Reperfusion of occluded branch retinal arteries by transluminal Nd:YAG laser embolysis combined with intravenous thrombolysis of urokinase

Purpose: To report successful treatment with transluminal Nd:YAG laser embolysis (TYE) combined with urokinase thrombolysis for reperfusion of occluded branch retinal arteries with visible emboli. Methods: A total of 34 eyes from 34 patients with acute, severe vision loss secondary to a branch retinal artery occlusion with visible emboli and retinal whitening were examined. Each patient was administered TYE therapy, which focused on the embolus, using an ocular contact lens; a 0.3–0.9 mJ laser pulse was delivered directly and gradually according to the reaction. Fundus photographs and fundus fluorescein angiography (FFA) were obtained before and immediately after the laser treatment. All patients received urokinase thrombolysis therapy drops intravenously for 5 days at 10–20 u/d. The follow-up period ranged from 6 to 14 months after therapy. The morphological characteristics of FFA associated with obstruction recovery of arterial fluorescence filling and visual function were analyzed. Results: After TYE therapy, FFA examinations showed that the retinal artery and its branches exhibited completely restored blood flow without obstruction in 13 eyes, accounting for 38.2% of the cases. The blood flow was mostly recovered in 11 eyes (32.4% of patients). FFA examinations following the combined intravenous urokinase thrombolysis therapy showed that the retinal artery and its branches exhibited completely restored blood flow after obstruction in 16 eyes (47.1% of patients). The blood flow was mostly recovered in 15 eyes (44.1% of patients). Conclusion: TYE combined with urokinase thrombolysis is effective for reperfusion of occluded branch retinal arteries and improving visual recovery in patients with visible emboli.

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The use of multimodal imaging in the evaluation of a patient with central retinal artery occlusion in the setting of asteroid hyalosis: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02774-w ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Timothy M. Janetos ◽

Olga German ◽

Rukhsana Mirza

Keyword(s):

Multimodal Imaging ◽

Vision Loss ◽

Central Retinal Artery Occlusion ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Central Retinal Artery ◽

Timely Diagnosis ◽

Cardiovascular Morbidity And Mortality ◽

Asteroid Hyalosis ◽

Retinal Artery

Abstract Background A central retinal artery occlusion (CRAO) is an ophthalmic emergency due to its strong association with cerebrovascular and cardiovascular morbidity and mortality. A timely diagnosis is necessary but difficult in the setting of dense asteroid hyalosis, as typical fundoscopic findings can be obscured. We present a case where multimodal imaging in an eye with an obscured fundus could lead to timely diagnosis and management of CRAO in a patient with acute vision loss. Case presentation A 94-year-old Caucasian woman with a history of exudative macular degeneration presented to the retina clinic with acute vision loss in one eye over the course of an afternoon. The patient had dense asteroid hyalosis, and a direct retinal exam was not possible. Multimodal imaging suggested a CRAO diagnosis. The patient received digital ocular massage directly prior to undergoing fluorescein angiography (FANG), which confirmed the diagnosis. The patient was transported from clinic to the emergency room for an emergency stroke workup, which revealed a spontaneous echo in the left atrial appendage, and the patient was started on antiplatelet therapy. When she presented for follow-up within a week, the patient noted that her vision had improved at the time of digital ocular massage and continued to improve thereafter. Her FANG showed marked reperfusion of the retina, and she subsequently has completely regained her baseline visual acuity. Conclusions Multimodal imaging is useful in evaluating visual loss in patients with acute vision loss. In addition, ocular massage is a simple, low-risk intervention that may have benefit in the treatment of acute CRAO. Patients who present to ophthalmologists with an acute CRAO need an emergency referral for evaluation of cerebrovascular and cardiovascular comorbidities.

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Concurrent Bilateral Central Retinal Artery Occlusion Secondary to Sickle Cell Crisis

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/23247096211028392 ◽

2021 ◽

Vol 9 ◽

pp. 232470962110283

Author(s):

Gowri Renganathan ◽

Piruthiviraj Natarajan ◽

Lela Ruck ◽

Roberto Prieto ◽

Bharat Ved Prakash ◽

...

Keyword(s):

Sickle Cell Disease ◽

Sickle Cell ◽

Vision Loss ◽

Central Retinal Artery Occlusion ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Cell Disease ◽

Sickle Cell Crisis ◽

History Of ◽

Retinal Artery

Vascular occlusive crisis with a concurrent vision loss on both eyes is one of the most devastating disability for sickle cell disease patients. Reportedly occlusive crisis in the eyes is usually temporary whereas if not appropriately managed can result in permanent vision loss. A carefully managed sickle cell crisis could prevent multiple disabilities including blindness and stroke. We report a case of a 24-year-old female with a history of sickle cell disease who had acute bilateral vision loss during a sickle crisis and recovered significantly with a timely emergent erythrocytapheresis.

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Imaging Methods in Retinal Artery Occlusion

Güncel Retina Dergisi (Current Retina Journal) ◽

10.37783/crj-0189 ◽

2020 ◽

pp. 13-17

Keyword(s):

Imaging Techniques ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Sudden Onset ◽

Diagnosis And Treatment ◽

Fundus Fluorescein Angiography ◽

Imaging Methods ◽

Invasive Method ◽

Retinal Microcirculation ◽

Retinal Artery

Advances in ophthalmic imaging methods shed light on the management of retinal artery occlusion (RAO). RAT is an ocular emergency that can cause painless, sudden onset, unilateral vision, or loss of visual field. RAO requires early diagnosis and treatment. Fundus fluorescein angiography (FFA), which can be used in diagnosis and follow-up, is an invasive method requiring intravenous dye application which can cause side effects. In recent years, optical coherence tomography angiography (OCTA) has become widely available as an alternative to FFA in various ophthalmologic diseases. OCTA is a new type of angiography used for fundus imaging. It is a non-invasive method for measuring and quantifying the retinal microcirculation without the use of dyes. Many other imaging modalities used in ophthalmology clinics have been used in many areas of diagnosis and treatment of RAO patients. This review deals with the results of different imaging techniques in patients with RAO.

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Case Report: Central Retinal Artery Occlusion in a COVID-19 Patient

Frontiers in Pharmacology ◽

10.3389/fphar.2020.588384 ◽

2020 ◽

Vol 11 ◽

Author(s):

Andrea Montesel ◽

Claudio Bucolo ◽

Victoria Mouvet ◽

Emmanuelle Moret ◽

Chiara M. Eandi

Keyword(s):

Vision Loss ◽

Previous History ◽

Central Retinal Artery Occlusion ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Central Retinal Artery ◽

History Of ◽

Severe Vision Loss ◽

Retinal Artery ◽

Vascular Occlusions

We report a case of central retinal artery occlusion (CRAO) in a patient with a previous history of severe COVID-19 disease. This disease has been associated with inflammatory-induced homeostasis changes leading to endothelial dysfunction and a procoagulant state with multi-organ involvement, but the burden of thromboembolic complications in COVID-19 patients is currently unknown. The pathogenesis of retinal artery occlusions is a multifactorial process where inflammation and hypercoagulation state are established risk factors. Even if our experience may represent a coincidental relationship, it is likely that COVID-19 patients could be at risk of developing retinal vascular occlusions. A focused ophthalmological surveillance is advisable to prevent and manage this possible cause of severe vision loss that has an important impact in health care system.

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Bilateral Central Retinal Artery Occlusion in Infective Endocarditis

Journal of VitreoRetinal Diseases ◽

10.1177/2474126420960903 ◽

2020 ◽

pp. 247412642096090

Author(s):

Mohamed Mohamed ◽

Tahira Scholle

Keyword(s):

Infective Endocarditis ◽

Vision Loss ◽

Central Retinal Artery Occlusion ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Central Retinal Artery ◽

Motion Vision ◽

Hand Motion ◽

Cherry Red Spot ◽

Retinal Artery

Purpose: This report describes a patient with bilateral, sequential central retinal artery occlusions (CRAOs) due to infective endocarditis (IE). Methods: A case report is presented. Results: A 35-year-old man with IE who recently completed a course of intravenous antibiotic therapy presented with sudden right-eye vision loss. Examination revealed hand motion vision, a cherry-red spot in the macula in the right eye, and an embolus in the inferotemporal arcade of the left eye. The diagnosis of right-eye CRAO secondary to IE was made, with the presumed source being his dental caries. The patient was admitted with plans for aortic valve replacement and dental extraction. During his hospitalization, the patient suffered from a CRAO in his left eye, resulting in bilateral loss of vision. Conclusions: IE can have severe embolic complications; prompt diagnosis and treatment medically and surgically are necessary to reduce further morbidity and mortality.

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Central retinal artery occlusion from Streptococcus gallolyticus endocarditis

BMJ Case Reports ◽

10.1136/bcr-2020-235763 ◽

2020 ◽

Vol 13 (9) ◽

pp. e235763

Author(s):

Rita Serras-Pereira ◽

Diogo Hipolito-Fernandes ◽

Luísa Azevedo ◽

Luísa Vieira

Keyword(s):

Vision Loss ◽

Central Retinal Artery Occlusion ◽

Transoesophageal Echocardiography ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Central Retinal Artery ◽

Streptococcus Gallolyticus ◽

Cardiovascular Comorbidities ◽

Cherry Red Spot ◽

Retinal Artery

Central retinal artery occlusion (CRAO) is a rare but blinding disorder. We present a case of a 81-year-old woman with multiple cardiovascular comorbidities admitted to the emergency department due to sudden, painless vision loss on left eye (oculus sinister (OS)) on awakening. The patient also reported long standing fatigue associated with effort that started 4 months before admission. She presented best corrected visual acuity of counting fingers OS. Funduscopy OS revealed macular oedema with cherry red spot pattern. Blood cultures came positive for Streptococcus gallolyticus in the context of a bacteremia and native mitral valve vegetation identified on transoesophageal echocardiography. CRAO of embolic origin was admitted in the context of an infective endocarditis. CRAO can be the first manifestation of a potentially fatal systemic condition and thus multidisciplinary approach is warranted with close collaboration between ophthalmologists and internists in order to provide proper management and the best possible treatment.

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