Publications

Introduction: Hyperhomocysteinemia (hHcy) is observed in approximately 5% of the general population. hHcy can be associated with increased risk of ocular vascular and neuro-ophthalmology disorders in par with that of cardiovascular and central nervous system diseases. Purpose: To evaluate the ocular manifestations of hHcy and their therapeutic response to treatment. Materials and Methodology: It is an interventional study done between June 2012 and February 2015. This study includes the (1) patients with hHcy referred from other departments for ophthalmic evaluation, (2) the patients who presented in the ophthalmology department with various vascular and neuro-ophthalmology findings associated with hHcy. All the patients with hHcy with ocular manifestations were started on vitamin B6 20 mg, B12 500 µg, folic acid 5 mg and glycine 500 mg along with other supportive treatment. Their serum homocysteine levels were repeated after 6 months. Results: Out of 59 cases of hHcy 25 patients (42.3%) showed ocular findings such as branch retinal vein occlusion, papilledema, visual field defects, non-arteritic anterior ischemic optic neuropathy and optic disc pallor. Among the patients with ocular manifestations 32% (8 cases) of patients had intermediate, 60% (15 cases) had moderate and 2 patients (8%) had severe hHcy. Treatment of these cases with vitamin supplementation showed a decrease in fasting serum homocysteine levels by 10 ± 4 µmol/L (range 6-15 µmol/L) after 6 months and resolution of the clinical findings in vaso occlusive disorders and papilledema. Out of the 7 neuro ophthalmology patients 2 patients showed worsening of the neurological defects. Conclusion: hHcy treated with vitamin B12 and folic acid shows a decrease in the risk of hHcy complications. All detected cases of hHcy should undergo an ophthalmic evaluation at the earliest. Key words: Branch retinal vein occlusion, Hyperhomocysteinemia, Non-arteritic anterior ischemic optic neuropathy, Optic disk pallor, Papilledema, Visual field defects