The impact of elevated lipoprotein a levels on retinal vein occlusion in young individual: Case report with 7 months follow‐up

Abstract

Aims/Purpose: Branch retinal vein occlusion (BRVO) occurs when a branch of the retinal vein becomes obstructed. The aim of this study case was to provide insights into the potential role of Lipoprotein (Lp) (a) in the pathogenesis of BRVO.Methods: Case of a 47‐year‐old woman with no significant ophthalmological or general medical history, except the use of oral contraception and smoking habits. Presented to the emergency care after 5 days of experiencing a sudden vision loss in her right eye.Results: The ophthalmological examination revealed a visual acuity of 10/10 on the left (OS) and VBLM/10 on the right eye (OD). Slit lamp and Fundus examination showed on OD a relative afferent pupillary defect and the classic features of acute retinal branch vein occlusion, including tortuous veins, capillary occlusion, papillary and macular oedema and haemorrhages. While all was normal in OS. A comprehensive ophthalmic examination was conducted, including fluorescein angiography and optical coherent tomography that showed no abnormal vessel growth at this stage. Then, the indication for a dexamethasone intravitreal implant has been made along with panretinal photocoagulation (PRP) in the ischaemic areas. More, discontinuing oral contraception, the serum concentrations of specific antibodies, as anticardiolipin and antiphospholipids, as well as homocysteine and Lp (a) levels. The blood tests yielded negative results except for the abnormal plasma level of lipoprotein (a), which was measured at 900 mg/L. After 2 months of follow‐up. The visual acuity in OD was measured at 9/10. Moreover, the restoration of normal macular thickness after 4 months. However, at 6 months follow‐up, the appearance of a neovascularization adjacent to the previously laser‐treated area. As a result, a series of closely spaced PRP was performed along with an intravitreal anti‐vascular endothelial growth factor. After 1 month, a complete disappearance of the neovascularization was observed.Conclusions: Identification of independent and highly predictive risk factors for BRVO is still a big challenge. The main goals are the preservation of visual acuity and the prevention of relapses. This case report emphasizes the importance of incorporating a systematic Lp (a) testing into clinical practice, even in young individual.