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OPHTHALMIC IMAGE
Year : 2022  |  Volume : 2  |  Issue : 2  |  Page : 627

Bilateral central retinal artery occlusion in a child due to hyperhomocystinemia


Department of Ophthalmology, Jawaharlal Institute Postgraduate Medical Education and Research, Puducherry, India

Date of Web Publication13-Apr-2022

Correspondence Address:
Sandip Sarkar
Department of Ophthalmology, Jawaharlal Institute Postgraduate Medical Education and Research, Puducherry - 605 006
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_2811_21

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How to cite this article:
Jacob N, Srihari B, Deb AK, Kasturi N, Sarkar S. Bilateral central retinal artery occlusion in a child due to hyperhomocystinemia. Indian J Ophthalmol Case Rep 2022;2:627

How to cite this URL:
Jacob N, Srihari B, Deb AK, Kasturi N, Sarkar S. Bilateral central retinal artery occlusion in a child due to hyperhomocystinemia. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 May 19];2:627. Available from: https://www.ijoreports.in/text.asp?2022/2/2/627/342981



Bilateral central retinal artery occlusion (CRAO) is extremely rare in children. Only a few such cases have been reported in the literature to date with varying etiology.[1],[2],[3],[4],[5] A 8-year-old child presented with sudden painless vision loss (no light perception) in both eyes (OU). Fundus examination OU showed features suggestive of CRAO [Figure 1]a and [Figure 1]b. Optical coherence topography (OCT) showed foveal atrophy [Figure 1]c and [Figure 1]d. On systemic evaluation, his homocysteine levels were elevated (23.19 μmol/L). He was treated with oral pyridoxine 100 mg TDS and oral folic acid 5 mg OD. There was very minimal improvement in vision (hand movements OU) on follow-up. At 3 months follow-up, OU disc pallor with arteriolar attenuation and sheathing [Figure 1]e and [Figure 1]f were observed.
Figure 1: (a and b) Fundus photograph of both eyes showing disc edema, narrowing of arteries, mild tortuosity of veins, and a cherry-red spot at the macula suggestive of central retinal artery occlusion (CRAO); (c and d) Optical coherence tomography (OCT) revealed foveal atrophy in both eyes; (e and f) Fundus photograph of both eyes at 3 months showing disc pallor with arteriolar attenuation and sheathing

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Ethical approval

Written informed consent for publication (including the images) has been obtained from the parent of the patient. All procedures carried out were in accordance with the tenets of the Declaration of Helsinki. Approval from the institute's ethics committee was not required for a case report according to the Indian Council of Medical Research guidelines.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Karth P, Singh R, Kim J, Costakos D. Bilateral central retinal artery occlusions in an infant with hyperhomocysteinemia. J AAPOS 2012;16:398-400.  Back to cited text no. 1
    
2.
Wu T, Sheu S, Chou L. Henoch-Schonlein purpura with bilateral central retinal artery occlusion. Br J Ophthalmol 2002;86:351-2.  Back to cited text no. 2
    
3.
Sinha S, Rau ATK, Kumar RV, Jayadev C, Vinekar A. Bilateral combined central retinal artery and vein occlusion in a 3-year-old child with nephrotic syndrome. Indian J Ophthalmol 2018;66:1498-501.  Back to cited text no. 3
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4.
Nishiguchi KM, Ito Y, Terasaki H. Bilateral central retinal artery occlusion and vein occlusion complicated by severe choroidopathy in systemic lupus erythematosus. Lupus 2013;22:733-5.  Back to cited text no. 4
    
5.
Joshi U, Afroz S, Ranka S, Mba B. Bilateral central retinal artery occlusion from catastrophic antiphospholipid syndrome. BMJ Case Rep 2018;2018:bcr2018226463.  Back to cited text no. 5
    


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