Isolated monocular visual loss as an initial manifestation of polycythemia vera.
A 25-year-old man developed prolonged loss of vision in the left eye. Examination revealed that visual acuity was 20/20 in the right eye and 10/20 in the left eye, with a left relative afferent pupillary defect. Fundoscopy showed multiple cotton wool spots in the left whole retina with normal optic disc. Fluorescein angiography (FA) revealed markedly delayed arterial, venous and recirculation time in the left eye without retinal arterial or venous occlusion. Bone marrow aspirate confirmed polycythemia vera. After the patient underwent phlebotomy, his visual acuity markedly improved and cotton wool spots in the retina disappeared. On follow-up FA, delayed arterial and venous filling, and recirculation time also became normalized. This case suggests that ischemic damage of the retina due to the great viscosity of blood may be a possible mechanism of monocular visual loss in polycythemia vera. Clinicians should be aware that isolated monocular visual loss may be an initial manifestation of polycythemia vera, since if untreated, polycythemia vera carries a high risk of permanent complications due to intravascular thrombosis.
Ahn
Bo-Young
BY
Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Republic of Korea.
Choi
Kwang-Dong
KD
Choi
Young-Jin
YJ
Jea
Seung-Youn
SY
Lee
Ji-Eun
JE
D000328:Adult; D001766:Blindness / Q000000981:diagnostic imaging / Q000209:etiology*; D016022:Case-Control Studies; D005451:Fluorescein Angiography / Q000379:methods; D005500:Follow-Up Studies; D007839:Functional Laterality; D006801:Humans; D008297:Male; D011087:Polycythemia Vera / Q000150:complications* / Q000000981:diagnostic imaging; D011859:Radiography