Oral contraceptive pills: A risk factor for retinal vascular occlusion in in-vitro fertilization patients
A 31-year-old female having primary infertility was recruited for in vitro fertilization-intracytoplasmic sperm injection cycle (IVF-ICSI). The cause for infertility was male factor. She was given oral contraceptive pills for persistent functional ovarian cyst of 3.5 cm × 3.5 cm which persisted for two menstrual cycles prior to starting her IVF cycle. After few weeks of treatment, she started complaining of painless blurring of vision in right eye associated with metamorphopsia without redness, discharge, or colored halos. On examination, her visual acuity in left eye was found to be 6/6 without glasses but in right eye it was 6/18 with correction and was not improving with pinhole. All the anterior segment findings were found to be within normal limits in both eyes. On fundus examination, left eye was found to be within normal limits, but right eye showed dilated tortuous central vein with multiple dots and blot hemorrhages all over the fundus, along with macular edema which was confirmed on optical coherence tomogram []. In both the eyes, intraocular pressure was found to be within normal limits. The systemic investigations undertaken were within normal limits. Since all the work up done was within normal limits, it was diagnosed to be a case of CRVO in right eye secondary to the OCP. The patient was given intra-vitreal injection of Bevacizumab (Avastin) and was meticulously followed up for 6 months. After 6 months, her vision in right eye improved to 6/6 partial and the macular edema regressed as seen on optical coherence tomogram, but the patient is still complaining of metamorphopsia till her last follow up.