Multimodal imaging in retinal artery macroaneurysms

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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Indocyanine green angiography imaging findings in artery occlusions

European Journal of Ophthalmology ◽

10.1177/11206721211037832 ◽

2021 ◽

pp. 112067212110378

Author(s):

Ramesh Venkatesh ◽

Nikitha Gurram Reddy ◽

Vishma Prabhu ◽

Pukhraj Rishi ◽

Arpitha Pereira ◽

...

Keyword(s):

Indocyanine Green ◽

Multimodal Imaging ◽

Indocyanine Green Angiography ◽

Retinal Vessel ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Imaging Features ◽

Retinal Artery ◽

Choroidal Perfusion ◽

Rouleaux Formation

Purpose: To describe the multimodal imaging features including indocyanine green angiography (ICGA) in cases diagnosed clinically as central retinal artery occlusion (CRAO) at its different disease stages. Methods: In this retrospective observational study, patients diagnosed clinically as CRAO or hemi-CRAO were included. All patients underwent multimodal imaging with optical coherence tomography (OCT), fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were studied. Analysis of ICGA images in different stages of artery occlusions and its correlation with accompanying FFA and OCT images was done. Results: Eight such studies in five patients were available for analysis. The most important observation noted on ICGA was the presence of hypercyanescent spots seen during the acute stages of the disease in four of the five cases. The spots were accompanied by retinal vessel staining on FFA in the corresponding region. As the disease showed signs of resolution, the hypercyanescent spots on ICGA and retinal vessel staining on FFA disappeared. The hypercyanescent spots seen on the ICGA were noted due to the red blood cell aggregation or ‘rouleaux’ formation. In addition, choroidal perfusion abnormalities were noted on ICGA in all five cases in the acute stage. Conclusion: Choroidal perfusion changes can be identified in acute phase of retinal artery occlusion. Rouleaux formation in the retinal circulation occurs due to the slowing of the blood flow following artery occlusion. These are seen as hypercyanescent spots in the late phase on ICGA.

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Multimodal Imaging, OCT En Face, and OCT Angiography of an Anomalous Retinal Artery: Case Report and Review of the Literature

Case Reports in Ophthalmology ◽

10.1159/000518285 ◽

2021 ◽

pp. 773-777

Author(s):

Beatriz Vidal-Villegas ◽

Juan Antonio Miralles de Imperial-Ollero ◽

Enrique Santos Bueso ◽

Julián García-Feijoo ◽

Maria Paz Villegas-Pérez

Keyword(s):

Nerve Fiber ◽

Multimodal Imaging ◽

Anatomical Variation ◽

Spectral Domain ◽

Optic Coherence Tomography ◽

Fiber Layer ◽

Nerve Fiber Layer ◽

En Face ◽

Retinal Artery ◽

First Time

The purpose is to study for the first time the vascular plexuses and the retinal nerve fiber layer and raphe of a patient with a very uncommon anatomical variation: an anomalous retinal artery supplying the whole macula. We used multimodal imaging, en face spectral-domain optic coherence tomography, and spectral-domain optic coherence tomography angiography. One patient presented in his left eye a very unusual anatomical variation of macular vascularization. A retinal artery deriving from the inferior temporal retinal artery irrigated the whole macula. The formation of the papillomacular bundle and the temporal raphe nerve fiber layer has been attributed to the earlier development of the central retina and to the existence of 2 distinct watershed zones. However, there are very uncommon anatomical variations of the retinal vasculature in which large retinal vessels cross the raphe and could influence the morphology and structure of the nerve fiber layer of the posterior pole. We review the literature on the subject and document for the first time an anomalous artery that irrigates the whole macula, normal thickness and morphology of the nerve fiber layer, and the temporal raphe.

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Multimodal Images of Acute Central Retinal Artery Occlusion

Case Reports in Ophthalmological Medicine ◽

10.1155/2017/5151972 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4

Author(s):

Parth Shah ◽

Stephen G. Schwartz ◽

Harry W. Flynn

Keyword(s):

Multimodal Imaging ◽

Optical Coherence Tomography Angiography ◽

Central Retinal Artery Occlusion ◽

Retinal Artery Occlusion ◽

Retinal Ischemia ◽

Artery Occlusion ◽

Central Retinal Artery ◽

Imaging Studies ◽

Retinal Artery ◽

Multimodal Images

Two illustrative cases of acute central retinal artery occlusion (CRAO) are presented with multimodal imaging, including fluorescein angiography (FA) and commercially available optical coherence tomography angiography (OCT-A). In both patients, retinal ischemia was imaged well using both FA and OCT-A, and the two imaging studies provided comparable pictures. OCT-A provides useful information for the diagnosis and management of patients with acute CRAO, without the need for dye injection.

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Analysis of Multimodal Imaging Characteristics of Transient Central Retinal Artery Occlusion

10.21203/rs.3.rs-354006/v1 ◽

2021 ◽

Author(s):

Weiting An ◽

Qi Zhao ◽

Jindong Han

Keyword(s):

Multimodal Imaging ◽

Central Retinal Artery Occlusion ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Posterior Pole ◽

Cotton Wool ◽

Cotton Wool Spot ◽

Imaging Characteristics ◽

Capillary Plexus ◽

Retinal Artery

Abstract Background To observe and analyze the multimodal imaging characteristics of transient central retinal artery occlusion (T-CRAO). Methods Retrospective observational study. Eight patients (8 eyes) diagnosed as T-CRAO in Tianjin Medical University Eye Hospital were included in this study. There were 6 males (6 eyes) and 2 females (2 eyes) with an average age of 63.8 years (38-78years). The clinical manifestation was acute vision loss. All patients underwent best corrected visual acuity (BCVA), slit lamp microscope, color fundus photography (CFP), fundus fluorescein angiography (FFA), optical coherence tomography (OCT) and OCT angiography (OCTA). The clinical data and multimodal imaging characteristics of patients were analyzed. Results There were 4 eyes with BCVA from 0.05 to 0.1 and 4 eyes from 0.1 to 0.3. CFP demonstrated multiple patchy “cotton-wool spot”-like lesions in posterior pole, without typical cherry-red spot. FFA manifested as sluggish filling of arteries, filling front, and delayed filling of vein. The filling was completed within 5 to 10 seconds. The “cotton-wool spot”-like lesions showed low fluorescence in early stage. Some lesions filled gradually; others still showed low fluorescence in late stage. OCT showed inner layer and local nerve fiber layer of retina was thickened. The reflexes of lesions were enhanced intermittently, especially the “hump-like” change of inner nuclear layer (INL). OCTA revealed the vascular density (VD) of superficial capillary plexus (SCP) and deep capillary plexus (DCP) of retina was decreased, the shape of the arcade was damaged, and the foveal avascular zone (FAZ) area was enlarged. En-face image showed isolated patchy hyperreflective lesions at SCP and fused patchy hyperreflective lesions at DCP.Conclusions CFP demonstrated multiple patchy “cotton-wool spot”-like lesions in posterior pole; OCTA revealed decreased VD of SCP and DCP. After treatment, the “cotton-wool spot”-like lesions gradually vanished, and the VD partially recovered.

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Complications of Intra-Arterial tPA for Iatrogenic Branch Retinal Artery Occlusion: A Case Report through Multimodal Imaging and Literature Review

Medicina ◽

10.3390/medicina57090963 ◽

2021 ◽

Vol 57 (9) ◽

pp. 963

Author(s):

Katherine Dalzotto ◽

Paige Richards ◽

Tyler D. Boulter ◽

Marilyn Kay ◽

Mihai Mititelu

Keyword(s):

Visual Field ◽

Multimodal Imaging ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Fundus Photography ◽

Automated Perimetry ◽

Branch Retinal Artery Occlusion ◽

Retinal Artery ◽

Sd Oct

Background and Objectives: To document, through multimodal imaging, the post-procedural clinical course and visual outcome of a patient who received intra-arterial tissue plasminogen activator (tPA) for acute iatrogenic branch retinal artery occlusion (BRAO), and to review the literature and guidelines regarding the use of tPA for retinal arterial occlusions. Methods: A 28-year-old female patient who sustained an iatrogenic BRAO and subsequently received intra-arterial tPA was followed through her post-interventional course of 3 months with serial exams and multimodal imaging, including color fundus photography, visual field testing, spectral domain optical coherence tomography (SD-OCT), and OCT angiography (OCT-A). Results: A patient with history of left internal cerebral artery (ICA) aneurysm and baseline visual acuity (VA) of 20/20 developed an acutely symptomatic BRAO after undergoing a neuroendovascular procedure and was acutely treated with tPA through the left ophthalmic artery. At two weeks follow-up, a central posterior pole hemorrhage was noted although VA was preserved. A superior altitudinal defect was shown on automated perimetry. VA dropped to 20/50 at 7 weeks follow-up and hyperreflective material deep to the attachment between the posterior hyaloid and the internal limiting membrane (ILM) consistent with hemorrhage was noted on SD-OCT. At 11 weeks follow-up, VA returned to 20/20, SD-OCT revealed a membrane bridging the foveal depression, OCT-A showed decreased vascularity in the inferior macula, and the visual field defect was stable by automated perimetry. Conclusions: Intraocular hemorrhage is a possible complication of intra-arterial tPA administration for BRAO, and a careful analysis of risks, benefits, and goals of this procedure must be considered by both provider and patient before such intervention.

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Sclerochoroidal calcification as an incidental finding during oncological staging of a patient with parotid malignancy: A case report

European Journal of Ophthalmology ◽

10.1177/1120672121999629 ◽

2021 ◽

pp. 112067212199962

Author(s):

Nicola Vito Lassandro ◽

Luca Danieli ◽

Michele Nicolai ◽

Vittorio Pirani ◽

Paolo Pelliccioni ◽

...

Keyword(s):

Multimodal Imaging ◽

Incidental Finding ◽

Correct Diagnosis ◽

Preoperative Staging ◽

Malignant Lesion ◽

Enhanced Depth Imaging ◽

Elevated Lesion ◽

Retinal Artery ◽

Challenging Situation ◽

The Right

Introduction: Incidental finding of mass lesion in the choroid represents a very challenging situation for the ophthalmologist. We describe a case of an incidental, computed tomography (CT)-hyperintense, choroidal lesion in a patient with parotid malignancy and renal failure, and how multimodal imaging helped us reaching the correct diagnosis. Case description: A 63-year-old man with parotid gland malignancy was brought to our attention because preoperative staging CT showed a hyperintense choroidal lesion of the right eye. Fundus examination showed a yellow elevated lesion near the superior temporal branch retinal artery. Enhanced depth imaging optical coherence tomography (EDI-OCT), A- and B-scan ultrasonography, and Indocyanine Green Angiography (ICGA) allowed us to exclude a malignant lesion and to diagnose a sclerochoroidal calcification. Conclusion: Multimodal imaging can guide the clinician to choose the appropriate therapeutic approach even in case of uncommon conditions like sclerochoroidal calcification.

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