Central Retinal Vein Occlusion in a Patient with Retinal Vasculitis and Crohn’s Disease

Abstract

The authors report a rare case of a 47-year-old woman with Crohn's disease (CD) who presented with retinal vasculitis and central retinal vein occlusion (CRVO) during remission. The patient complained of sudden painless visual loss in her left eye (OS). Ophthalmologic evaluation revealed a best corrected visual acuity (BCVA) of 20/20 in the right eye and hand movements in OS. Ophthalmoscopy and fluorescein angiography of OS showed signs of nonischemic CRVO and extensive vasculitis. She was treated with oral prednisolone, mercaptopurine, and intravitreal bevacizumab in OS. After 1 month of treatment, VA of OS improved to 5/10 and after 1 year it was 10/10 with complete resolution of retinal vasculitis and nonischemic CRVO.

Hypertension, hyperlipidaemia and thrombophilia as the most common risk factors for retinal vein occlusion in patients under 50 years

“…In TED, RVO is caused by increased orbital pressure and venous congestion 36 . These four RFs have been mentioned in isolated case reports only 30,[35][36][37][38] and were rare in our cohort as well.…”

“…HC and HRT is important RF for vascular occlusions especially in young women. Although it was not clearly identified how use of HC or HRT leads to RVO, there are many studies suggesting that it increases RVO risk 30,31 .…”

Risk factors for central retinal vein occlusion in young adults

“…The association between retinal vasculitis and CRVO had been described previously in a patient with Crohn disease-related retinal vasculitis, and it was posited that severe inflammation of the retinal vasculature can have occlusive effect on arteries and veins, resulting in CRVO. 43 Retinal vasculitis has not been studied extensively and is not a well-recognized risk factor for CRVO in older populations. Our result suggested a potentially unique risk factor of CRVO in young adults that warrants further investigation.…”

The main aspects of retinal vein occlusion etiopathogenisis in young adults. Part I. Neuroretinovasculitis (prothrombotic potential, clinical manifestations)

“…Более поздние исследования (2012-2016) установили возможную ассоциацию нейроретиноваскулита, сопровождающегося окклюзией ретинальных вен, с серонегативным ревматоидным артритом, высокими титрами антинуклеарных антител и болезнью Крона [25,29,80], с хориоретинитами и ретинальными васкулитами инфекционной природы (бактериальной, вирусной, токсоплазменной и др.). При дебюте ОВС признаки реактивации герпесвирусной, цитомегаловирусной и токсоплазменной инфекций определяются более чем у 50 % больных [2].…”

“…Нейроретиноваскулит с вторичной ОВС встречается у 1 % больных с болезнью Крона [25,29,76]. Одним из предрасполагающих факторов выступает склонность к гипофибринолизу и гиперкоагуляции.…”