Branch retinal vein occlusion secondary to hormone replacement therapy in a transgender woman

Abstract

To report a case of branch retinal vein occlusion (BRVO) in a transgender woman having undergone hormone replacement therapy. Observational case report. A 44-year-old transgender woman on hormone replacement therapy with transdermal estradiol gel for the past 6 years was referred for sudden loss of vision and metamorphopsia in her left eye (LE) for the past 3 weeks. Best-corrected visual acuity (BCVA) was 20/20 in her right eye (RE) and 20/40 in her LE. Dilated fundus examination showed deep flame-shaped hemorrhages, cotton wool spots, and arteriovenous crossing changes. Spectral-domain optical coherence tomography (SD-OCT, Spectralis; Heidelberg Engineering, Heidelberg, Germany) showed retinal edema in the superonasal perifoveal area. Optical coherence tomography angiography (OCTA PlexElite, Carl Zeiss Meditec, Inc, Dublin, CA) revealed the presence of areas of non-perfusion, disorganization of the capillary network and capillary ectasia and dilation. The patient was treated with 3 monthly intravitreal injections of aflibercept. Three-month follow up revealed complete resolution of the macular edema, with BCVA having improved to 20/20 in the LE. As estrogen increases cardiovascular risk when used in hormone replacement therapy, RVO is a complication that must be taken into account by clinicians, especially in transgender women (male-to-female) who are more at risk.