A 55-year-old hypertensive woman presents with sudden vision loss in one eye. Fundoscopy reveals a large superficial retinal hemorrhage in all four quadrants, dilated tortuous veins, and a few cotton-wool spots. IOP is 22 mmHg. The fellow eye shows arteriovenous crossing changes. The patient is on warfarin for atrial fibrillation with an INR of 3.5. Which underlying hematologic workup is most likely to yield an etiology in this young patient with CRVO?
- A Hemoglobin A1c and lipid profile
- B Hypercoagulable screen (factor V Leiden, prothrombin gene mutation, antiphospholipid antibodies) ✓
- C Carotid Doppler ultrasonography
- D HbA1c only, as diabetes is the leading systemic risk factor
Correct answer: B. Hypercoagulable screen (factor V Leiden, prothrombin gene mutation, antiphospholipid antibodies)
Explanation
In patients under 55 years presenting with retinal vein occlusion, particularly without significant cardiovascular risk factors, a hypercoagulable workup is indicated. Factor V Leiden, prothrombin G20210B mutation, protein C and S deficiency, antithospholipid antibodies, and hyperhomocysteinemia should be screened. Diabetes and hypertension are risk factors for older patients but less likely to be the sole explanation in a young patient.
Reference: AAO BCSC Section 12: Retina and Vitreous, 2022-2023 ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.