Front Med (Lausanne). 2026 Sep 15;13:1926148. doi: 10.3389/fmed.2026.1926148. eCollection 2026.
ABSTRACT
BACKGROUND: Ischemic central retinal vein occlusion (ischemic CRVO) is a severe, vision-threatening vascular event. While most cases stem from conventional cardiovascular or local anatomical etiologies, its presentation in association with relapsed mantle cell lymphoma (MCL) and suspected cancer-associated hypercoagulability is rare. This report highlights that retinal vascular occlusion in a patient with relapsed MCL represents a rare ocular manifestation of severe systemic prothrombotic activity.
CASE PRESENTATION: An 89-year-old male with established stage IV MCL (CD20+, cyclin D1+, SOX-11+, Ki-67∼10%), whose systemic relapse had been documented 6 months prior, developed sudden, painless vision loss in his right eye (best-corrected visual acuity, BCVA 0.01) while hospitalized for disease management. Multimodal ophthalmic examination and optical coherence tomography (OCT) supported the diagnosis of ischemic CRVO with prominent macular edema. Laboratory workup revealed marked coagulation abnormalities (D-dimer 4.34 mg/L FEU, Fibrinogen Equivalent Units; antithrombin activity 78%). Cranial MRI (magnetic resonance imaging) revealed multifocal chronic/non-acute ischemic cerebral changes and periventricular leukoaraiosis without acute diffusion restriction. Following a localized peribulbar injection of triamcinolone acetonide (20 mg), right eye BCVA improved to 0.1, with anatomical reduction of retinal edema. Prophylactic panretinal photocoagulation (PRP) was unfeasible due to posterior capsular opacification and severe systemic frailty. Four months later, the patient developed neovascular glaucoma requiring cyclocryotherapy for palliative pain management.
CONCLUSIONS: In patients with active relapsed MCL, ischemic CRVO may occur as a focal manifestation of a generalized prothrombotic state. When severe retinal vascular occlusion presents in patients with advanced hematological malignancies, systemic coagulation assessment and neuroimaging evaluation should be considered to identify underlying prothrombotic risks and subclinical cerebrovascular disease, even in the absence of overt focal neurological deficits.
PMID:42812221 | PMC:PMC13619490 | DOI:10.3389/fmed.2026.1926148