A Rare Cause of Unilateral Central Retinal Vein Occlusion in a Young Patient: Type III Mixed Cryoglobulinemia

Abstract

Purpose. To report a young male with unilateral central retinal vein occlusion (CRVO) associated with cryoglobulinemia. Case Presentation. A 33-year-old male without any known systemic or ocular disorder was admitted to our clinic with a complaint of visual loss for three days in his left eye. Based on the clinical, laboratory, and ophthalmological assessments, we diagnosed this case as type III mixed cryoglobulinemia with unilateral CRVO with macular edema. For treatment, two intravitreal ranibizumab injections were administered monthly and oral prednisone (64 mg/day) was begun. Subsequently, cryoglobulins became undetectable, macular edema decreased, and the visual acuity improved to 20/32 over an 8-week period. At 24 weeks, the patient's visual acuity remained 20/32 and no recurrence was observed while the patient was still on prednisone (16 mg/day). Conclusion. Cryoglobulinemia should be considered in the differential diagnosis of the patients with CRVO.

Figure 1

(a) Fundus photograph of the left eye shows central retinal vein occlusion with disk edema, dilated retinal veins, peripapillary cotton-wool spots, and hemorrhages. (b) Fluorescein angiogram (1 minute and 14 seconds after injection of the dye) photograph of the left eye shows central retinal vein occlusion with marked delay in arteriovenous transit time, masked by retinal hemorrhages, vessel wall staining, and a few small patches of retinal capillary obliteration. (c) Fundus photography of the left eye after 8 weeks shows that superficial cotton-wool spots and retinal hemorrhages were all resolved.

Figure 2

(a) Optical coherence tomography of the left eye shows macular edema (central foveal thickness: 437 μm). (b) Optical coherence tomography of the left eye after 8 weeks (central foveal thickness: 242 μm) (after two monthly ranibizumab injections).