Polycythemia-Related Proliferative Ischemic Retinopathy Managed with Smoking Cessation: A Case Report

Abstract

Ischemic retinopathy characterized by neovascularization could result from several diseases such as proliferative diabetic retinopathy, hypertensive retinopathy, and retinal vein occlusion. However, ocular ischemic conditions caused by polycythemia have rarely been described. We report the first case of polycythemia-related proliferative ischemic retinopathy in a 41-year-old male heavy smoker who had ocular ischemic condition due to secondary polycythemia. He had sudden loss of vision in his right eye vision with vitreous hemorrhage and a tortuous retinal artery. Tracing back to his history, he was a heavy smoker with more than one pack of cigarettes per day for more than 30 years. Laboratory data revealed elevated levels of hemoglobin (17.7 g/dL) and hematocrit (51.6%) without other abnormal findings. We performed retinal photocoagulation on the neovascular areas and the fibrous membrane. Additionally, the patient was advised to quit smoking. Owing to adherence to this treatment, the patient’s vision gradually recovered. Although rare, polycythemia can cause retinal ischemic events and should be considered as a sight-threatening disease. Photocoagulation is effective on the regression of the neovascular lesion. Most importantly, changes in lifestyle together with smoking cessation are effective in managing secondary polycythemia. In conclusion, prevention and cessation of tobacco consumption helps improve vision health.

Von Hipple-Lindau disease complicated with central retinal vein occlusion: a case report

“…The arm-choroid filling time was found to correlate with hematocrit level and platelet counts as the artery-venous transit time was found to correlate to the hematocrit and hemoglobin levels [17]. In a recent report, high blood viscosity and erythrocyte vascular adhesion caused by polycythemia can lead to delay in retinal arteriovenous transit time and retinal artery phase filling time, and finally lead to ischemic retinopathy [18]. In this patient the same phenomenon was observed, therefore ischemic lesions of the eye and brain may have been caused by blood hyper viscosity due to polycythemia.…”

Secondary polycythemia and venous thromboembolism: a systematic review

“…Secondary polycythemia and VTE RBC mass ranges from 23 to 29 mL/kg in healthy adult women and 26 to 32 mL/kg in adult men. 2,10 Polycythemia is classified as an abnormal increase in red blood cell mass. 10 Hematocrit values greater than 48% in women and greater than 51% in men, and hemoglobin values greater than 16.5 g/dL in women and 18.5 g/dL in men can be indicative of polycythemia.…”

“…2,10 Polycythemia is classified as an abnormal increase in red blood cell mass. 10 Hematocrit values greater than 48% in women and greater than 51% in men, and hemoglobin values greater than 16.5 g/dL in women and 18.5 g/dL in men can be indicative of polycythemia. 10 An elevation in RBC mass characterizes secondary polycythemia due to a physiologically appropriate response to chronic hypoxemia or due to a physiologically inappropriate secretion of factors that promote erythropoiesis.…”

“…22 Cigarettes contain over seven thousand different chemicals from which nicotine and carbon monoxide have been identified to result in smoking-related hypoxia. 10 Nicotine acts as a peripheral vasoconstrictor, resulting in decreased delivery of oxygen to the peripheral tissues, leading to hypoxia. 10 Additionally, the carbon monoxide in cigarettes impairs the body's normal gas exchange, further contributing to the hypoxia seen in cigarette smokers.…”

“…10 Nicotine acts as a peripheral vasoconstrictor, resulting in decreased delivery of oxygen to the peripheral tissues, leading to hypoxia. 10 Additionally, the carbon monoxide in cigarettes impairs the body's normal gas exchange, further contributing to the hypoxia seen in cigarette smokers. 10 Carbon monoxide has a higher affinity for hemoglobin than oxygen; as a result, carbon monoxide binds with hemoglobin more preferentially, resulting in the formation of carboxyhemoglobin.…”