Ophthalmology Department of Hospital universitario SAS Jerez de la Frontera, Jerez de la Frontera, Spain.
Western University Collage of Dental Medicine, Pamona, California, USA.
J Med Case Rep. 2021 May 29;15(1):307. doi: 10.1186/s13256-021-02865-8.
We report our findings in a patient who developed central retinal vein occlusion (CRVO) and was a chronic user of olanzapine, an antipsychotic medication.
A 50-year-old Caucasian man, non-smoker, was referred to our clinic with the chief complaint of floater appearance in his left eye for the past 3 days. His past medical history indicated that he had been taking antipsychotic drugs (olanzapine) for about 3 years, with no other systemic disease or risk factors for CRVO. In the examination, his best-corrected visual acuity (BCVA) was 0.7 in the left eye. The fundus showed signs of nonischemic CRVO with subhyaloid hemorrhage and intraretinal hemorrhage in the posterior pole and superior and inferior retina, without macular edema, confirmed by optical coherence tomography (OCT). We ruled out other probable differential diagnoses and risk factors which lead to CRVO through a complete physical exam and blood analysis (complete blood count, glucose, urea, creatinine, lipid profile, erythrocyte sedimentation rate, C-reactive protein, prothrombin time, partial thromboplastin time, Bleeding time (BT), fibrinogen level, proteins, antiphospholipid antibodies, homocysteine blood level, antithrombin III, protein C and S, factor V Leiden, prothrombin mutation, angiotensin-converting enzyme level, other autoantibodies, and human leukocyte antigen [HLA]-B51). Finally, we confirmed the probable side effect of olanzapine in CRVO, which has not been previously reported. A possible pro-thrombogenic mechanism of olanzapine at the molecular level is an affinity for 5-HTserotonin receptors. Blocking these receptors results in increased platelet aggregation and increased blood coagulability.
These results indicate that CRVO can be a complication of chronic use of antipsychotic medications such as olanzapine, as shown for the first time in our case report. Clinicians should question patients who develop a sudden CRVO whether they are using antipsychotic medications such as olanzapine.
我们报告了一位慢性使用奥氮平（一种抗精神病药物）的患者发生视网膜中央静脉阻塞（CRVO）的病例。
一位 50 岁的白人男性，不吸烟，因左眼出现漂浮物 3 天就诊，主要诉述为左眼出现漂浮物。他的既往病史表明，他大约 3 年前开始服用抗精神病药物（奥氮平），没有其他系统性疾病或导致 CRVO 的危险因素。检查时，他的左眼最佳矫正视力（BCVA）为 0.7。眼底检查显示非缺血性 CRVO 伴有玻璃体内下方视网膜出血和后极部视网膜内出血，未见黄斑水肿，这一结果通过光学相干断层扫描（OCT）得到了证实。我们通过全面的体格检查和血液分析（全血细胞计数、血糖、尿素、肌酐、血脂谱、红细胞沉降率、C 反应蛋白、凝血酶原时间、部分凝血活酶时间、出血时间（BT）、纤维蛋白原水平、蛋白、抗磷脂抗体、同型半胱氨酸血水平、抗凝血酶 III、蛋白 C 和 S、因子 V Leiden、凝血酶原突变、血管紧张素转换酶水平、其他自身抗体和人类白细胞抗原 [HLA]-B51）排除了其他可能的鉴别诊断和导致 CRVO 的危险因素。最后，我们证实了奥氮平导致 CRVO 的可能的副作用，这在以前的报告中尚未报道过。奥氮平在分子水平上可能具有促血栓形成的机制，即与 5-HT 血清素受体的亲和力。阻断这些受体可导致血小板聚集增加和血液凝固性增加。
这些结果表明，CRVO 可能是慢性使用奥氮平等抗精神病药物的并发症，我们的病例报告首次证明了这一点。临床医生应询问发生突发性 CRVO 的患者是否正在使用奥氮平等抗精神病药物。
