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Title

Retinal vascular accident in first trimester of pregnancy

Purpose	To highlight the need for systemic evaluation in patients with branch retinal artery occlusion (BRAO).
Methods	We examined a 31-year-old, 8 weeks pregnant woman who presented at our department of Ophthalmology of the University Hospitals Leuven with complaints of a whitish spot in front of her left eye for 1 day. A thorough routine ophthalmic examination was performed and completed with autofluorescence and infrared imaging, OCT-cirrus, OCT-angiography and fluorescein angiography as well as elaborated neurologic and cardiovascular review.
Results	A fundoscopic exam revealed a whitish elevated zone involving the superonasal macula with a congruent hyper-reflective zone in the inner retinal layers on optical coherence tomography. Fluorescein angiography showed a branch retinal artery occlusion and OCT-angiography showed disruption of the deep capillary plexus consistent with the diagnosis of BRAO associated with paracentral acute middle maculopathy. The patient was admitted to the stroke unit and a series of tests were performed. Thrombophilia screening showed an initial low protein C, but a second sample could not confirm the deficiency. Carotid duplex showed no stenosis and a duplex sonography of the lower extremities showed no evidence for thrombosis, but a transesophageal echocardiogram showed a small patent foramen ovale with a spontaneous right-left shunt. Both acetylsalicylic acid 80mg/day and dalteparin sodium 5000IU/day were started and a closure of the PFO will be performed after completion of the pregnancy.
Conclusion	It is important to perform profound neurologic and cardiovascular examination in patients with BRAO. Underlying causes should be identified and accordingly treated to prevent other ischemic events.
Conflict of interest	No

Authors 1

Last name	STOCKMAN
Initials	AC
Department	UZ LEUVEN
City	LEUVEN

Authors 2

Last name	JACOB
Initials	J
Department	UZ LEUVEN
City	LEUVEN

Authors 3

Last name	LEYS
Initials	A
Department	UZ LEUVEN
City	LEUVEN