vitamin-b-12 and Myopia

There has been a great interest in the last decades about the clinical significance of elevated total plasma homocysteine (tHcy), and especially its possible association with an increased cardiovascular risk. Measurement of tHcy is clearly indicated when homocystinuria is suspected in young or adult patients (in the presence of a severe, atypical or progressive myopia with ectopia lentis and/or venous thromboembolism and/or severe, premature or atypical atherosclerotic vascular disease) and in the evaluation of vitamin B12 and/or folic acid deficiencies. The current evidence does not support either the screening measurement of tHcy or the treatment with vitamin B12 and/or folic acid supplementation in patients with cardiovascular disease. It is important to remember that it remains to be proved whether the long-term administration of folic acid at pharmacological doses is safe.

Topics: Adolescent; Adult; Cardiovascular Diseases; Child; Child, Preschool; Ectopia Lentis; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Homocystinuria; Humans; Hyperhomocysteinemia; Infant; Infant, Newborn; Life Style; Male; Middle Aged; Myopia; Pregnancy; Randomized Controlled Trials as Topic; Risk Factors; Vitamin B 12; Vitamin B 12 Deficiency

To report the case of a 28-year-old patient with persistent bilateral burning pain and foreign body sensation in both eyes for the past 1 year. The patient showed a poor response to 0.05% cyclosporine eye drops and frequent instillations of artificial tears. Ocular examination showed few superficial punctate epithelial defects, well-positioned laser in situ keratomileusis (performed 5 years ago with symptomless recovery) flaps, and clear interfaces bilaterally, with a tear film breakup time of 7 and 8 seconds in the right and left eyes, respectively. The results of Schirmer tests, confocal microscopy, corneal esthesiometry, and meibography were normal for both eyes. The patient was incidentally diagnosed with vitamin B12 deficiency, with a serum vitamin B12 value of 90 pg/mL (reference range, 236-911 pg/mL), during routine laboratory tests. In view of weak correlation between signs and symptoms, a putative diagnosis of ocular neuropathic pain secondary to vitamin B12 deficiency was made.. Case report.. The patient was treated with parenteral vitamin B12, and topical therapy was continued without any changes. The patient experienced dramatic improvement with a decrease in symptoms within 3 weeks of administering vitamin B12 supplements and was symptom-free in the absence of any topical medication 6 months after treatment.. Vitamin B12 deficiency, although common in India, has not been reported to be associated with ocular symptoms, including pain and mimicking those seen in severe dry eye. Vitamin B12 deficiency should be considered in the differential diagnosis of ocular neuropathic pain and dry eye in patients presenting with recalcitrant ocular neuropathic pain.

Topics: Adult; Eye Pain; Humans; Infusions, Parenteral; Keratomileusis, Laser In Situ; Male; Myopia; Neuralgia; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

Pronounced osteoporosis was discovered in a 44-year-old man presenting with an herniated intervertebral disk. He reported severe myopia, incomplete dislocation of the lenses and retinal detachment. He did not know of any thrombembolic events in the past. On physical examination Marfan-like appearance and a funnel chest were noted. Because of these findings Marfan syndrome was suspected.. Considering the findings of the x-rays, homocystinuria was suspected as a cause of osteoporosis, despite apparently normal cognitive functions. This diagnosis was confirmed by greatly increased values of serum homocysteine and a positive test for urinary homocystine. Since methionine and homocystine were both elevated, the diagnosis of cystathionin-beta-synthase deficiency was established.. After taking folate and vitamin B6, the homocysteine level decreased moderately. Betaine and subsequently vitamin B12 were added. Homocysteine values declined markedly on this therapeutic regimen. Two years later the patient was admitted again because of atypical angina. Coronary heart disease could be excluded by coronary angiography.. Diagnosis of premature osteoporosis should prompt consideration of homocystinuria even in adults. Premature arteriosclerosis, thrombembolic diseases, dislocation of the lens and retinal detachment may give further clues.

Topics: Adult; Age Factors; Angina Pectoris; Betaine; Diagnosis, Differential; Drug Therapy, Combination; Folic Acid; Homocysteine; Homocystine; Homocystinuria; Humans; Intervertebral Disc Displacement; Lens Subluxation; Male; Marfan Syndrome; Myopia; Osteoporosis; Retinal Detachment; Vitamin B 12; Vitamin B 6; Vitamin B Complex