Photo essay: combined occlusion of the central retinal artery and vein in a pediatric patient secondary to infective endocarditis

Bilateral combined central retinal artery and vein occlusion in a 3-year-old child with nephrotic syndrome

Nephrotic syndrome (NS) is a common disease of childhood but ophthalmic manifestations are seldom reported. We report a rare occurrence of bilateral combined central retinal artery and vein occlusion in a 3-year-old with NS. The child presented with bilateral painless loss of vision, central pallid retinae with cherry red spots, vascular tortuosity, and retinal hemorrhages. There was delayed filling of the arteriolar circulation and a delay in arteriovenous transit time on angiography and increased central retinal thickening on optical coherence tomography. She was treated with oral steroids, subcutaneous low molecular weight heparin, and oral acetylsalicylic acid. The central retinae showed resolution of the hemorrhages, tortuosity, edema, and pallor within 3 weeks. Visual acuity recovered bilaterally to 20/360, 20/190, and 20/40 at 1, 3, and 6 weeks, respectively. We discuss the possible reasons for good recovery in our patient. Though bilateral combined central retinal artery and vein occlusion is rare in pediatric NS, the treating physician should be aware of this entity as it can be successfully managed.

Unilateral central retinal vein occlusion as a first manifestation of diabetes mellitus in a ten-year-old girl

Central retinal vein occlusion (CRVO) is relatively rare in the pediatric age group. We present a case of CRVO as the first manifestation of diabetes mellitus in a ten-year-old girl. The associated macular edema was managed successfully with a single injection of Ranibizumab. Ophthalmologists should consider the possibility of diabetes mellitus in pediatric cases of CRVO.

Branch retinal vein occlusion followed by central retinal artery occlusion in Churg-Strauss syndrome: unusual ocular manifestations in allergic granulomatous angiitis

PURPOSE

To describe a rare branch retinal vein occlusion (BRVO) followed by central retinal artery occlusion (CRAO) in a patient with Churg-Strauss syndrome (CSS).

METHODS

A 55-year-old man with a not yet diagnosed CSS developed a BRVO in the left eye and 1 year later a CRAO with painless and acute vision loss in the same eye. Medical history included bronchial asthma, history of allergy, eosinophilic pneumonia, bilateral pleuric and pericardial effusion, hypereosinophilia, and purpuric vasculitis.

RESULTS

CRAO in the left eye was diagnosed by retinal whitening and a cherry red spot with coexisting old BRVO evidenced by previous laser photocoagulation. Corticosteroids and cyclophosphamide therapy improved his general condition but no visual recovery occurred.

CONCLUSIONS

BRVO and CRAO can occur in the same eye in CSS. In the presence of systemic signs or symptoms, it is important to rule out systemic vasculitis in order to start appropriate immune-modulatory treatment thereby avoiding unnecessary mortality.

Central retinal venous occlusion in an otherwise-healthy child

Isolated retinal venous occlusion rarely occurs in otherwise-healthy children.(1-3) We report a unilateral case of central retinal vein occlusion with secondary proliferative retinopathy and neovascular glaucoma in a 6-year-old girl. Despite an extensive workup, no etiology was identified.