Images in Clinical Medicine from The New England Journal of Medicine — Lipemia Retinalis Associated with Secondary Hyperlipidemia. BACKGROUND: Lipemia retinalis is a rare condition characterized by creamy, white colored vessels. It is directly related to the levels of plasma triglycerides. We report the case of a week-old boy presenting with increased cholesterol and triglyceride levels. Examination revealed lipemia retinalis. Genetic.
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Hyperlipidemia is an identified factor of premature vessel atherosclerosis. Lipemia retinalis is an unusual retinal manifestation of hyperlipidemia and is thought to be directly correlated with the serum triglyceride level.
This paper discusses the case of a year-old patient with lipemia retinalis, which deteriorated his visual acuity. The normalization of serum lipids, reversion of retinal vessels alterations and visual acuity improvement was achieved after an intensive statin lipid-lowering therapy. Hyperlipidemia can cause lipemia retinalis, which is characterized by the hyperlipidemic vascular lesions-whitish color of vessels, lipid infiltration into the retina and decrease of visual acuity.
The lipid-lowering therapy may lead to the normalization of the appearance of the fundus and restore the visual acuity. The consequences of hyperlipidemia are multiorgan and include premature atherosclerosis with all its effects, lesions of the digestive system liver and pancreasskin and sometimes ocular changes [ 1 ].
Lipemia retinalis is a rare retinal manifestation of hypertriglyceridemia [ 2 — 4 ]. It was first described by Heyl in [ 5 ]. Retinal vessels become cream colored due to the scattering of light by the triglyceride-laden chylomicrons. Very high levels of triglycerides are required; hypercholesterolemia alone does not produce this vascular appearance [ 2 ]. In clinical practice, elevated serum triglycerides are most often observed in persons with metabolic syndrome, despite the fact that secondary or genetic factors can heighten triglyceride levels [ 6 ].
We report the case of a year-old patient treated for age-related macular degeneration who had exudative form in the right eye and non-exudative in the left eye for 2 years, and presented a deterioration of vision in his left eye. For this reason, preparations containing antioxidants, vitamins and minerals Zinc were prescribed.
However, it is not certain that he used them systematically. He had also a history of lipid disorder high serum cholesterol and dyslipidemia in anamnesis. The visual acuity in his right eye was counting fingers at 2 m and acuity in his left eye decreased from 0. Retunalis fundus examination revealed lipemia retinalis; the hyperlipidemic vascular lesions had whitish-colored vessels and lipid infiltration into the retina and age-related macular degeneration in both eyes.
The right eye fundus with signs of lipemia retinalis optic disc and nasal part of retina. Characteristic whitish vessels are visible. It is difficult to distinguish the arteries liprmia the veins.
Lipemia Retinalis of Prematurity
The left eye fundus with signs of lipemia retinalis optic disc and a part of macula. Subsequently, considering the lipid disturbances, the patient was referred to the Department of Internal Medicine to perform further diagnosis and treatment.
During hospitalization, the medical diagnosis was made on the basis of medical history, medical examination and diagnostic investigations. The patient suffered from coronary disease, hypertension, hyperlipidemia, hepatic lesion and alcoholic dependence. The right eye fundus after treatment. The retinal vessels abnormalities returned to normal.
Nevertheless, the age-related macular degenerations remained a big scar in the macula. The left eye fundus after treatment. Nevertheless, the age-related macular degenerations remained retinal pigment defects, drusen.
After the treatment, the visual acuity of right eye did not change, but the left eye improved to 0. It was impossible to achieve significant improvement of visual acuity in the right eye because of the severe form of macular degenerations. Primary and secondary hyperlipidemias retinzlis identified factors of premature vessel atherosclerosis. Endothelial damage in atherosclerosis is characterized by abnormal vascular functionality [ 7 — 9 ].
Despite the fact that alterations in the cardio-vascular system, skin changes and digestive symptoms are well known and expected, the ocular retinalid in hyperlipidemia are often forgotten. However, there are reports describing the ocular lesions in hyperlipoproteinemia, such as xanthelasma a deposition of lipid the in eyelidlipid keratopathy corneal arcusretinal artery and vein occlusions, ischemic optic neuropathy, cataract and even dry eye [ lipemixlipemiq11 ].
According to Nagra et al. Typically, the retinal findings do not occur until the triglyceride level reaches mg per deciliter.
The findings can fluctuate widely from day to day, depending on the triglyceride level [ 2 ]. Hypercholesterolemia alone does not produce retinal changes [ 12 ].
Patients with lipemia retinalis in typical cases maintain good vision, and fundus changes resolve when serum lipid levels are reduced [ 213 ]. However, it was shown in a rabbit model of hypercholesterolemia that normalization of serum cholesterol levels was not enough to reverse cholesterol-induced vascular damage to the choroid and retinal vessels.
These vascular changes could be compatible with llpemia chronic ischemia that could produce retinal degeneration [ 714 ]. It is interesting that in the described patient, lipemia retinalis was observed at concentrations of triglycerides below mg per deciliter.
Lipemia Retinalis of Prematurity | JAMA Ophthalmology | JAMA Network
We believe that rwtinalis the presented case an extremely high serum cholesterol level and dyslipidemia could contribute to the vascular changes.
In the case of our patient, hyperlipidemia was secondary to a lipid-rich diet, excessive use of alcohol and lack of physical activity. It should be stressed that a lipid disorder resulting in lipemia retinalis causes a risk of life-threatening atherosclerotic disease [ 48lipenia ] and other severe complications like acute pancreatitis [ 15 ]. Moreover, characteristic retinal findings may be the only sign of lipid disturbances which are often asymptomatic.
Lipemia retinalis in a day-old infant with hyperlipoproteinemia: case report
In such patients a multidisciplinary approach is necessary to obtain the desirable systemic outcome [ 415 ]. After 2 months of lipid-lowering therapy, the serum cholesterol and triglyceride levels returned to normal. Such intensity of age-related macular degeneration at a relatively young age could be caused by irreversible, microscopic damage to choroid and retina.
Lipid-lowering treatment of lipemia retinalis with statin and improvement in vision rwtinalis not been reported thus far in the medical literature.
The authors have no financial or other relationships that might lead to a conflict of interest. National Center for ,ipemia InformationU. Journal List Med Sci Monit v. Published online Aug 1. Author information Article notes Copyright and License information Disclaimer.
Received Jun 4; Accepted Nov This article has been cited by other articles in PMC. Summary Background Hyperlipidemia is an identified factor of premature vessel atherosclerosis. Case Report This paper discusses the case of a year-old patient with lipemia retinalis, which deteriorated his visual acuity.
Conclusions Hyperlipidemia can cause lipemia retinalis, which is characterized by the hyperlipidemic vascular lesions-whitish color of vessels, lipid infiltration into the retina and decrease of visual acuity.
Case Report We report the case of a year-old patient treated for age-related macular degeneration who had exudative form in the right eye and non-exudative in the left eye for 2 years, and presented a deterioration of vision in his left eye. Open in a separate window. Discussion Primary and secondary hyperlipidemias are identified factors of premature vessel atherosclerosis.
Lipid-lowering therapy may lead to the normalization of the fundus appearance and tetinalis of visual acuity. Footnotes Disclosure The authors have no financial or other relationships that might lead to a conflict of interest. Chylomicronemia and the chylomicronemia syndrome: Lipemia retinalis associated with branch retinal vein occlusion. Images in clinical medicine.
Lipemia retinalis associated with secondary hyperlipidemia. Liepmia Engl J Med. A combination of genetics and the American diet and lifestyle. Trans Am Ophthalmol Soc. Alterations in the choroids in hypercholesterolemic rabbits: Cerebral atherosclerosis causes neurodegenerative diseases.
Preventing visual loss from chronic eye disease in primary care: Kumar J, Wierzbicki AS. Lipemia retinalis N Engl J Med. Ocular manifestations of hyperlipoproteinemia. Reversal of lipemia retinalis with dietary control. Macroglial and retinal changes in hypercholesterolemic rabbits after normalization of cholesterol levels. Horton M, Thompson K. Lipemia retinalis preceding acute pancreatitis.
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