Title
HYPERHOMOCYSTEINEMIA AS CAUSE OF CENTRAL RETINAL VEIN OCCLUSION
Introduction
Central retinal vein occlusion (CRVO) is a common cause of vision loss in older individuals. Local and systemic risk factors have been found consistently to be associated with the onset of CRVO. Recently, hyperhomocysteinemia has emerged as a new risk factor to retinal vascular diseases. The role of dietary supplementation with folic acid and vitamin B6 are still being debated in this cases.
Methods
Case report and review of the relevant literature about CRVO and hyperhomocysteinemia.
Results
61-year-old patient, female, previously healthy, admitted to an eyecare due to vision loss in the left eye (OS) for three months. She had already undergone laser treatment and intravitreal Aflibercetp applications, both performed by another doctor. Ophthalmological examination presented with visual acuity of 20/20 in the oculus dexter (OD). Left eye (OS) was 20/200. Dilated fundus, appeared normal in the OD. OS presented with intraretinal hemorrhages, intraretinal flame hemorrhages in all quadrants and laser marks compatible with CRVO. Optical Coherence Tomography confirmed macular edema in the OS. Patient underwent a complete cardiovascular investigation that revealed only hyperhomonocysteinemia (32μmol/L). Aflibercept and focal laser were chosen to treat macular edema. Vitamin B and folic acid were introduced in an attempt to prevent new thromboembolic phenomena.
Discussion
High homocysteine causes endothelial injury and dysfunction. Elevated homocysteine may result from low levels of folic acid, vitamin B6, B12 or genetic alterations. Recent studies suggested that in older patients nutricional rather then genetic factors may be more importante in raising plasma total homocysteine levels and that vitamin supplementation with folic acid and vitamin B reduces homocysteine levels. Measurement, treatment and monitoring homocysteine levels may be valuable in the management of these patients and might help prevent recurrent disease.
Keywords
hyperhomocysteine; CRVO; centralretinalveinocclusion; hyperhomocysteinemia
Area
CLINICAL CASE
Authors
Renata BIGOLIN SIVIERO, CARLOS AUGUSTO MOREIRA JR, CARLOS AUGUSTO MOREIRA-NETO, RAFAELA BIGOLIN SIVIERO, MARCELLO QUADROS RIBEIRO, JOSÉ FÁBIO DE OLIVEIRA MIRANDA, THIAGO ISSAMU SWIECH, LUIZ GUSTAVO BETASSI NOCERA