ATYPICAL PRESENTATION OF CRVO IN YOUNG FEMALE

Dr.K.RAJESH M.S., FVRS

SRI ISHA RETINA FOUNDATION – EYE HOSPITAL
VIJAYAWADA
rajesh.retina@gmail.com, isharetina@gmail.com
• 12th February 2019, M.R.NO – 963

• 39 yr old Female

• C/o – Defective Vision Right Eye from 1 week

No H/o Fever, Trauma or any systemic illness

• B.P – 139/75 mm hg
 Right Eye Left Eye

6/6p
BCVA 6/6

17 IOP 16

Lids and adnexae

Appears normal Appears normal

Full and Painless EOM Full and painless

Anterior segment
Appears Normal Appears Normal

CRVO Posterior segment Appears Normal

CRVO in 39 yr Female with no systemic illness
Vision – 6/12
• Sent her to physician for further evaluation

• Started Heparin s.c 8000 IU for 1 week

• Pradaxa 150 mg BD(Dabigatran Etexilate)
• Ecospirin 150 mg od
• Gave intravitreal Accentrix on 01-03-2019

No financial interest
• Antiphospholipid syndrome with elevated anti β2 glycoproteins

• ? Sjogrens
 ANTIPHOSPHOLIPID SYNDROME (APS)

• Also known as Hughes syndrome, is an autoimmune condition associated with recurrent

vascular thrombosis and pregnancy morbidity.

• APS is divided into primary APS where the condition occurs alone, and secondary APS
where the condition occurs in association with another autoimmune disease such as
Systemic Lupus Erythematosus (SLE).

• Antibodies targeting cardiolipin, ß2-glycoprotein-1 (ß2GP-1) , phosphatidylserine and lupus

are commonly found in patients with the clinical symptoms of APS.
 β2 GLYCOPROTEINS
• Autoantibodies to B2-glycoprotein (Apolipoprotein H) are associated with arterial and
venous thrombosis as well as recurrent spontaneous abortion.

• IgG and /or IgM class antibodies against ß2GP-1B2 occur with prevalence of 30%-60% of
APS cases.

• ß2GP-1 antibodies are only found in case of autoimmune diseases, whereas antibodies
against cardiolipin can be detected in APS and in certain infections (syphilis, Borreliosis,
AIDS, hepatitis, tuberculosis).

• Detection of these antibodies provide a serological aid for the differentiation of

autoimmune diseases from infections.
Wiechens B, Schröder JO, Pötzsch B, Rochels R. Primary
antiphospholipid antibody syndrome and retinal occlusive vasculopathy.
American journal of ophthalmology. 1997 Jun 1;123(6):848-50.
Anti-β2 Glycoprotein 1 and the Anti-phospholipid
Syndrome Keane, Pearse A. et al.American Journal of
Ophthalmology , Volume 142 , Issue 4 , 701 - 702
• Clinical dilemma is how far should we go in pinning down a diagnosis when a patient has
a history of vascular thrombosis without conventional risk factors and in young patients.

• Finally, prompt detection of these antibodies and therapeutic intervention can prevent
not only future thrombotic ocular episodes but also such episodes in other vital
anatomic organs.

• In the right clinical setting, more exhaustive testing should be performed.

THANK YOU