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Title

Bilateral vitreous hemorrhage in a neonate with galactosemia: a rare complication with severe implications

Purpose	To describe ocular manifestations in a patient with galactosemia. Cataract is the main ocular complication of the disease, occurring in 30% of patients, and may resolve spontaneously upon dietary treatment. Anecdotal reports have mentioned vitreous hemorrhage (VH) as a complication in some patients.
Methods	case report
Results	We describe a male neonate who presented with acute liver failure at day 10, characterized by failure to thrive, jaundice, coagulopathy and encephalopathy. Blood spot testing showed absence of GALT activity, confirming the diagnosis of galactosemia. At 20 days of age, a bilateral cataract and floaters in the vitreous were noted. The cataract resolved under a galactose-free diet, but at 2.5 months of age VH were seen in both eyes. Vitrectomy and peripheral laser photocoagulation was performed in the left eye, and a month later in the right eye, with phacophagia of the left eye. Peroperative fundoscopy showed ischemia of the peripheral retina with telangiectatic vessels and crystalline depositions. There was no recurrence of the VH during postoperative follow-up. A review of the literature confirmed – although seemingly rare – VH to be a complication of galactosemia. VH may be due to the coagulopathy and brittle vessels, noted during vitrectomy. In this patient we also noticed retinal ischemia, capillary occlusions and depositions, which may cause new vessel growth and consecutively VH. If left untreated, VH in children may lead to amblyopia and visual impairment.
Conclusion	This case emphasizes the need to be aware of VH in all galactosemia patients and for ophthalmological follow up.
Conflict of interest	No
Details of conflicting interests	author 1 and 2 contributed equally to this work

Authors 1

Last name	VAN NUFFEL
Initials	S
Department	UZGent
City	Gent

Authors 2

Last name	De Vilder
Initials	EYG
Department	UZ Gent
City	Gent

Authors 3

Last name	Verloo
Initials	P
Department	UZ Gent
City	Gent

Authors 4

Last name	Nerinckx
Initials	F
Department	UZ Gent
City	Gent

Authors 5

Last name	Delbeke
Initials	P
Department	AZ Sint-Jan
City	Brugge