hematologic Tests
Humans
Hypertension
Light
Protein C
Protein S
Protein S Deficiency
Pupil Disorders
Retinal Artery
Retinaldehyde
Visual Acuity
Antibodies, Anticardiolipin
Antithrombin III
Blood Coagulation Factors
Protein C
Protein S
Retinaldehyde

Figure

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  Figure 1. Fundus photograph of the left eye showing diffuse retinal opacification with a prominent cherry-red spot in the macula at the initial visit.

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  Figure 2. Fluorescein angiograms of the left eye at the initial visit. (A) At 22 seconds after injection, filling of the retinal arterioles is still incomplete. (B) At 56 seconds after injection, filling of the retinal vein is complete. The left eye shows a delayed arm-to-retinal circulation time and shows amarkedly delayed arteriovenous transit time.

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  Figure 3. Fundus photograph of the left eye shows narrowing of the retinal arteries and optic disc pallor at 2-year follow-up.

Reference

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