Virginia Research Day 2025

Medical Student Research Case Reports

11 Branched Retinal Artery Occlusion in a 23-Year-Old Pregnant Patient Leading to Discovery of Underlying Protein S Deficiency

Kaylie Ward¹; Paige O’Brien Daly¹, MA; Erica Boerth2; Carlos Blattner, MD, FACOG Corresponding author: kward03@vcom.edu

¹ Edward Via College of Osteopathic Medicine - Virginia Campus 2 Emory and Henry University Physician Assistant Studies-Marion, VA

Retinal artery occlusion is rare in young adults, and its presentation during pregnancy is often indicative of an underlying hypercoagulable state, such as an inherited thrombophilia. This case report describes a rare instance of branched retinal artery occlusion (BRAO) in a 23-year-old pregnant patient with previously undiagnosed Protein S deficiency. A 23-year-old G1P0 woman presented in her first trimester with sudden, painless vision loss in her right eye, reporting a central visual defect. Ophthalmologic evaluation confirmed BRAO,

prompting a hypercoagulable workup that identified Protein S deficiency. Initial management included low-dose aspirin, but upon Protein S deficiency diagnosis, prophylactic enoxaparin (40 mg daily) was recommended by hematology and maternal-fetal medicine teams to mitigate thrombotic risk. A multidisciplinary approach was adopted to monitor maternal and fetal well-being, including serial growth ultrasounds. No further thrombotic events were observed, and the pregnancy progressed without significant complications.

This case underscores the importance of screening for thrombophilias in pregnant patients presenting with atypical thrombotic events, such as BRAO. Early recognition and tailored anticoagulation management are critical in high-risk pregnancies to reduce maternal and fetal morbidity, highlighting the role of a multidisciplinary team approach in optimizing outcomes.

103 2025 Research Recognition Day