Bilateral vitreous hemorrhage with branch retinal vein occlusion secondary to hyperhomocysteinemia: A rare case report

Retinal vascular occlusions are uncommon in young people and require more in-depth investigation into the cause. A high level of circulating homocysteine carries a risk for retinal vaso-occlusive events. We, hereby, report a rare case of hyperhomocysteinemia-related bilateral branch retinal vein occlusion (BRVO). A 27-year-old male presented with sudden painless gross diminution of vision in the left eye (LE) for 10 days. Further assessment revealed inferotemporal BRVO (ITBRVO) in the right eye (RE) with mild vitreous hemorrhage (VH) and dense VH in the LE. Extensive investigations into the cause revealed an elevated level of serum homocysteine. The patient was started on Vitamin B6 and B12 supplementation. RE sectoral panretinal photocoagulation and LE pars plana vitrectomy were done. LE ITBRVO was noted intraoperatively for which endolaser was done. Hyperhomocysteinemia through its prothrombotic properties is an independent modifiable risk factor for vascular thrombotic events. Hence, it should be considered as a differential diagnosis for retinal vascular occlusions to prevent further recurrences and cerebrovascular events, especially in young adults.