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Abstract
Abstract
Multiple Choroideal Infarctions in Homocysteinemia
Schäfer S., Spraul C. W., Lang G. E.
Ulm University, Dept of Ophthalmology
Purpose: Elevated levels of blood homocysteine have been identified as an independent risk factor for artherosclerotic and thrombotic diseases. Arterial, as well as venous occlusive diseases have been associated with homocysteinemia. We report a patient who had multiple choroidal infarctions associated with homocysteinemia.
Method: A 68 year old patient presented with acute deterioration of vision in his left eye. There was no ocular trauma in his history. Arterial hypertension was known, but well controlled by a beta-blocker and calcium antagonist, further the patient was on salicylic acid (100mg per day) as a regular medication. We performed a fluorescence angiography, Magnetic Resonance Imaging (MRI) and blood analyses.
Results: The clinical examination displayed a visual acuity of finger counting in his left eye, the intraocular pressure was normal in both eyes and there were no abnormalities in the anterior eye segment. Clinically, in both eyes hypertensive fundus changes were present. The left eye had multiple spot-like choroidal lesions. In the fluorescence angiography, multiple choroidal areas with disturbed perfusion were present as well as an edema of the optic nerve head. The blood analysis revealed elevated levels of homocysteine 33.9 µmol/l (5.0-15.0 µmol/l normal range); all other parameters, especially the levels of methylentetrahydrofolatreductase (MTHFR), were normal. Except for a supratentorial microangiopathy, the MRI w