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Citation: Rojbani E, Oueslati Y, Bouchoucha S, Abdaoui M, Rannen R. Hemiretinal arteriovenous occlusion in Crohn’s disease a case report: A case

report. Jr. med. res. 2023; 6(2):9-11. Rojbani et al © All rights are reserved. https://doi.org/10.32512/jmr.6.2.2023/9.11

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Case Report

Rojbani Eya

1,2

, Oueslati Yassin

*1,2

, Bouchoucha Saker

1,2

, Abdaoui Mouna

1,2

, Rannen Riadh

1,2

Hemiretinal arteriovenous occlusion in Crohn’s disease: A case report.

1: Department of Ophthalmology

Principal Military Hospital, Tunis, Tunisia

2: College of Medicine, Tunis, Tunisia

* Corresponding author

Correspondence to:

weslatiyassin10@gmail.com

Publication Data:

Submitted: March 27,2023

Accepted: June 19,2023

Online: November 30,2023

This article was subject to full peer-

review.

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Only few cases of retinal vascular accidents in association with Crohn

disease (CD) have been reported. To the best of our knowledge this one

of the first cases of unilateral arteriovenous hemiretinal occlusion in CD.

This complication is sight-threatening and needs immediate appropriate

diagnosis and treatment. We herein describe a case of Crohn’s disease

presenting with hemi-retinal arteriovenous occlusion.

Keywords

Crohn’s disease; vasculitis; artery; vein; occlusion.

Introduction

Crohn’s disease (CD) is a multisystemic inflammatory disorder. Conjunctivitis,

episcleritis, keratitis, iritis and uveitis are the most common manifestations

occurring in more than 10 % of cases [1,2].

Posterior segment is rarely involved (<1% of cases). We herein describe a new

case of hemiretinal arteriovenous occlusion. The aim of this report was to rule out

cause-to- effect relationship with the systemic disorders of CD.

Observation

A 48-year-old female with long CD history presented with headache and left eye

blurred vision for seven weeks. The patient was undergoing immunosuppressive

treatment for 10 years and had no previous ocular complaints.

Physical examination found best corrected visual acuity of 20/20 (Snellen) in the

right eye and 20/50 in the left.

Results of pupillary and motility examination were within normal in both eyes. In

the right eye, ophthalmoscopic examination showed no abnormalities. In the left

eye, slit-lamp examination identified corneal precipitates and cells in the anterior

chamber.

Fundus examination found numerous vitreous cells, extensive vascular sheathing

involving the arteries and the veins in the inferior part of the retina, extensive

blot hemorrhages scattered in the distribution of the inferotemporal vein and

retinal whitening between hemorrhage areas. Fluorescein Angiography of the left

eye was performed and confirmed hemiretinal arteriovenous occlusion, leakage of

the inferior vessel walls and capillary dropout responsible for masking effect in

the ischemic area with no objective neovascularization(Figure 1). On the right

side the, the fluorescein angiography was normal.

The Optical Coherence Tomography (OCT) of the left eye showed high reflectivity

of the inner retinal layers and central foveolar cysts associated to few exudates

(Figure 2). The OCT of the right eye was unremarkable.

Left OCT-Angiography (OCT-A) showed an enlargement of the central avascular

zone with rarefication of the superficial capillary plexus. OCT-A of the right eye

was normal (Figure 3). Screening for coagulopathy, autoimmune disorders and

tuberculosis was negative. Patient was treated by intravenous corticosteroids and

laser photocoagulation with satisfactory digestive and ocular evolution.

Abstract

Hemiretinal arteriovenous occlusion in Crohn’s disease a case report: A case report

Citation: : Rojbani E, Oueslati Y, Bouchoucha S, Abdaoui M, Rannen R. Hemiretinal arteriovenous occlusion in Crohn’s disease a case report: A case

Submit your manuscript: www.jmedicalresearch.com.

Figure 1: Initial presentation of a 48-year-old woman with hemiretinal arteriovenous occlusion in the left eye associated with Crohn’s disease. A. Fundus photo showing extensive vascular sheathing involving

the arteries and the veins in the inferior area of the retina, extensive blot hemorrhages scattered in the distribution of the inferotemporal vein and retinal whitening between hemorrhage areas. B. Early phase

fluorescein angiography showing delayed inferior arterial filling. C. Mid phase fluorescein angiography showing blocking (masking effect) in the inferior area of the retina, leakage of the inferior vessel walls and

capillary dropout. D. Late phase fluorescein angiography showing papillary hyperfluorescence.

Figure 2: Optical Coherence Tomography (OCT) of the left eye; showing Centro-foveolar cysts, a few exudates with high reflectivity of the inner retinal layers

Figure3: Optical Coherence Tomography-Angiography (OCT-A) of the left eye; showing an enlargement of the central avascular zone with a rarefication of the superficial capillary plexus.

Hemiretinal arteriovenous occlusion in Crohn’s disease a case report: A case report

Citation: : Rojbani E, Oueslati Y, Bouchoucha S, Abdaoui M, Rannen R. Hemiretinal arteriovenous occlusion in Crohn’s disease a case report: A case

Submit your manuscript: www.jmedicalresearch.com.

Conflict of Interest: None

References

[1] Debourdeau E, Charmard C, Carriere I, Plat J, Villain M, Boivineau L, et al . Retinal Microcirculation Changes in Crohn's Disease Patients under Biologics, a Potential Biomarker of Severity: A Pilot Study. J Pers Med.

2022;12:230.

[2] Coussa RG, Ali-Ridha A, Vila N, Alshareef R, Chen J. Simultaneous central retinal artery occlusion and optic nerve vasculitis in Crohn disease. Am J Ophthalmol Case Rep. 2016; 5:11-15.

[3] Figueiredo L, Rothwell R, Brandão A, Fonseca S. Central retinal vein occlusion in a patient with retinal vasculitis and Crohn's disease. Case Rep Ophthalmol Med. 2014; 2014:967878.

[4] Garcia-Diaz M, Mira M, Nevado L, Galván A, Berenguer A, Bureo JC. Retinal vasculitis associated with Crohn's disease. Postgrad Med J. 1995 ;71:170-2.

[5] Senthamizh T, Senthamizhselvan K, Sahoo NK, Kaliaperumal S. Panuveitis in a patient with active Crohn's disease. BMJ Case Rep. 2021;14:e239058.

Discussion

Crohn’s disease (CD) is a chronic immune-mediated disease characterized by inflammatory lesions that may involve retinal

microcirculation [1]. About 5 to 10% of affected patients present with ocular complications of both the anterior and posterior

segments of the eye [2]. Crohn disease occlusive vasculopathy is known to be risk facto of thromboembolic accidents [3].

severity of the retinal vasculopathy might be correlated to the activity of Crohn disease and is no more considered as collateral

effect of systemic inflammatory changes. Blood vessel wall disruption due to the combination of focal arteritic submucosal

inflammatory cells infiltration precipitates vision troubles [4]. Few reports of retinal central vein or artery occlusion were

published. Most of the described Lesions were bilateral. Unilateral arteriovenous occlusion is a very rare finding. Systemic

steroid and immunosuppressive agents are the consensual treatment of the sight threatening entity[5].