Hyperhomocysteinemia, High Altitude, and Varied Retinal Manifestations: Unravelling the Enigma

Rana, Vipin, Meenu Dangi, Sandepan Bandopadhayay, Vijay K. Sharma, Satyabrat Srikumar, Jitesh Goyal, and B.V. Rao. Hyperhomocysteinemia, High Altitude, and Varied Retinal Manifestations: Unravelling the Enigma. High Alt Med Biol. 24:234-237, 2023.-We present five cases of young defense personnel, who were posted at high altitude (HA) for >6 months and presented with reduction of vision between June 2022 and February 2023. The diagnosis made were ocular ischemic syndrome, central retinal artery occlusion, central retinal vein occlusion, branch retinal vein occlusion, and branch retinal artery occlusion. There were no associated comorbidities. Hematological workup revealed increased serum homocysteine and hemoglobin in all patients. Computed tomography angiography was done in cases of ocular ischemic syndrome, and central retinal artery occlusion, which revealed occlusion of carotid artery. All patients were given tab folic acid in view of hyperhomocysteinemia (HHcy). This case series highlights that prolonged exposure to HA may lead to HHcy, which can directly or indirectly lead to various sight-threatening retinal diseases. Thus, effective preventive strategies, such as dietary or pharmacological interventions aimed at lowering serum homocysteine levels, are crucial for individuals posted at HA for longer duration.