Endocrine Abstracts

Introduction: Retinal vein occlusions (RVO) are a heterogeneous group of disorders characterized by impaired venous return from retinal circulation. RVO can be classified into branch retinal vein occlusion (BRVO), hemiretinal vein occlusion (HRVO), and central retinal vein occlusion (CRVO) depending on the site of the obstruction. Major risk factors for BRVO include systemic arterial hypertension, arteriosclerosis, and diabetes, although many associations have been reported including thrombophilia and inflammatory conditions such as Behcet disease. Herein we report a BRVO in a young man in whom Behcet’s disease was suspected.

Observation: A non-smoking 36-year-old patient, type 1 diabetic for 14 years on insulin, with no other significant medical history, presented in ophtalmology department for a brutal decrease in unilateral visual acuity of the right eye. Admission examination found visual acuity 4/10 right, 10/10 left, with skin lesions on both legs. Fluorescein angiography showed BRVO in the right, with bilateral minimal diabetic retinopathy. OCT macula scan found significant macular edema in the right eye requiring intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF). Given the notion of recurrent mouth ulcers and nodular skin lesions, the patient was referred to internal medicine department for suspicion of Behcet’s disease. The admission examination found no erythema nodosum, no pseudofolliculitis, no oral or genital ulcer scars. There was no neurological manifestation, no uveitis. Dermatological examination found eruptive lesions on both legs made up of multiple confluent and circumferential erythematous and brownish macules. There were infiltrated erythematous purple inflammatory nodules on the posterolateral sides of leg, some varicosities and oedema. A skin biopsy showed non-specific necrotic remodeling of the hypodermis compatible with lipodermatosclerosis. Glycated haemoglobin (HbA1c) at 7.3%. Besides, blood count ionogram, lipid and thyroid analyzes were normal. An exhaustive etiological investigation. As part of the etiological assessment, looking for Behcet’s disease, coagulopathy, or connectivitis, pathergy test was negative. HLA typing didn’t show HLA B27 or B51 antigen. In addition, antinuclear antibodies, anti-extractable nuclear antigen, anti-cyclic citrullinated peptides, cryoglobulinemia and antiphospholipid antibodies were all negative. In addition, thrombophilia investigation didn’t reveal any anomalies. Therefore, this episode was attributed to diabetes, which is already at the stage of degenerative complications (diabetic retinopathy), and the patient was referred to his ophthalmologist and endocrinologist for follow-up.

Conclusion: Among the wide spectrum of RVO, diabetes remains one of the main causes. Until today, it still one of the leading causes of vision loss. So let’s stay classic and don’t forget diabetes!