title: [Cilioretinal artery occlusion and central retinal vein occlusion complicating hyperhomocysteinemia: a case report].
abstract: BACKGROUND
  Hyperhomocysteinemia is known to be a risk factor in both retinal artery and retinal vein occlusions. We report the case of a young patient with combined occlusion of the cilioretinal artery and the central retinal vein due to hyperhomocysteinemia.
  
  
  METHODS
  A 23-year-old patient without significant medical history, presented for sudden, painless visual loss in the right eye. Ophthalmologic examination revealed best-corrected visual acuity of the right eye 8/10 P2, and 10/10 P2 on the left. Anterior segment exam was normal in both eyes, while the right fundus revealed white, ischemic edema, centered around a cilioretinal artery, sparing the fovea, with some hemorrhagic spots and disc edema. Fluorescein angiography confirmed delayed filling of the right cilioretinal artery and revealed a normal disc on the left. Two weeks later, the clinical picture had evolved into a right ischemic CRVO, confirmed by a second angiogram, with a decrease in visual acuity to 3/10.
  
  
  RESULTS
  A work-up was performed, including: a full lipid profile, serum electrolytes, ESR, CRP, a complete blood count (leukocytes, platelets, hemoglobin were normal), a coagulation work-up (PT, PTT, protein C, protein S, antithrombin III, factor V Leiden were normal), ANCA, antiphospholipid antibodies and antinuclear antibodies were negative, and finally cardiology studies (cardiac echo, carotid Doppler) and neurology (brain MRI) were ordered and came back normal. Otherwise, plasma homocysteine was moderately high on two samples, at 18.3 μmol/L and 17.78 μmol/L. Thyroid and renal work-ups were ordered. Urgent PRP was performed, and vitamin therapy (vitB12, vitB6, folic acid) was instituted. The subsequent course was remarkable for recovery of visual acuity to 10/10, P2 with persistence of an inferior altitudinal central scotoma. MTHFR C677T polymorphism was negative.
  
  
  CONCLUSIONS
  Retinal vascular occlusions (RVO) are serious events, which require investigation for underlying systemic disease, which can be life-threatening. The clinical picture is variable depending on the location of the occlusion, the extent of the ischemic area and the degree of macular involvement. The etiologies of RVO are varied, requiring a thorough biological assessment in young subjects. The association between hyperhomocysteinemia and RVO is proven, while this association with the MTHFR C677T polymorphism was not found. Vitamin therapy reduces plasma levels of homocysteine by 25% but its role in the treatment and prevention of RVO remains to be demonstrated.
  
  
  CONCLUSIONS
  Several cases of occlusion of the central retinal vein or one of its branches have been published. Combined occlusion of the central retinal vein and cilioretinal artery secondary to hyperhomocysteinemia does not appear to have been published, which would make our case unique.
authors.affiliation: Service d'ophtalmologie, faculté de médecine, université Mentouri de Constantine, CHU Constantine, BP 325, route Ain El Bey, 25017 Constantine, Algérie; Laboratoire de recherche en maladies métaboliques, université Mentouri de Constantine, BP 325, route Ain El Bey, 25017 Constantine, Algérie. Electronic address: berkiz@gmail.com.
authors.forename: Z
authors.initials: Z
authors.lastname: Berkani
authors.forename: Y
authors.initials: Y
authors.lastname: Kitouni
authors.forename: A
authors.initials: A
authors.lastname: Belhadj
authors.forename: K
authors.initials: K
authors.lastname: Sifi
authors.forename: N
authors.initials: N
authors.lastname: Abbadi
authors.forename: C
authors.initials: C
authors.lastname: Bellatrache
authors.forename: D
authors.initials: D
authors.lastname: Hartani
authors.forename: R
authors.initials: R
authors.lastname: Kherroubi
mesh_terms: D019842:Ciliary Arteries / Q000473:pathology; D005451:Fluorescein Angiography; D006801:Humans; D020138:Hyperhomocysteinemia / Q000150:complications* / Q000175:diagnosis; D008297:Male; D015356:Retinal Artery Occlusion / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D012169:Retinal Vein / Q000473:pathology; D012170:Retinal Vein Occlusion / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D014786:Vision Disorders / Q000175:diagnosis / Q000209:etiology; D055815:Young Adult
keywords: Central retinal vein occlusion; Cilioretinal artery occlusion; Génotype MTHFR; Hyperhomocysteinemia; Hyperhomocystéinémie; MTHFR genotype; Occlusion de la veine centrale de la rétine; Occlusion de l’artère ciliorétinienne; Sujet jeune; Young subject