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Letter to the Editor
Protein C and protein S deficiency associated with retinal, optic nerve, and cerebral ischaemia
  1. JAYAKRISHNA AMBATI,
  2. OMAR E HANUCH,
  3. GEORGE H BRESNICK
  1. Department of Ophthalmology, University of Rochester School of Medicine and Dentistry, Rochester, USA
  1. Dr J Ambati, Retina Service, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA.

https://doi.org/10.1136/bjo.83.6.753b

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    Editor,—Deficiencies in the vitamin K dependent factors protein C and protein S can lead to arterial or venous thrombosis. Branch and central retinal arterial and venous occlusions1-4 have been associated with deficiencies in these plasma proteins, as have amaurosis fugax5 and stroke.6 We report, to the best of our knowledge, the first case of ischaemic optic neuropathy associated with combined protein C and protein S deficiency.

    CASE REPORT

    A 47 year old woman with non-insulin dependent diabetes mellitus with documented absence of previous retinopathy presented with blurring of vision and bright flashing lights in her right eye for 2 weeks, associated with vague periocular discomfort and left sided facial and leg numbness. Best corrected visual acuity was 20/30 right eye and 20/25 left eye. The anterior segment examination was unremarkable and the intraocular pressures were 15 mm Hg right eye and 14 mm Hg left eye. A large …

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