SUPERFICIAL AND DEEP CAPILLARY ISCHEMIA AS A PRESENTING SIGN OF RETINAL VASCULOPATHY WITH CEREBRAL LEUKOENCEPHALOPATHY AND SYSTEMIC MANIFESTATIONS. (2018)

• Record Type: Journal Article
• Authors: Nagiel, Aaron; Lalane, Robert A.; Jen, Joanna C.; Kreiger, Allan E.
• Is Part Of: Retinal cases & brief reports. Volume 12(2018)Supplement 1
• Publication Date: 2018
• Subjects: ultra–widefield imaging -- optos -- fluorescein angiography -- paracentral acute middle maculopathy -- optical coherence tomography -- OCT angiography -- capillary nonperfusion -- retinal vasculopathy -- TREX1-associated retinal vasculopathy -- cerebroretinal vasculopathy -- HERNS; Retina -- Diseases -- Periodicals; Retina -- Periodicals; Retinal Diseases -- Periodicals; Retina -- Case Reports; Retinal Diseases -- Case Reports; 617.7
• DOI: 10.1097/ICB.0000000000000641
• Languages: English
• ISSNs: 1935-1089

Abstract

Abstract : Purpose: The aim of this study was to investigate the presenting sign of retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations, a rare autosomal dominant condition caused by mutations in the TREX1 gene, and to explore the potential efficacy of bevacizumab in preventing capillary occlusions. Methods: Observational case report with the use of ultra–widefield fluorescein angiography, optical coherence tomography, and optical coherence tomography angiography. Results: A 31-year-old man with a family history of retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations presented with a scotoma in his left eye. The visual acuity was 20/20 in both eyes, and his examination was notable for scattered cotton wool spots in the retina of both eyes as well as an area of paracentral acute middle maculopathy in the left eye. Ultra–widefield fluorescein angiography revealed peripheral capillary nonperfusion and vascular leakage corresponding to the cotton wool spots. Spectral domain optical coherence tomography and optical coherence tomography angiography confirmed the presence and distribution of superficial capillary plexus and deep capillary plexus ischemia. Neurologic examination and imaging were normal. A trial of monthly intravitreal bevacizumab injections to the left eye over 6 months resulted in diminished capillary leakage. Conclusion: Retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations is a rare genetic condition manifested most commonly by cerebral and retinal ischemia. This retinal vasculopathy leads to occlusions of small-caliber retinal vessels in the superficial plexus and deep plexus with resulting cotton wool spots and paracentral acute middle maculopathy, respectively. Recognition of the retinal findings by ophthalmologists and neurologists may avoid unnecessary brain biopsies in diagnosing this rare disorder. Abstract : Retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations is a rare autosomal dominant syndrome that results in systemic vaso-occlusive events. This case report describes a young man with superficial and deep retinal capillary ischemia as the presenting sign of the condition.