gms | German Medical Science

102. Jahrestagung der DOG

Deutsche Ophthalmologische Gesellschaft e. V.

23. bis 26.09.2004, Berlin

Combined central retinal artery and vein occlusions in homocysteinemia

Meeting Abstract

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  • corresponding author S. Eckert - Universitäts-Augenklinik Ulm, Ulm
  • C. W. Spraul - Universitäts-Augenklinik Ulm, Ulm
  • G. E. Lang - Universitäts-Augenklinik Ulm, Ulm

Evidenzbasierte Medizin - Anspruch und Wirklichkeit. 102. Jahrestagung der Deutschen Ophthalmologischen Gesellschaft. Berlin, 23.-26.09.2004. Düsseldorf, Köln: German Medical Science; 2004. Doc04dogP 146

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dog2004/04dog637.shtml

Veröffentlicht: 22. September 2004

© 2004 Eckert et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

Combined central retinal artery and vein occlusions are rare and usually associated with a poor prognosis.

Methods

We report on two patients with combined occlusion of the central retinal artery and vein, associated with an elevated homocysteine level.

Results

A 41-year-old patient presented with sudden visual loss in his right eye. His medical history was uneventful. Visual acuity was 1/18 in his right and 1.0 in his left eye. Funduscopic examination displayed a hyperemic optic disc with associated edema, intraretinal hemorrhages, cotton wool spots and tortuositas of the vessels in all quadrants. Fluorescein angiography displayed increased arm retina time and arteriovenous passage time. We found a homozygous mutation of methylene tetrahydrofolate reductase (MTHFR) gene and an elevated plasma homocysteine level (>50mmol/l). Therefore a replacement therapy with folic acid, vitamin B6 and B12 was given. A 52-year-old patient presented with acute visual loss in his left eye. Eighteen years ago, he had a central retinal vein occlusion in his right eye. Myocardial infarction occurred one year ago. Besides elevated homocysteine level the patient had arterial hypertension and hypercholesterinemia. The patient was on beta-blocker, hypocholesterinemic agent, acetylsalicylic acid, folic acid, vitamin B6 and B12. Best corrected visual acuity was 0.2 in his right and 0.9 in his left eye. Funduscopic examination displayed a blurred and hyperemic optic disc with associated edema, intraretinal hemorrhages, cotton wool spots and tortuositas of the vessels in all quadrants. Fluorescein angiography showed a combined occlusion of the central retinal artery and vein. Under replacement therapy plasma homozysteine level was normal (8.6 mmol/l). A mutation of MTHFR gene was excluded.

Conclusions

Homocysteinemia is a risk factor for retinal vascular occlusive disease. As a mechanism changes of endothelial cells and vascular smooth muscle cells are postulated. Increased plasma homocysteine level can be caused by mutation of the MTHFR gene as seen in patient 1 or the lack of folic acid, vitamin B6 and B12 as present in patient 2. This rare cause of combined central artery and vein occlusion should be considered especially in young people. Replacement therapy with folic acid, vitamin B6 and B12 is indicated.