Rare case of Bilateral Central Retinal Artery Occlusion (CRAO) in a 3 year old Child with Nephrotic Syndrome with Good Outcome

Anand Vinekar¹
A.T.K Rao²
Vasudha Naresh¹
Rachna Kumar¹
Alia Gul¹
Ravindra Battu¹

¹Narayana Nethralaya Postgraduate Institute of Ophthalmology, Bangalore, India
²M.S Ramaiah Medical College & Hospital, Bangalore, India

AIM: To report a rare case of bilateral CRAO in a child with nephrotic syndrome treated with low molecular weight heparin (LMWH) who showed visual and ophthalmoscopic improvement over 6 weeks.

CASE: A 3 year old female child on treatment for nephrotic syndrome since the age of 18 months, presented with sudden, acute, bilateral painless loss of vision associated with an acute exacerbation of the systemic disease. She had a visual acuity of perception of light in both eyes for 4 days prior to presenting to us. Fundus examination revealed bilateral central pallid retina with cherry red spots at the macula, with a partial area of sparing in the cilio-retinal distribution, corroborated on fluorescein angiogram and SD-OCT. She was managed for her nephrotic disease with steroids. Additionally LMWH was given for 5 days and switched over to Aspirin thereafter for 6 weeks. Visual acuity measured using Teller Acuity was 20/360, 20/190 to 20/40 (both eyes) at 1, 3 and 6 weeks on treatment. The retinal appearance also showed resolution of the edema and pallor.

CONCLUSIONS: To the best of our knowledge, this is the first report of resolution of central retinal artery occlusion in an infant with nephrotic syndrome presumably due to LMWH.