Retinal vein occlusion in young adults: The crucial role of underlying cause investigation
Cristina Calvo Simón, Carla Sánchez Remacha, Luca Manuel Bueno Borghi, Miguel Castillo Fernández, Julia Aramburu Clavería, Marta Suñer Martínez, Eva Josefina Nuñez Moscarda, Marta Orejudo de Rivas, Pablo Cisneros Arias, Ana María Abad Pascual, Javier Ramos Duarte, Edurne de la Cámara Sahuquillo, Inmaculada Herrero Sánchez, Pablo Tejada González, Francisco Javier Ascaso PuyueloAims/Purpose: To present a case of a young patient with retinal vein occlusion (RVO) who was subsequently diagnosed with acute leukemia, highlighting the importance of early hematological evaluation in such cases.
Methods: A 40‐year‐old woman presented to the emergency department with a one‐week history of decreased visual acuity in her right eye. The visual acuity was 4/10 in the right eye and 10/10 in the left eye. Fundus examination of the right eye revealed papilledema, flame‐shaped hemorrhages, cotton‐wool spots, and vascular tortuosity. The left eye showed punctate hemorrhages in the superior retina, a choroidal nevus, and vascular tortuosity. OCT confirmed macular edema in the right eye. A full blood count was performed due to the patient's young age and lack of known cardiovascular risk factors.
Results: The patient was diagnosed with central retinal vein occlusion (CRVO) in the right eye and superior branch retinal vein occlusion (BRVO) in the left eye. As for the ocular management, an intravitreal injection of Ozurdex® was scheduled for the right eye to address the macular edema.
As for the systemic assessment, a complete blood count was performed. It included an antiphospholipid profile, antithrombin III and factor V Leiden, among others.
Although initial considerations focused on a potential thrombophilia, the blood tests revealed acute leukemia with 135,000 leukocytes, hemoglobin of 5.3 g/dL, and platelets of 104,000. This critical finding led to immediate specialized treatment for the underlying hematological condition.
Conclusions: This case underscores the significance of a thorough hematological evaluation in young patients presenting with retinal vein occlusion. Acute leukemia, although rare, can initially present with ophthalmological manifestations. Early diagnosis and treatment of systemic conditions can significantly improve patient outcomes. Interdisciplinary collaboration is essential in managing such complex cases.