scholarly journals Bilateral central retinal artery occlusion from catastrophic antiphospholipid syndrome

2018 ◽  
pp. bcr-2018-226463 ◽  
Author(s):  
Udit Joshi ◽  
Sana Afroz ◽  
Sagar Ranka ◽  
Benjamin Mba
Keyword(s):  
Antiphospholipid Syndrome ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Acute Onset ◽  
Central Retinal Artery ◽  
Left Index Finger ◽  
High Dose ◽  
Catastrophic Antiphospholipid Syndrome ◽  
Retinal Artery

A 23-year-old woman with history of systemic lupus erythematous presented with dizziness and headache and was admitted for the stroke workup. During her stay, she had sudden painless loss of vision in her right eye consistent with central retinal artery occlusion (CRAO). Ocular massage and paracentesis were attempted without success to resume the flow. She was started on oral high-dose steroids (1 mg/kg) for lupus flare and therapeutic anticoagulation for antiphospholipid syndrome (positive for anticardiolipin and beta-2 microglobulin antibodies). On day 4, she started having painful bluish discoloration of her left index finger and right fifth toe, and on day 5 she had acute onset of left blurry vision with findings consistent with CRAO. She fulfilled the criteria of catastrophic antiphospholipid syndrome and was started on intravenous pulse steroids, plasmapheresis and higher international normalised ratio goal of 3–3.5 with improvement in her left eye vision from 20/200 to 20/20 on near card test by the end of treatment.

Simultaneous Bilateral Primary Occlusion of the Ophthalmic Artery due to Florid Giant Cell Arteritis

2021 ◽  
Author(s):  
Tim Berger ◽  
Kassandra Xanthopoulou ◽  
Elena Zemova ◽  
Rainer M. Bohle ◽  
Berthold Seitz ◽  
...  
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Ophthalmic Artery ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
High Dose ◽  
Retinal Artery ◽  
The Right

Abstract Purpose To report a case of simultaneous bilateral ophthalmic artery occlusion in diagnosed giant cell arteritis (GCA). Observations A 77-year-old male patient presented to the emergency department with simultaneous vision loss in both eyes for 3 hours. Headache at both temples and jaw claudication had been present for 3 weeks. Laboratory values demonstrated an initially increased C-reactive protein (CRP) of 202.0 mg/L and an erythrocyte sedimentation rate (ESR) of 100 mm within the first 20 minutes. Duplex sonography of the right and left temporal arteries revealed a “halo sign.” A case of GCA was suspected, and intravenous high-dose methylprednisolone therapy was immediately administered. The clinical examination revealed a bilateral central retinal artery occlusion and fluorescein angiography showed a hot optic disc in the right eye and patchy choroidal hypoperfusion in both eyes. Biopsy of the left temporal artery was performed, which confirmed a florid temporal arteritis with complete thrombotic occlusion of the vascular lumen. Despite a good response to the administered therapy (CRP 17.0 mg/L 1 week after initiation), the visual prognosis was significantly limited through retinal and optic nerve involvement. By the follow-up examination 8 weeks later, the near visual acuity was 20/400 in the right and left eye at a distance of 16 inches. Conclusion and Importance We hereby present a simultaneous bilateral ophthalmic artery occlusion as a rare complication of GCA. The combination of central retinal artery occlusion, arteritic anterior ischemic optic neuropathy, and choroidal hypoperfusion suggests an acute inflammatory involvement of the ophthalmic artery. In cases of the slightest suspicion of giant cell arteritis, an immediate high-dose steroid therapy initiation is of utmost importance.

Hyperbaric Oxygenation Combined with Nifedipine Treatment for Recent-Onset Retinal Artery Occlusion

1993 ◽  
Vol 3 (2) ◽  
pp. 89-94 ◽  
Author(s):  
I. Beiran ◽  
P. Reissman ◽  
J. Scharf ◽  
Z. Nahum ◽  
B. Miller
Keyword(s):  
Beneficial Effect ◽  
Visual Loss ◽  
Hyperbaric Oxygenation ◽  
Central Retinal Artery Occlusion ◽  
Arterial Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Acute Onset ◽  
Central Retinal Artery ◽  
Retinal Artery

We describe the results of early hyperbaric oxygenation combined with nifedipine treatment for central retinal artery occlusion, and explain the results pathophysiologically. We report four cases in which hyperbaric oxygenation therapy was applied in combination with nifedipine, eyeball massage, and glycerol for the treatment of central retinal artery occlusion. In two of the cases in which therapy was started less than 100 minutes after the acute onset of visual loss and one case in which therapy was started during the course of central arterial occlusion, considerable improvement in visual acuity was observed, while in the fourth case in which therapy was started six hours after the acute onset of visual loss, no improvement appeared. We conclude from these results that hyperbaric oxygenation therapy has a beneficial effect on the final visual outcome of central retinal artery occlusion, provided it is applied early enough. Further investigation is needed to fully define the nature and terms of this beneficial effect.

Bilateral Central Retinal Artery Occlusion (CRAO) after Opium Consumption

2014 ◽  
Vol 3 (9) ◽  
Author(s):  
L. Rezaei ◽  
H. Ghanbari ◽  
M. Taghaodi ◽  
M. Malekahmadi ◽  
M. Adinevand ◽  
...  
Keyword(s):  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
Retinal Artery

Central Retinal Artery Occlusion Following Prone Transcranial Surgery for Craniosynostosis and Discussion of Risk Factors

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Grayson Roumeliotis ◽  
Stewart Campbell ◽  
Sumit Das ◽  
Goran Darius Hildebrand ◽  
Peter Charbel Issa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
Retinal Artery ◽  
Transcranial Surgery

scholarly journals 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

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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