[Peripheral retinal arterial obstruction associated with hyperhomocysteinemia: case report].
Hyperhomocysteinemia is a risk factor for thromboembolic events of the retina associated with vascular venous or arterial occlusion. We describe a patient with occlusion of the peripheral arteriolar network without active vasculitis, associated with neovascular proliferation, peripheral vitreous-retinal traction and relapsing vitreous hemorrhage. The high serum homocysteine level resulting from vitamin B12 and folic acid deficiency, without further changes in the coagulation cascade including the test for Leiden's Factor V, indicates hyperhomocysteinemia as a direct causal factor in this clinical condition. Despite a high PPD, Eales Disease, a major differential diagnosis, was not fully considered, since it is established by exclusion. The patient was treated with photocoagulation and vitamin supplements and the condition was successfully controlled. Patients with retinal vascular obstruction should have their total plasma homocysteine levels measured, since this modifiable risk factor can be easily treated with dietary approaches including vitamin supplementation.
Misawa
Alexandre Kazuo
AK
Departamento de Oftalmologia, Faculdade de Medicina, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brasil.
Suzuki
Hisashi
H
Maia
Otacílio de Oliveira
OO
Bonanomi
Maria Teresa Brizzi Chizzotti
MT
Melo
Carlos Sérgio Nascimento de
CS
D000328:Adult; D005492:Folic Acid / Q000627:therapeutic use; D006801:Humans; D020138:Hyperhomocysteinemia / Q000150:complications* / Q000188:drug therapy; D008297:Male; D015356:Retinal Artery Occlusion / Q000209:etiology*; D014805:Vitamin B 12 / Q000627:therapeutic use
D005492:Folic Acid; D014805:Vitamin B 12