Visual function recovery after central retinal artery occlusion in a patient with primary diagnosed granulomatosis with polyangiitis

On September, 2019 a 46 year old male complains of lasting febrile fever approximately 2 weeks, frequent diarrhoea, nose bleeding, weight loss, runny nose from June and nose deformity that appeared recent. After numerous examinations diagnosis is made: granulomatosis with polyangiitis a.k.a. Wegener Granulomatosis, acute renal insufficiency, nephritic syndrome, high AntiPR3 antibodies. Solumedrol pulse therapy was started with 500mg i/v for three days, followed by p/o prednisolone 60mg and cyclophosphamide 800mg per day and 5 plasmapheresis therapies. After five days patient complains about painless vision loss in his left eye. Visual acuity (VA) right eye = 0.6, OS = hand movements, TOU=18mmHg. Left eye had dilated non-reactiv pupil and fundoscopy revealed central retinal artery occlusion (CRAO). Therapy prescribed: acetazolamide 250mg for 13 days. Eyeball massage was performed. Due to acute ophthalmic complication additionally s/c heparin 5000 IU four times per day for six days in total was prescribed. After two days from initiated heparin therapy patient notice mild eyesight improvement. After 6 days his vision has renewed. Two weeks after the onset BCVA OS = 1.0, optic disc with visible margins, pinky, slight paleness in temporal quadrant, narrowed retinal vessels. Also digital perimetry shows mild peripheral visual field defect that is almost completely diminished 2 months after event. Although cases like this are rare we should always consider systemic vasculitis if we dectect ocular manifestation like CRAO especially among younger patients. Early detected vasculitis caused central retinal artery occlusion with previous prednisolone pulse therapy, cyclophosphamide, plasmapheresis, eye massage and early subcutaneous heparin administration after CRAO occurrence for a patient with Granulomatosis with Polyangiitis and severe end-organ damage can lead to excellent outcome in visual acuity although most of cases like this end’s up with poor visual outcome due to late patient referral to the ophthalmologist.