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Oral contraceptive pills: A risk factor for retinal vascular occlusion in in-vitro fertilization patients.

Aggarwal RS, Mishra VV, Aggarwal SV - J Hum Reprod Sci (2013)

Bottom Line: We describe the development of central retinal venous occlusion with associated cystoid macular edema (CME) in two healthy infertile women who were recruited for in vitro fertilization cycle for infertility.Hence, even if no systemic diseases are detected.Physical examinations are recommended periodically for young women on oral contraceptive pills.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Institute of Kidney Diseases and Transplantation Sciences, Ahmedabad, Gujarat, India.

ABSTRACT
Retinal vascular occlusion is the most common cause of retinopathy leading to severe visual loss in all age groups. Central retinal vein occlusion (CRVO) is usually seen in older age group and is often associated with systemic vascular diseases. Although the exact cause and effect relationship has not been proven, central retinal vein occlusion has been associated with various systemic pathological conditions, hence a direct review of systems toward the various systemic and local factors predisposing the central retinal vein occlusion is advocated. We describe the development of central retinal venous occlusion with associated cystoid macular edema (CME) in two healthy infertile women who were recruited for in vitro fertilization cycle for infertility. Predisposing risk factors associated with central retinal vein occlusion are obesity, sedentary life style, smoking, and some systemic diseases such as hyperlipidemia, hypertension, associated autoimmune disorders e.g., antiphospholipid antibody syndrome, lupus, diabetes mellitus, cardiovascular disorders, bleeding or clotting disorders, vasculitis, closed-head trauma, alcohol consumption, primary open-angle glaucoma or angle-closure glaucoma. In our patients, they were ruled out afterdoing allpertaining investigations. The cases were managed with further avoidance of oral contraceptives and intra-vitreal injections of Bevacizumab (Avastin), an anti-vascular endothelial growth factor (anti-VEGF drug) and Triamcinolone acetonide (a long acting synthetic steroid). Hence, even if no systemic diseases are detected. Physical examinations are recommended periodically for young women on oral contraceptive pills.

No MeSH data available.


Related in: MedlinePlus

Fundus photograph showing right eye having upper temporal branch retinal vein occlusion with optical coherence tomography showing macular edema
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Figure 2: Fundus photograph showing right eye having upper temporal branch retinal vein occlusion with optical coherence tomography showing macular edema

Mentions: A female patient aged 38 years who was a case of primary infertility was recruited for her fourth consecutive IVF cycle. She was started on monophasic OCP on Day 2 of her periods. Tubal factor was the cause of infertility. Her three consecutive cycles of IVF had failed earlier prior to initiation of this fourth IVF cycle. At that time also, she was given monophasic OCP for down regulation of ovaries as well as to make the ovaries silent after the failure of cycle. After a few months of treatment, she complained of painless diminution of vision in right eye, which was not associated with any other complaint. On examination, her best corrected visual acuity was found to be 6/12 partial in right eye and 6/6 in left eye. The anterior segment findings were within normal limits. On fundus examination, the upper temporal vein was found to be dilated and congested, with cotton wool spots and dot and blot hemorrhages along the upper temporal branch of retinal vein. Associated macular edema was confirmed on optical coherence tomogram [Figure 2]. All the systemic and local causes investigated were within normal limits. It was diagnosed to be secondary to OCP. Patient was given an intra-vitreal injection of triamcinolone acetonide a steroid compound. The edema and hemorrhages resolved within 3 months and the visual acuity improved to 6/6 after 3 months.


Oral contraceptive pills: A risk factor for retinal vascular occlusion in in-vitro fertilization patients.

Aggarwal RS, Mishra VV, Aggarwal SV - J Hum Reprod Sci (2013)

Fundus photograph showing right eye having upper temporal branch retinal vein occlusion with optical coherence tomography showing macular edema
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3713585&req=5

Figure 2: Fundus photograph showing right eye having upper temporal branch retinal vein occlusion with optical coherence tomography showing macular edema
Mentions: A female patient aged 38 years who was a case of primary infertility was recruited for her fourth consecutive IVF cycle. She was started on monophasic OCP on Day 2 of her periods. Tubal factor was the cause of infertility. Her three consecutive cycles of IVF had failed earlier prior to initiation of this fourth IVF cycle. At that time also, she was given monophasic OCP for down regulation of ovaries as well as to make the ovaries silent after the failure of cycle. After a few months of treatment, she complained of painless diminution of vision in right eye, which was not associated with any other complaint. On examination, her best corrected visual acuity was found to be 6/12 partial in right eye and 6/6 in left eye. The anterior segment findings were within normal limits. On fundus examination, the upper temporal vein was found to be dilated and congested, with cotton wool spots and dot and blot hemorrhages along the upper temporal branch of retinal vein. Associated macular edema was confirmed on optical coherence tomogram [Figure 2]. All the systemic and local causes investigated were within normal limits. It was diagnosed to be secondary to OCP. Patient was given an intra-vitreal injection of triamcinolone acetonide a steroid compound. The edema and hemorrhages resolved within 3 months and the visual acuity improved to 6/6 after 3 months.

Bottom Line: We describe the development of central retinal venous occlusion with associated cystoid macular edema (CME) in two healthy infertile women who were recruited for in vitro fertilization cycle for infertility.Hence, even if no systemic diseases are detected.Physical examinations are recommended periodically for young women on oral contraceptive pills.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Institute of Kidney Diseases and Transplantation Sciences, Ahmedabad, Gujarat, India.

ABSTRACT
Retinal vascular occlusion is the most common cause of retinopathy leading to severe visual loss in all age groups. Central retinal vein occlusion (CRVO) is usually seen in older age group and is often associated with systemic vascular diseases. Although the exact cause and effect relationship has not been proven, central retinal vein occlusion has been associated with various systemic pathological conditions, hence a direct review of systems toward the various systemic and local factors predisposing the central retinal vein occlusion is advocated. We describe the development of central retinal venous occlusion with associated cystoid macular edema (CME) in two healthy infertile women who were recruited for in vitro fertilization cycle for infertility. Predisposing risk factors associated with central retinal vein occlusion are obesity, sedentary life style, smoking, and some systemic diseases such as hyperlipidemia, hypertension, associated autoimmune disorders e.g., antiphospholipid antibody syndrome, lupus, diabetes mellitus, cardiovascular disorders, bleeding or clotting disorders, vasculitis, closed-head trauma, alcohol consumption, primary open-angle glaucoma or angle-closure glaucoma. In our patients, they were ruled out afterdoing allpertaining investigations. The cases were managed with further avoidance of oral contraceptives and intra-vitreal injections of Bevacizumab (Avastin), an anti-vascular endothelial growth factor (anti-VEGF drug) and Triamcinolone acetonide (a long acting synthetic steroid). Hence, even if no systemic diseases are detected. Physical examinations are recommended periodically for young women on oral contraceptive pills.

No MeSH data available.


Related in: MedlinePlus