Recurrent combined branch retinal vein and branch retinal artery occlusion associated with PAMM as the first manifestation of lung adenocarcinoma: a case report

PURPOSE: To report a case of recurrent bilateral combined branch retinal vein occlusion (BRVO) and branch retinal artery occlusion (BRAO) with paracentral acute middle maculopathy (PAMM) as the first manifestation of lung adenocarcinoma. CASE REPORT: A 54-year-old male with a history of inferonasal BRVO in the left eye (LE), was referred to our department for blurred vision in the LE. On examination, best-corrected visual acuity was 20/20 in the right eye (RE) and 20/25 in the LE. Fundus examination showed tortuosity and dilatation of the inferotemporal branch vein, cotton-wool spots, retinal hemorrhages, and areas of retinal whitening in both eyes corresponding to a BRVO associated with BRAO and PAMM. A few months later, the patient complained of blurred vision in the RE. Examination revealed a superior temporal BRVO and BRAO. An exhaustive work-up was performed. Results showed a high level of antiphospholipid antibodies. Chest scan showed the presence of a pulmonary mass related to lung adenocarcinoma. The patient underwent a surgical removal of the lung tumoral mass and chemotherapy. The level of antiphospholipid antibodies was back to normal and no recurrence of ocular symptoms was noted after a follow-up of one year. CONCLUSION: The association between retinal vascular occlusions and systemic carcinomas is rare. Malignant tumors may induce a hypercoagulation state and an increased risk of thromboembolic complications including branch retinal vascular occlusions.