Retinal arterial occlusions in the young: Systemic associations in Indian population

Abstract

Purpose:To determine the systemic associations in retinal arterial occlusions (RAO) in young Indian individuals less than 40 years of age.Materials and Methods:Case records of 32 patients (35 eyes) of less than 40 years, with non-traumatic RAO were analysed. All patients underwent detailed ophthalmic and systemic evaluation including hemogram, lipid profile, coagulation profile, vasculitis screening, carotid Doppler, echocardiogram.Results:In the study 21 were males and 11 were females. The age ranged from 11-39 years (Mean 27.6 ± 8.43). Nine (28%) patients were below 20 years of age. Among 35 eyes, 28 (80%) had central retinal artery occlusion (CRAO), three (8.6%) had branch retinal artery occlusion (BRAO), two (5.7%) each had cilio-retinal (CLAO) and hemi-retinal artery occlusion (HRAO). Vision ranged from no perception of light to 20/20. On systemic evaluation, in 21 (65.6%) patients a hypercoagulable state was responsible for the RAO. Conditions leading to a hypercoagulable state included hyperhomocysteinemia (21.9%), hyperlipidemia (15.6%), anticardiolipin antibody (6.2%), antiphospholipid antibody (6.2%), polycythemia, thrombocytosis, protein S deficiency, use of oral contraceptives and renal disorder (3.1% each). Six (18.7%) patients had cardiac valvular defects. Vasculitis screening was positive in three (9.4%) patients. Two (6.2%) had isolated systemic hypertension. In two (6.2%) patients no abnormality could be detected.Conclusion:The systemic associations of RAOs in the Indian population were distinctly different from those reported in the Western population. Hyperhomocysteinemia was the commonest association found. Whereas associations reported in the Western population such as cardiac abnormalities, coagulation disorders, hemoglobinopathies and oral contraceptive use were uncommon.

Transient branch retinal artery occlusion in a 15-year-old girl and review of the literature

“…Frequent etiologies include hypercoagulable states, hyperhomocysteinemia, vasculitis, emboli from cardiac valvular disease, and other risk factors such as smoking, use of oral contraceptives, and vasospasm such as in a history of migraine [2][3][4][5][6][7] . There are few published reports of retinal artery occlusion associated with hyperhomocysteinemia in children [7][8][9] . Abnormal accumulation of homocysteine in plasma, as found in this inborn error of metabolism of the amino acid methionine, also has a toxic effect on endothelial cells resulting in arteriosclerosis, and arterial and venous thromboembolic events at a young age.…”

“…Elevations in the plasma homocysteine concentration can occur because of genetic defects in the enzymes involved in homocysteine metabolism, nutritional deficiencies in vitamin cofactors (folate, vitamin B6, or vitamin B12), or other factors including some chronic medical conditions and drugs. Ratra and Dhupper suggested that the common systemic association of retinal artery occlusion in the Indian population was hyperhomocysteinemia 8 . Karth et al described a previously healthy 7-week-old boy who developed bilateral central retinal artery occlusion in the presence of hyperhomocysteinemia 9 .…”

Ophthalmic Complications and Ocular Changes in Pregnancy- A Review

“…Central artery occlusions have visual loss which is central and dense. Branch artery occlusions involve sections of the peripheral visual field which may go unnoticed [32,33]. Central Retinal vein occlusion may present as a dense central scotoma with subtle intermittent episodes of blurred vision or it may be a sudden, painless monocular vision loss.…”

Branch Retinal Artery Occlusion as a Presenting Feature of Apla Syndrome and Homocysteinemia

“…Elevated homocysteine levels have also been described as an independent risk factor for retinal vascular occlusions especially in young individuals of Indian origin. 5,6 To the best of our knowledge, presence of APS with hyperhomocysteinemia presenting with BRAO as its initial manifestation has not been described previously.…”

“…4 Other mechanisms include exogenous emboli, thrombotic, vasospastic and vasculitic events. 4,5 We present the case of a young girl who presented with branch retinal artery occlusion. These conditions may occur alone or in combination with each other.…”