Vitamin A retinopathy secondary to Billroth II anastomosis triggered after the beginning of dialysis

Purpose: To report a case of vitamin A retinopathy secondary to Billroth II anastomosis triggered after the beginning of dialysis in a patient with a chronic renal failure. Case report: A 73-year-old male complained of nyctalopia that had started 9 months ago, coinciding with the beginning of dialysis. His medical history is remarkable for hepatic cirrhosis and Billroth II anastomosis 20 years ago. Best-corrected visual acuity (BCVA) was 60 letters in both eyes. Dilated fundus examination showed faint white-yellowish dots. Optical coherence tomography (OCT) illustrated hyperreflective dots and small hyporreflective cavities between the retinal pigment epithelium (RPE) and the ellipsoid zone (EZ). En face OCT showed multiple hyperreflective dots that coincide with white-yellowish dots of the fundus, and multiple hyporreflective defects which correspond to hyporreflective cavities seen in the OCT. Visual field examination showed concentric narrowing of the visual field. A diagnosis of vitamin A deficiency was confirmed and oral vitamin A supplementation was initiated. One month after treatment, the patient reported a subjective improvement of nyctalopia, and BCVA ameliorated up to 80 and 85 letters. Fundus examination, OCT, and en face OCT showed a diminution of the observed lesions. Moreover, visual field improved. Conclusion: Early diagnosis of vitamin A deficiency can prevent irreversible visual sequelae. This highlights the crucial role of ophthalmologists in the prompt detection of this condition. A lifelong monitoring should be needed in patients undergoing biliopancreatic diversion surgery. Furthermore, OCT and en face OCT becomes a main tool in the diagnosis and monitor response to treatment.