Complete recovery of lipemia retinalis with visual loss after early plasmapheresis

Background: To report a case of severe hypertriglyceridemia-induced bilateral lipemia retinalis with visual loss, whose striking fundus abnormalities completely resolved with visual recovery after two-times plasmapheresis.
Case Report: A 27-year-old female without prior ocular diseases but chronic alcohol abuse reported about proceeding bilateral visual loss for more than 4 months. Best corrected visual acuity was 0.2 on both eyes (equivalent to Snellen 20/100). Fundus biomicroscopy revealed bilateral lipemia retinalis of both the retinal veins and arteries. Optical coherence tomography was normal. Blood examination revealed a severe hypertriglyceridemia of 16442 mg/dl and hypercholesterolemia of 1799 mg/dl. All hepatic parameters were extremely elevated (gGT: 5351 U/l). The patient was transferred for early plasmapheresis to the medical department. One week after the second plasmapheresis, the patient reported significant visual recovery and the best-corrected visual acuity was 0.8 on both eyes (equivalent to Snellen 20/25). At serum triglyceride levels <200 mg/dl, lipemia retinalis had completely resolved. At a special low-fat diet and no alcohol consumption, the patient needed no statine therapy, but had to stay under continuous observation.
Conclusions: Plasmapheresis combined with low-fat diet and abstinence from alcohol was effective for treatment of a severe hypertriglyceridemia-induced bilateral lipemia retinalis with visual loss, whose exacerbation was caused by chronic alcohol abuse.

Keywords: lipaemia, retinal disease, hypertrigliceridemia, Plasmapheresis