A 66-year-old male presented with sudden blurring of vision in his left eye. Examination found his left eye vision was counting fingers at 1 meter while his right eye was normal. Imaging showed central retinal artery occlusion and central retinal vein occlusion in the left eye with severe macular edema. The patient had a history of metastatic penile cancer treated with chemotherapy including carboplatin, which is a known cause of combined central retinal artery and vein occlusions. He was treated with anti-VEGF therapy and monitoring of his cardiovascular risk factors.

1. A RARE CASE OF SUDDEN
UNILATERAL LOSS OF VISION
DR P V BHARGAVAN
MD, FRCP, FIMSA
SENIOR CONSULTANT, HOD
DEPT OF GENERAL MEDICINE
BABY MEMORIAL HOSPITAL

2. History
• 66 year old male, a known case of Metastatic carcinoma Penis
Stage 4, yp T3N3, Squamous cell type- Grade 2 . (No other comorbidities.)
• S/P Palliative Radiotherapy to Penis and Left inguinal area
• Total Penectomy , Left Inguinal Block Dissection, Perineal Urethrostomy
• 4 cycles of Palliative chemotherapy with Paclitaxel and Carboplatin

3. Presented with:
Sudden onset blurring of vision(painless) in Left eye x 3 days
On Examination:
Distant Vision in Right eye: 6/6
Distant Vision in Left eye: Counting fingers at 1 m
Pupils equal and reactive to light

4. Fundus findings– LEFT EYE

5. OPTICAL COHERENCE TOMOGRAPHY

6. Diagnosis
Central Retinal Artery Occlusion
and
Central Retinal Vein Occlusion
with
Severe Macular oedema

7. Discussion:
Causes of combined CRAO and CRVO
• Atherosclerosis: HTN, DM, Dyslipidemia, Smoking, hyperuricemia
• Embolism: Carotid, Cardiac, Aortic
• Inflammation: Temporal Arteritis, PAN, SLE, Pancreatitis, Behcets disease
• Thrombophilic disorder: Polycythemia, Protein c, s deficiency
• Infections: Toxoplasmosis , Mucormycosis
• Drugs: OCP, Cocaine, Interferon therapy, Anticancer drugs(Cisplatin, Carboplatin)
• Ophthalmic causes: raised intraocular pressure, foramen trauma, retinal migraine, Glaucoma
• Malignancies: Non hodgkins lymphoma, APLA,Prostate Cancer, Meningeal carcinomatosis
• Pregnancy
• IV Drug abuse

8. Treatment:
CRVO with macular oedema
• Anti VEGF therapy with intravitreal BEVACIZUMAB, RANIBIZUMAB or
AFLIBERCEPT
• Intravitreal TRIAMCINOLONE and DEXAMETHASONE IMPLANT
CRAO
• Thorough assessment of CVS
• Carotid endarterectomy
• Anticoagulation
• Aspirin
• Control of HTN, DM, Dyslipidemia

9. 14 patients with acute unilateral visual loss due to combined retinal artery and venous occlusions. All 14 patients
presented at the Polyclinic over a period of about 3 years. Fluorescein angiography was carried out in 12 patients to
confirm the diagnosis. Ten patients underwent Doppler sonography and 11 echocardiography.
Results: 11 of 14 patients presented several cardiovascular risk factors, i.e., immunocytoma and arterial hypertension
and hypercholesterolemia in one patient; another patient had chronic bronchitis, tachycardia and hypercholesterolemia.
Six patients presented coagulation anomalies, and eight patients had arterial hypertension. Doppler sonography revealed
normal carotid arteries in nine of ten patients. In 8 of 11 patients, echocardiography displayed no cardiac abnormalities.
Ophthalmoscopy revealed no emboli in any of these patients

10. A case of bilateral, early ischemic retinopathy presenting with cotton wool spots and only mild
visual loss, without neovascularization or intraretinal hemorrhage in a patient receiving carboplatin
and paclitaxel chemotherapy for cervical cancer, which resolved after cessation of the
chemotherapy.

11. THANK YOU