SPONTANEOUS RETINAL AND VITREOUS HEMORRHAGE WITH RETINAL DETACHMENT: A DISCUSSION OF MULTIPLE ETIOLOGY COMPOUNDING THE CLINICAL PICTURE.

Jason Guilford

Abstract

BACKGROUND: Ocular complications from anticoagulation therapy are rare. The chance of complications increases with the number of risk factors. We present a case wherein the clinical presentation was ostensibly attributable to anticoagulation therapy but further testing revealed hidden contributors.

CASE REPORT(S). A 57 year old white male presented for an eye exam because his primary care physician told him to. He had a history of a vitreous hemorrhage 2 years prior concurrent with a hospitalization for generalized edema and hypertension secondary to nephrotic syndrome. He ultimately received a diagnosis of glomerular sclerosis and was treated with oral prednisone. His clinical condition deteriorated requiring a conversion to dialysis one week later. While on dialysis, he had a staphylococcal aureus infection of his central line which was successfully treated with vancomycin. When the central line was removed, there was a clot in his right internal jugular vein. This necessitated initiation of intravenous heparin. Complicating this treatment was the fact that this patient had low antithrombin III clotting factor. Genetic testing revealed that this patient was heterozygous for factor V leiden which also reduces his ability to coagulate. Two days after beginning intravenous heparin, he developed intra-retinal and sub-retinal bleeds OS which progressed to vitreous hemorrhage and shallow retinal detachment. Despite the superior location of the retinopathy and detachment, the macula was never involved and vision throughout follow up remained at 20/20.

CONCLUSIONS. Mild hemorrhagic retinopathy with anticoagulant therapy is not uncommon. However, serious intra-ocular hemorrhage is a rare complication. Patients who present with serious hemorrhagic complication while undergoing anticoagulation therapy deserve investigation for uncommon contributing factors.

Details

Year: 2001

Program Number: Poster 83

Author Affiliation: VA Boston Healthcare System

Co-Authors: Kathy Moreira, Gerald Selvin, Robert Dunphy, Barry Fisch

Co-Author Affiliation: VA Boston Health Care System, VA Boston Healthcare System, VA Boston Healthcare System, VA Boston Healthcare System

Room: Exhibit Hall C