Bilateral Central Retinal Vein Occlusion with Hyperhomo cysteinaemia, treated early with anti VEGF

Abstract

Dear Editor,Retinal vein occlusion is a major cause of retinal vascular disease, second to diabetic retinopathy. Branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO) are the two major categories both have potential for loss of vision owing to complications causing macular edema and neovascularization. Many reports suggest hyperhomocysteinaemia is a risk factor for vascular occlusion. This may be related to increasing plasma homocysteine levels, or more probably to homodynamic change or local vascular insult. We report a case of 76 year old male patient presented with painless sudden loss of vision both eyes. He was not hypertensive (physician opinion was undertaken and all routine blood investigations were found to be within normal limits including hemogram, platelet count, ESR), non diabetic, non -alcoholic and occasional smoker. No past history of drug intake or cardiac illness was seen. Systemic Examination revealed no abnormalities. At presentation his visual acuity was finger counting at 3 meters in both eyes; his intraocular pressure was 16mm Hg in both eyes by applanation tonometer. Anterior segment examination was unremarkable except for early lenticular opacity in both eyes.Fundus examination revealed both eyes having central vein occlusion with well demarcated hemorrhages and edema along vessels (Figure 1). Macular OCT revealed increased thickness of macula (left more than right) with VMMC and Safdarjung Hospital New Delhi