Title: Atypical central retinal vein occlusion in a young healthy adult
Abstract:
Case presentation: A young male presented with a two-month history of blurred vision in his right eye. Assessment demonstrated Visual Acuity (VA) of 6/9, markedly reduced colour vision (1/17 Ishihara plates), and a positive relative afferent pupillary defect. Fundus examination revealed optic disc swelling, extensive retinal haemorrhages in all four quadrants, and vascular sheathing. OCT confirmed Cystoid Macular Oedema (CMO) with subretinal fluid. Fundus fluorescein angiography demonstrated retinal vasculitis with active leakage.
VA deteriorated to 6/60 within one week. Intravitreal aflibercept (2 mg) resulted in anatomical and functional improvement to 6/6, though recurrence of CMO at approximately seven weeks indicated ongoing retinal vascular inflammation. Intravitreal corticosteroids were discussed but declined given the risks in a young patient—including cataract formation, loss of accommodation. Systemic immunosuppression was also declined. Investigations including inflammatory markers, infective serology, thrombophilia screen, uveitis screen, fungal markers including beta-D-glucan, and MRI brain were unremarkable. His occupation as a palaeontology student undertaking excavation at an undisclosed location represents potential exposure to soil-associated pathogens beyond standard screening.
Conclusion: CRVO in young adults may represent a distinct presentation driven by inflammatory mechanisms. FFA may guide treatment endpoint by monitoring vasculitis and leakage activity. A personalised, shared decision-making approach is essential when diagnostic and therapeutic uncertainty persists.
