Supplementary Material for: Young-Onset Central Retinal Vein Occlusion with Antiphospholipid Syndrome and Hypophysitis

Purpose:
To describe a rare case of central retinal vein occlusion (CRVO) in an adolescent with primary antiphospholipid syndrome (APS) and coexisting lymphocytic hypophysitis (LH).

Methods:
Retrospective, observational case report.

Observations:
A 17-year-old female presented with acute vision loss in the right eye and was diagnosed with CRVO. She had no cardiovascular risk factors. Fundoscopy revealed optic disc swelling, macular exudates, and venous dilation. Fluorescein angiography demonstrated optic disc leakage without any signs of vasculitis. IgG anticardiolipin antibodies were persistently elevated on two separate occasions, thereby fulfilling the 2023 ACR/EULAR criteria for APS. Magnetic resonance imaging revealed pituitary stalk thickening and asymmetrical intrasellar enhancement, consistent with LH, although visual field loss and optic nerve abnormalities were not detected. A single intravitreal injection of ranibizumab was effective, resulting in complete resolution of serous retinal detachment and improvement in visual acuity. Anticoagulants were also administered. At 12-month follow-up, no progression of LH was observed.

Conclusions and Importance:
Coagulation should be thoroughly evaluated in cases of early-onset CRVO without systemic risk factors. This case highlights the importance of considering APS in young patients with CRVO without systemic risk factors. There is a shared immunologic predisposition when coexisting autoimmune disorders such as LH.