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A Journal on Ophthalmology
Minerva Oftalmologica 2014 September-December;56(3-4):63-7
Central retinal artery occlusion associated with multiple thrombophilia risk factors: a case report
Maurizio E. 1, Valverde S. 2, Gessoni F. 2, Canistro R. 3, Boscolo P. R. 1, Gessoni G. 4
1 Ophthalmology Unit, Ospedale Madonna della Navicella, Chioggia, Venezia, Italia;
2 Service of Laboratory, Medicine Ospedale Madonna della Navicella, Chioggia, Venezia, Italia;
3 Hematology end Oncology Unit, Ospedale Madonna della Navicella, Chioggia, Venezia, Italia;
4 Transfusional Service, Ospedale Madonna della Navicella, Chioggia, Venezia, Italia
AIM: Central retinal artery occlusion (CRAO) incidence lies between 0.5 and 1.5 per 1000 initial ophthalmic outpatient visits. The most common presentation of CRAO is an acute persistent painless loss of vision of variable degree. CRAO is a multifactorial disorder and usually in these patients are present a number of comorbid conditions moreover an association between CRAO and thrombophilia risk factors has been reported.
METHODS: BMG a 53 year-old-man presented with abrupt, painless, severe visual loss in his right eye. Ophthalmoscopy and fluorescein angiography confirmed diagnosis of CRAO. Investigations carried excluded cardiovascular diseases, diabetes, renal failure, autoimmune diseases, dyslipidemia, liver disease, diseases of the thyroid, hemoglobin abnormalities. This patient has been evaluated with a standard protocol for assessment of thrombophilia risk facts adopted in our institution.
RESULTS: In BMG multiple thrombophilia risk factors were observed: Modest increase in homocysteine plasma concentration due to a double heterozygous state for MTHFR polymorphisms C677T and A1298C; mild deficit in anti thrombin concentration; modest increase in Hb concentration.
CONCLUSION: Sudden loss of vision is an uncommon presentation to the general emergency department, and acute occlusive events of the retinal arterial circulation account for a substantial proportion of cases. As recommended in patient less than 60 years of age, in this patient a study to detect a hypercoagulable state was performed allowing us to highlight three risk factors whose association could play a role in precipitating the vessel occlusive event.