A drug-induced central retinal vein occlusion

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Abstract

Purpose

To report a case of central retinal vein occlusion probably caused by tranexamic acid medication.

Methods

A 45-year-old woman consulted in our emergency room because of a visual field defect in a her left eye without visual loss. Her past medical history revealed metrorrhagias treated by tranexamic acid and no cardiovascular disease. Visual acuity was 20/20 in both eyes. Slit-lamp examination was normal in both eyes and fundus examination showed peri-papillary haemorrhages LE. Two days later she complained of sudden visual loss LE. Visual acuity of her left eye was limited to light perception. Fundus examination revealed many haemorrhages, macular edema, and papillary edema. Fluorescein angiography showed central retinal vein occlusion associated with a cilioretinal occlusion. General and biological examinations revealed no abnormalities. Systemic disorders were excluded. Therefore we concluded to a iatrogenic pathology.

Results

In our patient after excluding systemic disorders potentially responsible for this ocular pathology we suspected a iatrogenic cause. Tranexamic acid is a classical treatment for haemorrhages especially in case of metrorrhagias. It allows haemostasis thanks to an antifibrinolytic action due to plasminogen inhibition. A few cases of vein and arterial occlusions caused by tranexamic acid treatment have been reported in literature.

Conclusion

In a young patient without systemic disorder presenting with a retinal vascular occlusion we must always keep in mind a drug-induced pathology.

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