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Ischemic central retinal vein occlusion associated with intake of oral contraceptives in a 19-year-old female patient with factor XII deficiencyM. Brieden, C. M. C. Klais, C. Kuhli, B. Kacer, H. O. C. Gümbel
Report of a case: A 19-year-old woman presented with a five-day episode of blurred vision in her right eye. The patients history was negative for ocular diseases or cardiovascular risk factors. However, two weeks prior to the onset of symptoms, she had started taking oral contraceptives.
Visual acuity was 0.6 O.D. and 1.0 O.S.. Dilated fundus examination of her right eye showed retinal changes consistent with the ischemic type of central retinal vein occlusion. The patient was then started on hemodilution therapy. However, because of a further decrease in visual acuity, hemodilution was discontinued and thrombolytic therapy (50 mg of rt-PA over 60 min) and continuous i.v. heparinization was started on day seven, followed by oral doses of aspirin and pentoxifylline. In addition, her oral contraceptive was stopped. Photocoagulation of the retina was performed after 4 weeks. Further investigation into possible causes of her retinal vein occlusion included a thrombophilia screening which revealed a factor XII deficiency (31%; norm: 54-135%). In the further course, her visual acuity improved and was 0,9 after eight months. By this time, her retinal changes had cleared and fluorescein angiographic findings were unremarkable.
Discussion: The present case suggests a causal relationship between retinal vessel occlusion and prothrombotic states associated with factor XII-deficiency. Ophthalmologists should be aware of coagulation disorders as a possible cause of retinal vein occlusion, especially in young and healthy women taking oral contraceptives.
Augenklinik, Johann-Wolfgang-Goethe-Universität, Theodor-Stern-Kai 7, D-60590 Frankfurt/Main