Primary Antiphospholipid Syndrome: A Hidden Predisposing Factor for Retinal Vein Occlusion and Choroidal Neovascular Membrane Formation Among Young Population

Background & Objectives: Antiphospholipid syndrome can lead to variable systemic and ophthalmic manifestations. The study aims to establish the relationship between retinal vein occlusion (RVO) or choroidal neovascular membrane (CNVM) with Antiphospholipid Syndrome (APS). Methods: A multicentric prospective cross-sectional study was carried out in three major eye centers in Bahrain that included The Eye Infirmary, Bahrain Royal Hospital, and King Hamad University Hospital. All young patients aging from 35 to 50 years, presenting with either RVO or CNVM and not known to have any underlying systemic disease were included in the study. Antiphospholipid confirmatory tests and coagulation profiles were done for all patients. Results: Total number of fourteen eyes of ten patients were enrolled in the study. Six patients had RVO, three out of them had central retinal vein occlusion (CRVO) and three had branch retinal vein occlusion (BRVO). Four patients had bilateral CNVM (total of 8 eyes). All patients recorded high activated partial thromboplastin time (aPTT) readings, six out of ten patients were labeled as primary APS, four of them had positive anti-cardiolipin antibodies and the other two patients were positive for plasma lupus anticoagulant. Conclusion: APS should be considered as an etiological factor in all cases of retinal vein occlusion and choroidal neovascular membrane affecting young otherwise healthy individuals. In this study, 60% of patients who fit the inclusion criteria were labeled as primary APS patients. Timely investigations and treatment in these cases can prevent major catastrophic thrombotic events which may involve any system or organ in the body. Keywords: Antiphospholipid syndrome, Blood coagulation tests, Eye, Lupus coagulation inhibitor, Retinal vein occlusion