Bilateral Occlusion of the Central Retinal Vein due to Excess of Factor VIII Level

Author(s): Bencharef H, Kouame H, Oukkache B

Introduction: Retinal vein occlusion (RVO) is an obstruction of the retinal venous system, frequently linked to cardiovascular risk factors in elderly; it remains rarer in young subjects, and requires a rigorous etiological investigation. In this article we report the first case of bilateral central retinal vein occlusion (CRVO) in a young patient related to excess factor VIII levels.

Case Presentation: A 22-year-old woman presented with a complaint of sudden and bilateral decreased visual acuity. The patient had no particular pathological history. The best-corrected visual acuity was reduced to light perception in both eyes. A complete fundus assessment including retinal angiography showed bilateral occlusion of the central retinal vein with areas of ischemia.

A complete assessment of thrombophilia was performed revealing an isolated excess of the plasma factor VIII level at 226.4%, checked on a second sample at 232%. The diagnosis of thrombophilia secondary to an increase in factor VIII responsible for OCRV was retained, and the patient was treated with panretinal photocoagulation in both eyes with specialized treatment in the hematology department. For her clinical course, at the visual level her state is stationary in light perception, and at the renal level, she continues her hemodialysis sessions at the rate of 3 sessions per week.

Conclusion: An elevated factor VIII level is an independent risk of venous thrombosis. Moreover, it is likely to influence the pathogenesis of central venous occlusion of the retina. These patients should be carefully evaluated to diagnose thrombophilia, including factor VIII, and initiate appropriate management as soon as possible.