Baylor College of Medicine Houston, TX, United States
Taaj Raasikh, MD1, Manreet Kaur, MD2 1Baylor College of Medicine, Houston, TX; 2Baylor College of Medicine, Baylor, TX
Introduction: It is well established that inflammatory bowel diseases (IBD) can present with ocular manifestations. Almost 10% of IBD patients will have ocular pathologies, most commonly episcleritis, scleritis and uveitis. We present a rare case of central retinal vein occlusion (CRVO) in a young adult with severe ulcerative colitis, successfully treated with systemic steroids and anticoagulation.
Case Description/Methods: Patient is a 20-year-old male with ulcerative colitis (UC) diagnosed 6 months ago, complicated by multiple flares. He was found to have a positive CMV PCR (VL 1820 IU/ml) during routine lab monitoring. He completed a four-week course of oral valganciclovir with negative viral load and was initiated on infliximab. During his subsequent ophthalmology examination, small hemorrhages of the right retina were noted as well as optic disc edema with scattered dot blot heme, without cystoid macular edema (CME). Repeat exam 2 weeks later showed stable disc edema however with new venous dilatation of right eye with CME and MRI brain revealed heterogeneous enhancement of the right optic nerve. Hypercoagulable workup was unremarkable. Throughout this time he did not experience visual loss, changes in vision or headaches and rest of ophthalmology examination including visual field and acuity was normal.
Two ophthalmologists reviewed the case and determined his presentation was consistent with CRVO. Given the worsening retina exam he was started on therapeutic anticoagulation with rivaroxaban per hematology. He also was started on high dose systemic steroids for a concurrent UC flare that resulted in a total colectomy. Subsequent retinal exams 2 months later showed resolution of right eye optic disc edema and retinopathy. The patient completed a 3-month course of anticoagulation and since his colectomy he has been off steroids and infliximab.
Discussion: CRVO is a rare ocular complication of IBD with a handful of cases reported in the literature. While IBD patients have higher incidents of thromboembolic events than the general population, retinal arterial and vein occlusions are rare. Treatment for CRVO typically involves intraocular steroids or anti-VEGF to help reduce swelling and neovascularization. There is limited evidence on the benefits of systemic anticoagulation. However, in our case the patient responded well to systemic steroids and anticoagulation. When concerning findings arise, being aware of the extent of ophthalmologic manifestations of IBD is important to ensure a prompt evaluation.
Disclosures: Taaj Raasikh indicated no relevant financial relationships. Manreet Kaur indicated no relevant financial relationships.
Taaj Raasikh, MD1, Manreet Kaur, MD2. P2713 - Central Retinal Vein Occlusion in the Setting of Severe Ulcerative Colitis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.