Presumed non-ischemic central retinal vein occlusion in a young woman using combined oral contraceptives with sustained recovery after a single aflibercept injection: a case report

Central retinal vein occlusion (CRVO) typically affects older adults with systemic vascular risk factors and is uncommon in young individuals. In younger patients, evaluation for systemic, inflammatory, autoimmune, and thrombophilic conditions is warranted. Hormonal contraceptive exposure may be a contributing factor, although causality is difficult to establish. A 22-year-old non-smoking woman presented with a one-week history of blurred and foggy vision in the right eye. She had no known systemic vascular risk factors but had used COCs for 16 weeks, which she discontinued two weeks before presentation. Fundus examination showed optic-disc edema, dilated and tortuous retinal veins, with widespread retinal hemorrhages consistent with CRVO. The clinical findings were most consistent with presumed non-ischemic CRVO; however, fluorescein angiography was not performed. At presentation, best-corrected visual acuity (BCVA) was 0.9 (approximately 20/22 Snellen; logMAR 0.05), and optical coherence tomography (OCT) showed a central macular thickness (CMT) of 296 μm with preserved foveal architecture. After 18 days of observation, visual acuity decreased to 0.2 (20/100 Snellen; logMAR 0.70), and severe center-involving macular edema developed, with CMT of 1062 μm. A single intravitreal injection of aflibercept (2 mg/0.05 mL) was administered. One week later, visual acuity improved to 0.5 (20/40 Snellen; logMAR 0.30), and central macular thickness decreased to 332 μm. By three weeks, visual acuity had recovered to 1.0 (20/20 Snellen; logMAR 0.00), with complete resolution of macular edema. Visual and anatomical recovery was documented at the seven-week and one-year follow-up examinations, without additional aflibercept injections. This case illustrates that severe macular edema may develop rapidly despite initially preserved visual acuity and foveal architecture in a young woman with CRVO. Recent combined oral contraceptive exposure was considered a possible contributing factor, although a causal relationship could not be established. A single aflibercept injection was followed by visual and anatomical recovery, with favorable findings at the seven-week and one-year examinations without additional treatment.