A case report of branch retinal artery occlusion in a teenager due to hyperhomocysteinaemia; the interplay of genetic and nutritional defects
Abstract Background Retinal vascular occlusions are uncommon in young people and require more in-depth investigation into the cause. Studies have revealed that a high level of circulating homocysteine poses a risk for retinal vaso-occlusive events across a wide age range. This case report reflects o...
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| Format: | Article |
| Language: | English |
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BMC
2018-09-01
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| Series: | BMC Ophthalmology |
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| Online Access: | http://link.springer.com/article/10.1186/s12886-018-0859-2 |
| _version_ | 1818525037398851584 |
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| author | Clare Shute |
| author_facet | Clare Shute |
| author_sort | Clare Shute |
| collection | DOAJ |
| description | Abstract Background Retinal vascular occlusions are uncommon in young people and require more in-depth investigation into the cause. Studies have revealed that a high level of circulating homocysteine poses a risk for retinal vaso-occlusive events across a wide age range. This case report reflects on how the interplay of genetic mutation and vitamin deficiency can cause a pathological level of homocysteine with resultant branch retinal artery occlusion in a young patient. Case presentation A 16-year-old boy presented to eye casualty with acute inferior visual field loss in the left eye. Visual acuity remained normal at 6/6 each eye and the event was painless. Initial assessment, and retinal photography revealed a left superior hemi-field branch retinal artery occlusion with macular sparing. Given the patient’s age, extensive investigation into the cause was carried out. Positive findings were of an elevated level of homocysteine as a result of vitamin B12 and folic acid deficiency as well as a genetic mutation in the MTHFR gene (encoding MTHFR enzyme which is vital in normal homocysteine metabolism). Vitamin B12 and folic acid were replaced which in turn normalized the patient’s homocysteine levels. At two months, the patient’s visual fields had also improved, and no further vascular event had occurred. Conclusions This case report has highlighted the link between hyperhomocysteinaemia and retinal artery occlusion. However, despite vitamin replacement being shown to normalize homocysteine levels, no evidence exists to date as to whether this will reduce the risk of further retinal vascular occlusion. |
| first_indexed | 2024-12-11T06:04:28Z |
| format | Article |
| id | doaj.art-770910a04ca4413ebf92fb4fb71781c1 |
| institution | Directory Open Access Journal |
| issn | 1471-2415 |
| language | English |
| last_indexed | 2024-12-11T06:04:28Z |
| publishDate | 2018-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Ophthalmology |
| spelling | doaj.art-770910a04ca4413ebf92fb4fb71781c12022-12-22T01:18:21ZengBMCBMC Ophthalmology1471-24152018-09-0118S11610.1186/s12886-018-0859-2A case report of branch retinal artery occlusion in a teenager due to hyperhomocysteinaemia; the interplay of genetic and nutritional defectsClare Shute0Royal Victoria HospitalAbstract Background Retinal vascular occlusions are uncommon in young people and require more in-depth investigation into the cause. Studies have revealed that a high level of circulating homocysteine poses a risk for retinal vaso-occlusive events across a wide age range. This case report reflects on how the interplay of genetic mutation and vitamin deficiency can cause a pathological level of homocysteine with resultant branch retinal artery occlusion in a young patient. Case presentation A 16-year-old boy presented to eye casualty with acute inferior visual field loss in the left eye. Visual acuity remained normal at 6/6 each eye and the event was painless. Initial assessment, and retinal photography revealed a left superior hemi-field branch retinal artery occlusion with macular sparing. Given the patient’s age, extensive investigation into the cause was carried out. Positive findings were of an elevated level of homocysteine as a result of vitamin B12 and folic acid deficiency as well as a genetic mutation in the MTHFR gene (encoding MTHFR enzyme which is vital in normal homocysteine metabolism). Vitamin B12 and folic acid were replaced which in turn normalized the patient’s homocysteine levels. At two months, the patient’s visual fields had also improved, and no further vascular event had occurred. Conclusions This case report has highlighted the link between hyperhomocysteinaemia and retinal artery occlusion. However, despite vitamin replacement being shown to normalize homocysteine levels, no evidence exists to date as to whether this will reduce the risk of further retinal vascular occlusion.http://link.springer.com/article/10.1186/s12886-018-0859-2Branch retinal artery occlusionHomocysteineHyperhomocysteinaemiaMTHFRVitamin B12Folic acid |
| spellingShingle | Clare Shute A case report of branch retinal artery occlusion in a teenager due to hyperhomocysteinaemia; the interplay of genetic and nutritional defects BMC Ophthalmology Branch retinal artery occlusion Homocysteine Hyperhomocysteinaemia MTHFR Vitamin B12 Folic acid |
| title | A case report of branch retinal artery occlusion in a teenager due to hyperhomocysteinaemia; the interplay of genetic and nutritional defects |
| title_full | A case report of branch retinal artery occlusion in a teenager due to hyperhomocysteinaemia; the interplay of genetic and nutritional defects |
| title_fullStr | A case report of branch retinal artery occlusion in a teenager due to hyperhomocysteinaemia; the interplay of genetic and nutritional defects |
| title_full_unstemmed | A case report of branch retinal artery occlusion in a teenager due to hyperhomocysteinaemia; the interplay of genetic and nutritional defects |
| title_short | A case report of branch retinal artery occlusion in a teenager due to hyperhomocysteinaemia; the interplay of genetic and nutritional defects |
| title_sort | case report of branch retinal artery occlusion in a teenager due to hyperhomocysteinaemia the interplay of genetic and nutritional defects |
| topic | Branch retinal artery occlusion Homocysteine Hyperhomocysteinaemia MTHFR Vitamin B12 Folic acid |
| url | http://link.springer.com/article/10.1186/s12886-018-0859-2 |
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