Central Retinal Vein Occlusion in Iron Deficiency Anemia

Young Joon Jo; Deok Goo Lee; Ki Yup Nam; Jung Yeul Kim

doi:10.3341/jkos.2009.50.9.1432

Journal List > J Korean Ophthalmol Soc > v.50(9) > 1008376

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Jo, Lee, Nam, and Kim: Central Retinal Vein Occlusion in Iron Deficiency Anemia

Original Article

J Korean Ophthalmol Soc 2009;50(9):1432-1436.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.9.1432

Central Retinal Vein Occlusion in Iron Deficiency Anemia

Young Joon Jo, MD^1,², Deok Goo Lee, MD¹, Ki Yup Nam, MD¹, Jung Yeul Kim, MD^1,²

¹Department of Ophthalmology, College of Medicine, Chungnam National University, Daejeon, Korea

²Chungnam National University Research Institute for Medical Sciences, Daejeon, Korea

Address reprint requests to Jung Yeul Kim, MD Department of Ophthalmology, Chungnam National University Hospital #640 Daesa-dong, Jung-gu, Daejeon 301-721, Korea Tel: 82-42-280-8433, Fax: 82-42-255-3745, E-mail: kimjy@cnu.ac.kr

Received 1 April 2009 Accepted 9 June 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report a case of central retinal vein occlusion caused by iron deficiency anemia in a healthy young adult.

Case Summary

A 23-year-old female was referred to the department of ophthalmology after 4 days of acute onset of decreased vision in her left eye. The best corrected visual acuity was 20/20 in the right eye and 10/20 in the left eye. There was no ocular pain, afferent pupillary defect or other ocular symptoms. Results of the anterior segment examination were normal. Fundus examination showed mild optic disc swelling, flame-shaped retinal hemorrhages around the optic disc, and vascular tortuosity with dilatation. The fluorescein angiography showed tortuous peripapillary veins, multiple blocked fluorescences due to retinal hemorrhages, and delayed arteriovenous transit time. All medical examinations and laboratory tests for the risk factors of central retinal vein occlusion were within normal limits, except for iron deficiency anemia. The patient was subsequently treated with oral iron. Three months after the first visit, the best corrected visual acuity was 20/20 in the patient's left eye with nearly normal fundus appearances and no iron deficiency anemia detected in laboratory tests.

Conclusions

In cases of CRVO in young adults without other systemic diseases and risk factors, evaluation of the hematologic state may be necessary.

Keywords: Central Retinal Vein Occlusion, Iron deficiency Anemia

References

1. The central vein occlusion study group. Baseline and early natural history report. Arch Ophthalmol. 1993; 111:1087–95.

2. The eye disease case-control study group. Risk factors for central retinalvein occlusion. Arch Ophthalmol. 1996; 114:545–54.

3. Gutman FA. Evaluation of a patient with central retinal vein occlusion. Ophthalmology. 1983; 90:481–3.

4. Fong AC, Schatz H. Central retinal vein occlusion in young adults. Surv Ophthalmol. 1993; 37:393–417.

5. Fong AC, Schatz H, McDonald HR, et al. Central retinal vein occlusion in young adults (papillophlebitis). Retina. 1992; 12:3–11.

6. Klien BA, Olwin JH. A survey on the pathogenesis of retinal vein occlusion. Arch Ophthalmol. 1924; 56:207.

7. Hayreh SS, Zimmerman B, McCarthy MJ, Podhajsky P. Systemic diseases associated with various types of retinal vein occlusion. Am J Ophthalmol. 2001; 131:61–77.

8. Jin YB, Park HS, Yoon IH. Comparison of Risk Factors Associated with Central and Branch Retinal Vein Obstruction. J Korean Ophthalmol Soc. 1998; 39:2343–52.

9. Kim US, Kim SW, Yu SY, Kwag HU. Laboratory Evaluation of Thrombophilic Factor in Retinal Vein Occlusive Disease. J Korean Ophthalmol Soc. 2003; 44:2004–9.

10. Oh DE, Park SE, Lee JH. Hematologic Risk Factors in Young- Aged Retinal Vein Occlusion. J Korean Ophthalmol Soc. 2003; 44:1806–12.

11. Lahey JM, Tunc M, Kearney J, et al. Laboratory evaluation of hypercoagulable state in patients with central retinal vein occlusion who are less than 56 years of age. Ophthalmology. 2002; 109:126–31.

12. Hayreh SS, Zimmerman MB, Podhajsky P. Hematologic abnormalities associated with various type of retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol. 2002; 240:180–96.

13. Chen V, Moisseiev J, Treister G. Severe ischemic process in a young man with central retinal vein occlusion. Metab Periatr Syst Ophthalmol. 1988; 11:67–9.

14. Kim SH, Kim JY. Bilateral Central Retinal Vein Occlusion in Primary Antiphospholipid Syndrome. J Korean Ophthalmol Soc. 2007; 48:1433–7.

15. Lym SB, Kwak NH, Huh W. Central Retinal Vein Occlusion in Multiple Myeloma Associated with Hyperviscosity Syndrome. J Korean Ophthalmol Soc. 1996; 37:1371–5.

16. Kacer B, Hattenbach LO, Hörle S, et al. Central retinal vein occlusion and nonarteritic ischemic optic neuropathy in 2 patients with mild iron deficiency anemia. Ophthalmologica. 2001; 215:128–31.

17. Kirkham TH, Wrigley PF, Holt JM. Central retinal vein occlusion complicating iron deficiency anaemia. Br J Ophthalmol. 1971; 55:777–80.

18. Matsuoka Y, Hayasaka S, Yamada K. Incomplete occlusion of central retinal artery in a girl with iron deficiency anemia. Ophthalmologica. 1996; 210:358–60.

19. Vine AK, Samama MM. The role of abnormalities in the anti-coagulant and fibrinolytic systems in retinal vascular occlusions. Surv Ophthalmol. 1993; 37:283–92.

20. Alexander MB. Iron deficiency anemia, thrombocytosis and cerebrovascular accident. South Med J. 1983; 76:662–3.

21. Akins PT, Glenn S, Nemeth PM, Derdeyn CP. Carotid artery thrombus associated with severe iron-deficiency anemia and thrombocytosis. Stroke. 1996; 27:1002–5.

22. Hicsonmez G, Suzer K, Suloglu G, Donmez S. Platelet counts in children with iron deficiency anemia. Acta Haematol. 1978; 60:85–9.

23. Cid J, Lozano M. Hemoglobin levels and platelet counts after iron therapy in iron deficiency anemia. Haematologica. 1998; 83:749.

24. Nagai T, Komatsu N, Sakata Y, et al. Iron deficiency anemia with marked thrombocytosis complicated by central retinal vein occlusion. Intern Med. 2005; 44:1090–2.

Figure 1.

Fundus photographs. (A) At the first visit, the left eye shows mild optic disc swelling, vascular tortuosity with dilatation, and some blot-like retinal hemorrhages. (B) At 2 weeks after the first visit, the left eye shows more severe optic disc swelling, vascular tortuosity with dilatation, flame-shaped retinal hemorrhages around the optic disc, and mild macular edema. (C) At 3 months after the first visit, the left eye shows a nearly normal fundus appearances besides a flame-shaped retinal hemorrhage near the inferortemporal vascular arcade. (D) At 5 Months after the first visit, the left eye shows a normal fundus appearances.

Figure 2.

FAG. (A) At the first visit, the fluorescein angiograph in arteriovenous phase of the left eye shows dilated and tortuous peripapillary veins, and multiple blocked fluorescences due to retinal hemorrhages. (B) At the first visit, the fluorescein angiograph in the late phase of the left eye shows mild macular leakage and multiple blocked fluorescences due to retinal hemorrhages.

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