Combined central retinal vein occlusion and cilioretinal artery occlusion in an MTHFR C677T homozygous 26-year-old patient with hyperhomocysteinemia: Case report

A 26-year-old female patient presented with sudden, painless visual disturbances in her right eye (RE). Fundus examination revealed signs of a central retinal vein occlusion (CRVO) (hemorrhages, mild venous tortuosity, mild disc swelling, and blurred disc margins), as well as a white ischemic area nasal to the optic nerve, suggesting a possible cilioretinal artery occlusion (CLRAO). A diagnosis of combined CRVO and nasal CLRAO with homozygosity for the C677T mutation in the methylenetetrahydrofolate reductase (MTHFR) gene and elevated levels of serum homocysteine was made. The patient was prescribed folic and acetylsalicylic acid and subsequent follow-up demonstrated gradual improvement.