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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 29  |  Issue : 2  |  Page : 134-135

Postpartum central retinal vein occlusion


Department of Community Ophthalmology, Global Hospital Institute of Ophthalmology, Abu Road, Rajasthan, India

Date of Web Publication10-Aug-2017

Correspondence Address:
Amit Mohan
Global Hospital Institute of Ophthalmology, Talehati, Abu Road, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kjo.kjo_61_17

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  Abstract 


Ophthalmic complications are possible during pregnancy or soon after child birth even in normal uneventful pregnancy. Here we are presenting a rare case of central retinal vein occlusion in a 26 year old female during 4th week of her puerperium without any history of preeclampsia. Fundus examination showed dilated tortuous veins, multiple flame shaped haemorrhage, and disc oedema. Optical coherence tomography revealed cystoid macular oedema. Intravitreal avastin injection was given. There was improvement in visual acuity with complete resolution of fundus findings within 6 months.

Keywords: Optical coherence tomography, postpartum, retinal vein occlusion


How to cite this article:
Mohan A, Thakarani J, Sukhwal R. Postpartum central retinal vein occlusion. Kerala J Ophthalmol 2017;29:134-5

How to cite this URL:
Mohan A, Thakarani J, Sukhwal R. Postpartum central retinal vein occlusion. Kerala J Ophthalmol [serial online] 2017 [cited 2019 Sep 21];29:134-5. Available from: http://www.kjophthal.com/text.asp?2017/29/2/134/212757




  Introduction Top


Pregnancy and the subsequent puerperium represent hypercoagulable states.[1] The incidence of venous thromboembolism during the pregnancy-associated period is six times greater than that in nonpregnant women, particularly during the third trimester and postpartum period.[2] Here, we are reporting a case of postpartum central retinal vein occlusion (CRVO).


  Case Report Top


A 26-year-old female without systemic disease presented with a complaint of blurred vision in the right eye (RE) for 6 days. There was a history of uneventfull full-term normal vaginal delivery of a healthy baby 1 month before.

On general ophthalmic examination, vision in RE was 6/60 unaided and with pinhole 6/18, vision in the left eye (LE) was 6/9 unaided, and with pinhole 6/9. Retinoscopy of both eyes was + 1.00/0.00. By dry refraction, acceptance of patient was RE − 0.50/− 0.75 × 75→6/18 and LE − 0.50/− 0.75 × 105→6/6. Slit lamp examination revealed normal anterior segment of both eyes. Intraocular pressure was 14 mmHg in both eyes. Fundus examination of RE showed dilated and tortuous veins and hemorrhages scattered throughout the retina [Figure 1] while LE fundus was normal. Optical coherence tomography was suggestive of cystoid macular edema [Figure 2].
Figure 1: Fundus photo of right eye showing central retinal vein occlusion

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Figure 2: Optical coherence tomography shows cystoid macular edema right eye

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Systemic investigations were within normal limit (including blood pressure, heart rate, complete blood count, erythrocyte sedimentation rate, lipid profile, and homocysteine). The patient was treated medically, prescribed eyedrops Nepafenac 1 drop three times a day. At the first follow-up (after 15 days), intravitral injection avastin (bevacizumab) 1.25 mg/0.05 ml was given. At 6 weeks macular edema diminished and at 6-month follow-up vision was improved to 6/9 in her RE with normal fundus, there was no signs of ischemia with normal intraocular pressure.


  Discussion Top


CRVO typically occurs in patients older than 50 years with risk factors including hypertension, diabetes, and open-angle glaucoma. CRVO in a young patient merits workup for underlying compressive, hematologic, or autoimmune etiology.[3] The effects of progesterone on the blood vessel walls result in venous stasis, even in normal pregnancy.[1],[4] The increased risk of thrombotic disorders during pregnancy and puerperium has been consistently reported;[1],[5],[6],[7] therefore, an increased risk of vision-threatening thrombotic conditions such as retinal vein occlusion (RVO) might also be present. RVO is the second most frequently occurring retinal vascular disease and one of the foremost sight-threatening conditions.[8],[9],[10],[11] There have only been a few reports of pregnancy-related RVO cases: three during normal pregnancy,[12],[13],[14] one during pregnancy with preeclampsia,[15] and one postpartum case following pregnancy with preeclampsia.[16] Despite this limited evidence, pregnancy is generally considered a risk factor for RVO.[17]

Pregnancy has been considered a hypercoagulable state not only in patients with hereditary thrombophilia and/or preeclampsia/eclampsia but also in normal pregnancy, which is associated with acquired changes in hemostatic factors including plasma fibrinogen, factor VIII, protein C, protein S, and platelets.[4] The incidence of venous thromboembolism during the pregnancy-associated period is six times greater than that in nonpregnant women, particularly during the third trimester and postpartum period.[2] Several cases of RVO in pregnancy have been reported, primarily in pregnancy with preeclampsia/eclampsia but also in normal pregnancy; therefore, it is generally assumed that normal pregnancy and the associated hypercoagulable state may induce RVO.[1],[12],[14],[15],[16],[18],[19]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gray G, Nelson-Piercy C. Thromboembolic disorders in obstetrics. Best Pract Res Clin Obstet Gynaecol 2012;26:53-64.  Back to cited text no. 1
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2.
Eldor A. Thrombophilia and its treatment in pregnancy. J Thromb Thrombolysis 2001;12:23-30.  Back to cited text no. 2
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Risk factors for central retinal vein occlusion. The Eye Disease Case-Control Study Group. Arch Ophthalmol 1996;114:545-54.  Back to cited text no. 3
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Errera MH, Kohly RP, da Cruz L. Pregnancy-associated retinal diseases and their management. Surv Ophthalmol 2013;58:127-42.  Back to cited text no. 4
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5.
Eldor A. Thrombophilia, thrombosis and pregnancy. Thromb Haemost 2001;86:104-11.  Back to cited text no. 5
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Hutcheon JA, Lisonkova S, Joseph KS. Epidemiology of pre-eclampsia and the other hypertensive disorders of pregnancy. Best Pract Res Clin Obstet Gynaecol 2011;25:391-403.  Back to cited text no. 6
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Thornton C, Dahlen H, Korda A, Hennessy A. The incidence of preeclampsia and eclampsia and associated maternal mortality in Australia from population-linked datasets: 2000-2008. Am J Obstet Gynecol 2013;208:476.e1-5.  Back to cited text no. 7
    
8.
Kamel H, Navi BB, Sriram N, Hovsepian DA, Devereux RB, Elkind MS. Risk of a thrombotic event after the 6-week postpartum period. N Engl J Med 2014;370:1307-15.  Back to cited text no. 8
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Hayreh SS. Prevalent misconceptions about acute retinal vascular occlusive disorders. Prog Retin Eye Res 2005;24:493-519.  Back to cited text no. 9
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10.
McIntosh RL, Rogers SL, Lim L, Cheung N, Wang JJ, Mitchell P, et al. Natural history of central retinal vein occlusion: An evidence-based systematic review. Ophthalmology 2010;117:1113-23.e15.  Back to cited text no. 10
    
11.
Rogers SL, McIntosh RL, Lim L, Mitchell P, Cheung N, Kowalski JW, et al. Natural history of branch retinal vein occlusion: An evidence-based systematic review. Ophthalmology 2010;117:1094-101.e5.  Back to cited text no. 11
    
12.
McLoone EM, Best RM. Pregnancy-related papillophlebitis. Eur J Ophthalmol 2004;14:65-6.  Back to cited text no. 12
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13.
Chew EY, Trope GE, Mitchell BJ. Diurnal intraocular pressure in young adults with central retinal vein occlusion. Ophthalmology 1987;94:1545-9.  Back to cited text no. 13
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14.
Gabsi S, Rekik R, Gritli N, Naili K, Hassoumi MH. Occlusion of the central retinal vein in a 6-month pregnant woman. J Fr Ophtalmol 1994;17:350-4.  Back to cited text no. 14
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15.
Gonzalvo FJ, Abecia E, Pinilla I, Izaguirre LB, Oliván JM, Honrubia FM. Central retinal vein occlusion and HELLP syndrome. Acta Ophthalmol Scand 2000;78:596-8.  Back to cited text no. 15
    
16.
Rahman I, Saleemi G, Semple D, Stanga P. Pre-eclampsia resulting in central retinal vein occlusion. Eye (Lond) 2006;20:955-7.  Back to cited text no. 16
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17.
Ryan SJ. Retina. 5th ed. Oxford: Saunders; 2013.  Back to cited text no. 17
    
18.
Roos NM, Wiegman MJ, Jansonius NM, Zeeman GG. Visual disturbances in (pre) eclampsia. Obstet Gynecol Surv 2012;67:242-50.  Back to cited text no. 18
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19.
Herbold TM, Lange T, Busse H, Uhlig CE. Acute monocular vision reduction in a pregnant patient. Ophthalmologe 2005;102:726-9.  Back to cited text no. 19
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    Figures

  [Figure 1], [Figure 2]



 

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