Hyperbaric oxygen treatment results in a group of Turkish central retinal artery occlusion patients with a combined presence of thrombophilic mutations

2020 ◽  
pp. 65-73
Author(s):  
Muhammer Özgür Çevik ◽  
◽  
Bekir Selim Bağli ◽  
Sadık Görkem Çevik ◽  
◽  
...  
Keyword(s):  
Visual Acuity ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Factor V ◽  
Factor V G1691a ◽  
Retinal Artery ◽  
Pai 1 ◽  
Hbo2 Therapy ◽  
Thrombophilic Mutations

Background: Central retinal artery occlusion (CRAO) is a rare ocular-ischemic syndrome causing irreversible blindness. Its pathophysiology has not been clarified, and no targeted therapies are available yet. Hyperbaric oxygen (HBO2) therapy is an approved therapy for CRAO and has been shown to improve the visual acuity of CRAO patients safely. However, further clinical data are required to classify HBO2 therapy as a type-I general agreement for CRAO. Materials and Methods: Eleven patients with non-arteritic CRAO were enrolled. Patient demographics, medical history, detailed eye examinations, HBO2 therapy results, pre-/post- HBO2 therapy visual acuity measurements and genotypes for common thrombophilic mutations (Factor V G1691A Leiden, Factor II G20210A, MTHFR A1298C, MTHFR C677T, and PAI-1-675 4G/5G) were obtained. Results: Six patients (54%) responded to HBO2 therapy compared to five non-responders (46%). Patients admitted before 12 hours responded well to HBO2 therapy. No systemic diseases nor advanced age were statistically correlated to CRAO. A combination of mutations rather than single mutations for each patient could be seen as responsible for CRAO. No Factor V G1691A Leiden mutations and only one FII G20210A mutation were observed. Eight patients (72%) had MTHFR 677T allele, five patients (45%) had MTHFR 1298C allele, and 10 patients (91%) had the PAI-1-675 4G allele. Conclusion: Not a single mutation but a combination of mutations and other unknown factors probably lead to CRAO, and if intervention is timely, HBO2 therapy offers improvement in visual acuity safely.

scholarly journals EMERGENCY TREATMENT FOR CENTRAL RETINAL ARTERY OCCLUSION ( CRAO )

2021 ◽  
Vol 1 (2) ◽  
pp. 7-8
Author(s):  
Nida Farida
Keyword(s):  
Visual Acuity ◽  
Emergency Treatment ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
Blurred Vision ◽  
Retinal Artery ◽  
Ocular Chamber ◽  
The Right

Central retinal artery occlusion (CRAO) is a blinding event but not considered as a common emergency problem. Since awareness of the case is low, patients usually come to the ophthalmologist later than the golden period and havingthe worst prognosis. We report the case of patient with a central retinal artery occlusion that had visual improvement after emergency treatment.A 47-year-old woman with no comorbidities presented with symptoms of a sudden blurred vision, no pain or redness in the right eye (RE). Best-corrected visual acuity in the RE was 1/60. A relative afferent pupillary defect was observed in the RE. Ocular fundus examination of RE was suggestive of CRAO. Emergency treatment were performed, including rebreathing of expired CO2, ocular massage and ocular chamber paracentesis. One week later, the visual acuity was improved.This case highlights that fast and accurate response in acute management of CRAO should be conducted, especially within the golden hours which is less than 6 hours after the accident, to prevent permanent visual loss of thepatient.

scholarly journals A Case of Incomplete Central Retinal Artery Occlusion Associated with Short Posterior Ciliary Artery Occlusion

2013 ◽  
Vol 2013 ◽  
pp. 1-4
Author(s):  
Shinji Makino ◽  
Mikiko Takezawa ◽  
Yukihiro Sato
Keyword(s):  
Visual Acuity ◽  
Optic Disc ◽  
Ophthalmic Artery ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
Posterior Ciliary Artery ◽  
Retinal Artery ◽  
Ciliary Artery

To our knowledge, incomplete central retinal artery occlusion associated with short posterior ciliary artery occlusion is extremely rare. Herein, we describe a case of a 62-year-old man who was referred to our hospital with of transient blindness in his right eye. At initial examination, the patient’s best-corrected visual acuity was 18/20 in the right eye. Fundus examination showed multiple soft exudates around the optic disc and mild macular retinal edema in his right eye; however, a cherry red spot on the macula was not detected. Fluorescein angiography revealed delayed dye inflow into the nasal choroidal hemisphere that is supplied by the short posterior ciliary artery. The following day, the patient’s visual acuity improved to 20/20. Soft exudates around the optic disc increased during observation and gradually disappeared. His hemodynamic parameters revealed subclavian steal syndrome as examined by cervical ultrasonography and digital subtraction angiography. We speculate that his transient blindness was due to ophthalmic artery spasms. In this particular case, spasms of the ophthalmic artery and occlusion of the short posterior ciliary artery occurred simultaneously. As the short posterior ciliary artery branches from the ophthalmic artery, the anatomical location of the lesion might be near the branching of both arteries.

Transient visual acuity loss after spine surgery in prone position: A case report and literature review

2020 ◽  
Author(s):  
Jun Xiong ◽  
Guiling Liang ◽  
Liang Hu ◽  
Wei Chen ◽  
Jie Deng ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Prone Position ◽  
Spine Surgery ◽  
Visual Loss ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Efficacious Treatment ◽  
Retinal Artery ◽  
Visual Acuity Loss

Abstract Background: Visual loss after spine surgery in prone position is disastrous postoperative complication because it is almost irreversible. Meamwhile, there is no optimal treatments and recommended peofessional guidelines. Case presentation: A 43 years old male patient complained visual loss after spine surgery in prone position. Immediate ophthalmic consultation undoubtedly considered central retinal artery occlusion, therefore combined therapies were administered including neurotrophy, anticoagulation, vasodilation and adequate fluid infusion, followed by hyperbaric oxygen treatment. After active treatment, his visual acuity recovered from postoperative 5 hours gradually. Conclusion: Because there is shortage of efficacious treatment against visual loss after spine surgery in prone position, the best method avoiding this complication is to pay great attention and prevent it.

scholarly journals Transient visual acuity loss after spine surgery in the prone position: a case report and literature review

2020 ◽  
Vol 48 (9) ◽  
pp. 030006052095227
Author(s):  
Jun Xiong ◽  
Guiling Liang ◽  
Liang Hu ◽  
Wei Chen ◽  
Jie Deng ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Prone Position ◽  
Spine Surgery ◽  
Visual Loss ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Retinal Artery ◽  
Visual Acuity Loss ◽  
Professional Guidelines

Visual loss after spine surgery in the prone position is a disastrous postoperative complication because it is almost irreversible. Additionally, the optimal treatments and recommended professional guidelines for visual loss after spine surgery are deficient. A 43-year-old man developed visual loss after spine surgery in the prone position. Immediate ophthalmic consultation confirmed central retinal artery occlusion. Therefore, combined therapies were administered, including neurotrophy, anticoagulation, vasodilation, and adequate fluid infusion, followed by hyperbaric oxygen treatment. After active treatment, his visual acuity gradually recovered from 5 hours postoperatively and continued to improve thereafter. We reviewed the literature on postoperative visual loss with a focus on spine surgery in the prone position. Because the etiology of this complication is complex and has few effective treatments, the best method for its avoidance is to pay close attention to preventing it during surgery.

scholarly journals Visual Improvement after Intra-Arterial Thrombolysis for Central Retinal Artery Occlusion Does Not Correlate with Time to Treatment

2016 ◽  
Vol 5 (3-4) ◽  
pp. 131-139 ◽  
Author(s):  
Paul S. Page ◽  
Alexander C. Cambon ◽  
Robert F. James
Keyword(s):  
Visual Acuity ◽  
Symptom Onset ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
Time To Treatment ◽  
Visual Improvement ◽  
Retinal Artery ◽  
Arterial Thrombolysis

Background: Intra-arterial thrombolysis (IAT) for the treatment of acute central retinal artery occlusion (CRAO) has demonstrated variable results for improving visual acuity and remains controversial. Despite limited evidence, time from symptom onset to thrombolysis is believed to be an important factor in predicting visual improvement after IAT. Methods: A comprehensive review of the literature was conducted and individual subject level data were extracted from relevant studies. From these, a secondary analysis was performed. Initial and final logarithm of the minimum angle of resolution (logMAR) scores were either abstracted directly from relevant studies or converted from provided Snellen chart scores. Change in logMAR scores was used to determine overall treatment efficacy. Results: Data on 118 patients undergoing IAT from five studies were evaluated. Median logMAR improvement in visual acuity was -0.400 (p < 0.001). There was no significant association between logMAR change and time to treatment when time (hours) was described as a continuous variable or described categorically [0-4, 4-8, 8-12, 12+ h; or 0-6, 6-12, 12+ h]. Conclusion: The visual improvement observed in this series had no relationship to the time from symptom onset to treatment with IAT. This suggests that patients may have the possibility for improvement even with delayed presentation to the neurointerventionalist. Other factors, such as completeness of retinal occlusion, may be more important than time to treatment. Additional studies to determine optimal patient selection criteria for the endovascular treatment of acute CRAO are needed.

scholarly journals Central Retinal Artery Occlusion after Filler Injection for Upper Lid Retraction

2021 ◽  
Vol 62 (11) ◽  
pp. 1560-1564
Author(s):  
Ui Seo Park ◽  
Young Jin Kim ◽  
Jae Wook Yang
Keyword(s):  
Visual Acuity ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
Hand Motion ◽  
Filler Injection ◽  
Cherry Red Spot ◽  
Upper Lid ◽  
Retinal Artery

Purpose: We report a case of central retinal artery occlusion after filler injection for upper lid retraction. Diagnosis and treatment were performed to recover visual acuity and good results.Case summary: A 40-year-old woman presented to our clinic with upper lid retraction. She was diagnosed with hyperthyroidism and thyroid orbitopathy. She had been examined regularly at a local clinic since 2016. At the first visit, her visual acuity was 1.0/1.0 and the intraocular pressure was 19 mmHg, with no unusual findings in the anterior segment. Hyaluronic acid filler was injected into the medial part of the left upper lid. As soon as the needle was removed, she complained of blurry vision and visual impairment. This was followed by the development of a relative afferent pupillary defect; her visual acuity was hand motion at 30 cm. After 5 minutes, we performed wide fundus imaging and optical coherence tomography, which revealed retinal artery occlusion and a cherry-red spot, along with inner retina hyperreflectivity. Under a diagnosis of central retinal artery occlusion, we performed anterior chamber paracentesis, intravenous mannitol and acetazole injection, and an ocular massage. Approximately 1.5 hours after filler injection, retinal artery reperfusion and loss of the cherry red spot were observed and, after about 3 hours, her vision had recovered to 1.0 from hand motion at 30 cm.Conclusions: Central retinal artery occlusion after filler injection, when diagnosed promptly, can be treated by anterior chamber paracentesis, intravenous mannitol and acetazole injection, and ocular massage.

scholarly journals Internal limiting membrane detachment in acute central retinal artery occlusion: a novel prognostic sign seen on OCT

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Ramesh Venkatesh ◽  
Chaitra Jayadev ◽  
Akhila Sridharan ◽  
Arpitha Pereira ◽  
Nikitha Gurram Reddy ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Central Retinal Artery Occlusion ◽  
Internal Limiting Membrane ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
Retinal Layer ◽  
Vitreous Opacities ◽  
Retinal Artery ◽  
Group 2

Abstract Background To present a series of acute central retinal artery occlusion (CRAO) cases showing internal limiting membrane detachment (ILMD) on optical coherence tomography (OCT) and to describe the possible etiopathogenesis and outcomes associated with it. Methods Demographic and OCT features of patients with acute CRAO were analysed retrospectively. OCT parameters noted were posterior vitreous opacities, ILMD, inner retinal layer stratification, hyperreflectivity and thickening, cystoid macular edema, neurosensory detachment. Eyes were grouped into Group (1) CRAO with ILMD; Group (2) CRAO with no ILMD. Results A total of 28 eyes of acute CRAO who had undergone OCT scans at the time of the acute episode were identified. Out of these, ILMD was noted in 5 eyes. The study findings suggested that cases of acute CRAO with ILMD are associated with poor presenting visual acuity and have more severe signs of retinal hypoperfusion on OCT, like inner retinal thickening, inner retinal hyperreflectivity and loss of inner retinal layer stratification. Patients with ILMD have poor final visual acuity and thinning and atrophy or necrosis of the inner retinal layers. Conclusion ILMD can occur in acute CRAO due to total retinal artery occlusion and severe retinal hypoperfusion. The presence of ILMD on OCT can be considered a sign of poor prognosis in cases of acute CRAO. Trial registration: Not applicable.

scholarly journals Visual Loss Caused by Central Retinal Artery Occlusion After Bee Sting: A Case Report

2021 ◽  
Vol 8 ◽  
Author(s):  
Zhitao Su ◽  
Zhongli Hu ◽  
Lei Wang ◽  
Yao Wang ◽  
Xiaoyun Fang ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Visual Loss ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
Optic Disk ◽  
Bee Sting ◽  
Systemic Treatments ◽  
Retinal Artery

A bee sting can lead to an extremely rare case of visual loss caused by central retinal artery occlusion (CRAO). In this study, we report a 66-year-old healthy woman who was referred to our Eye Center because of visual loss, which had occurred after bee sting 2 days earlier. The visual acuity was no light perception (NLP). Examination revealed left eyelid edema, conjunctiva congestion, a 6-mm fixed pupil, scattered retinal hemorrhage, and white-appearing ischemic retina with one small area of the normal-appearing retina temporal to the optic disk. Fundus fluorescein angiography revealed CRAO with one cilioretinal artery sparing. Her systemic workup revealed hypersensitivity, hypercoagulable state, myocardial damage, and hepatic damage. After topical and systemic treatments, the visual acuity was still NLP with improved systemic workup. In brief, CRAO may occur after bee sting, and visual acuity should be monitored for early diagnosis.

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