Central retinal venous occlusion in a child with hyperhomocy
An 8-year-old girl patient presented to our hospital because of a 2-year history on painless visual loss in the left eye. Upon examination, the visual acuity (VA) in the right eye was 20/25 which was 20/20 with −0.75DS, the presenting VA in the left eye was 20/1000 which was helpless with +0.25DS/−1.75DC × 170, both of the intraocular pressures by applanation tonometry were 14 mmHg. The examinations of the right eye were normal. Anterior segment findings in the left eye showed normal except the presence of afferent papillary defect. On indirect fundus examination, the optic disc had abnormal vessels and blush, and there was presence of dilated and tortuous retinal veins. Fluorescein angiography (FA) confirmed peripheral capillary non-perfusion (CNP) in the left eye, and optical coherence tomography (OCT) showed macular edema. FA also showed that normal choroidal filling, but there was a variable delay in retinal vascular. High fluorescence accumulated at the posterior pole in the late time. Finally, the girl patient was diagnosed as CRVO.

All investigations were within normal limits except plasma HCY. The level of HCY for the girl patient was 25.5 μmol/L (normal <15 μmol/L). For her retinovascular disease, laser photocoagulation was performed at peripheral CNP area and 0.05 ml intravitreal ranibizumab (Lucentis, Novatis) injection for alleviating the level of edema. For her HCY, oral folic acid, vitamin B12, and vitamin B6 were carried out according to the specialist physician.

After 13 months, NP area covered with laser spot, FA showed generally normal retinal vascular filling ), and the macular recovered to normal, a small amount of fluorescence leakage at the macular. The VA recovered to 20/100 in the left eye. Her HCY was 6.5 μmol/L.

Source: Medicine: June 2019 - Volume 98 - Issue 23 - p e15813

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