Dados do Trabalho

Título

RETINAL CENTRAL VEIN AND CILIORETINAL ARTERY OCCLUSION ASSOCIATED WITH HIGH-DOSE CAFFEINE INTAKE: A CASE REPORT

Introdução

The cilioretinal artery experiences lower perfusion pressure compared to the central retinal artery, resulting in its relative occlusion. Cilioretinal artery occlusion (CLRAO) accounts for 5-7% of retinal artery occlusions and is often associated with central retinal vein occlusion (CRVO) or anterior ischemic optic neuropathy. A significant vasoconstrictive response of retinal vessels has been observed after ingesting high doses of caffeine in healthy young individuals, as exemplified by this report of a young patient who developed CLRAO associated with CRVO.

Métodos

Observational study of a case of retinal central vein and cilioretinal artery occlusion associated with high-dose caffeine intake.

Resultados

A 20-year-old woman, without comorbidities or ophthalmological history, was admitted with a sudden decrease in visual acuity in the right eye (OD) for one day. Her best-corrected visual acuity (BCVA) was 20/200 in the OD and 20/20 in the left eye (OS). Pupillary reflexes were normal and biomicroscopy revealed no relevant findings. Fundus photograph indicated a perfused optic disc, diffuse venous tortuosity, and dot-blot hemorrhages in all four quadrants of the retina in the OD, with the presence of cilioretinal artery (CLRA) exhibiting sheathing and perivascular retinal pallor. Macular OCT showed an increased retinal thickness in the superior parafoveal region and a hyper-reflectivity band in the inner plexiform, inner nuclear and outer plexiform layers, consistent with acute paracentral middle maculopathy. This findings were corroborated by evidence of macular ischemia on OCT angiography. No abnormalities was observed in the OS. Thus, the diagnosis of unilateral CLRAO associated with non-ischemic CRVO was made. No significant abnormalities were found in laboratory tests, including nutrition, rheumatology, hematology, and infectious factors. Carotid Doppler ultrasound and neuroimaging showed no relevant findings. Despite an extensive medical history, the only notable information was the patient's high caffeine intake (800 mg/day) through capsules on the day of symptom presentation. Upon discontinuing caffeine supplementation and using brimonidine tartrate eye drops t.i.d, full BCVA recovery occurred within 2 months.

Conclusões

High-dose caffeine intake may be associated with retinal arterial occlusion. Therefore, in young individuals without apparent comorbidities, lifestyle factors need to be considered in the etiological assessment of retinal vascular occlusions.

Palavras Chave

Caffeine, Cilioretinal artery occlusion, Central retinal vein occlusion

Arquivos