<p>Combined Central Retinal Vein And Artery Occlusion In A Patient With Elevated Level Of Factor VIII: A Case Report</p>

Abstract

PurposeTo report a case of unilateral central retinal vein occlusion (CRVO) with central retinal artery occlusion (CRAO) in a patient with elevated Factor VIII.Case presentationA 48-year-old woman presented with a complaint of decreased visual acuity in her left eye that began 6 weeks prior. The patient had diabetes. The best-corrected visual acuity (BCVA) was hand motion, IOP was 34 mmHg, and there was a neovascularization of the iris in the left eye. A complete fundus evaluation including fluorescein angiography showed non-proliferative diabetic retinopathy in the right eye and CRVO with CRAO in the left eye. Systemic evaluation revealed elevated fibrinogen and Factor VIII suggestive of the diagnosis of thrombophilia due to elevated Factor VIII. This symptom was the first sign of the underlying disorder. IOP was normalized 1 week after IOP lowering agents were applied. Intravitreal anti-vascular endothelial growth factor treatment and pan-retinal photocoagulation were performed in the left eye. Additionally, to treat thrombophilia, warfarin treatment was started and flame-shaped retinal hemorrhage with cotton wool patch near the optic disc and around the retinal vascular arcade at the posterior pole had occurred in the right eye during treatment. Then, warfarin treatment was discontinued and retinal hemorrhage was decreased. In the left eye, the BCVA did not change during treatment.ConclusionElevated levels of Factor VIII as an independent risk in the development of venous thromboembolism. Combined cases usually present with severe visual loss and such patients should be thoroughly evaluated to diagnose underlying factors including Factor VIII, and initiate appropriate management at the earliest.

Central retinal artery occlusion and central retinal vein occlusion in contralateral eye

“…(2,3) Arterial occlusion is a rare condition, with an estimated incidence of 8.5 cases per 100,000 inhabitants, usually secondary to fatty embolus from the internal carotid artery, and it presents as sudden and painless visual field loss. (4)(5)(6) The CRVO has an estimated prevalence of 0.4% and its occlusions, (13) but they were not present in this patient. Carotid Doppler ultrasound and echocardiography are important ancillary tests to order and elucidate etiology of the cases.…”

“…(9) Systemic findings found in CRAO combined with CRVO include diabetes, hypertension, dyslipidemia, as well as inflammatory, coagulation and tumoral disorders. (12,13) Recently, high factor VIII indices have been associated with venous thromboembolism in cases of combined venous and arterial In 6-month follow-up of the condition in RE, there was a complete vascular recanalization, with no glaucoma associated, but atrophy of the retinal inner layers on OCT (Figure 5).…”

Current concepts in the diagnosis and management of antiphospholipid syndrome and ocular manifestations

“…Regarding APS associated with pure ophthalmic manifestations however, there are no current guidelines nor any therapeutic actions suggested other than for preventing subsequent events. Furthermore, systemic anticoagulation, particularly with warfarin, has been linked to increased risk of subsequent retinal vein and arterial occlusion, even at therapeutic dosages [55][56][57].…”

Ocular Complications in the Prone Position in the Critical Care Setting: The COVID-19 Pandemic

“…88 Whilst reports have been conflicting, a number of studies have demonstrated an association between thrombophilia and the presence of pro-thrombotic markers with retinal vascular occlusions; this includes high homocysteine levels, lupus anticoagulant, factor V Leiden mutation, high anticardiolipin IgM levels, protein C and S deficiency, lipoprotein a, elevated fibrinogen levels and increased plasma viscosity. 87,[89][90][91][92][93][94] Critically ill patients in intensive care are commonly found to develop hemostasis abnormalities and deranged coagulation. 95 Furthermore, patients with severe COVID-19 disease present with significant coagulation abnormalities leading to venous and arterial thromboembolic complications.…”