A clinical case of central retinal artery occlusion after pneumonia caused by SARS-CoV-2 (COVID-19)

In domestic and foreign medical periodical literature, highlighting the problem of ophthalmopathology against the background of coronavirus infection, the lesion of the anterior segment of the eye is most often described. It is extremely hard to find reports about pathology of the retina, optic nerve or central parts of the visual analyzer. However, it is widely acknowledged that there is a high risk of developing coagulopathy against the background of COVID-19 infection, which leads to occlusion and thrombosis of retinal vessels, ischemic neuropathies. The problem of irreversible loss of vision due to circulatory disorders of the retinal vessels was urgent even before the wide spread of coronavirus infection due to the high prevalence of atherosclerosis, hypertension and type 1 and 2 diabetes in the population. Also, it is widely known that occlusions and thrombosis of retinal vessels can be formidable harbingers of the developing life-threatening conditions. Knowledge about the high risk of vascular ophthalmopatology against the background of a previous COVID-19 infection by the primary echelon ophthalmologists, early diagnostics and treatment of ischemic conditions of the posterior segment of the eye will reduce the frequency of irreversible vision loss due to these diseases, secondary neovascular glaucoma cases, and will also help to send patients to the multidisciplinary hospitals in a timely manner for the prevention of fatal complications of coagulopathy. The article provides a brief overview of foreign literary sources regarding the history of outbreaks of coronavirus infection in the world, as well as possible ways of damage to the organ of vision by the coronavirus. A clinical case of damage to the vascular bed of the retina in both eyes due to coagulopathy against the background of pneumonia caused by COVID-19 is presented, which is actual due to the low illumination of similarly cases.

Download Full-text

Central Retinal Artery Occlusion as a Complication in Invasive Aesthetic Cosmetology: a Clinical Case

Ophthalmology in Russia ◽

10.18008/1816-5095-2021-3-584-590 ◽

2021 ◽

Vol 18 (3) ◽

pp. 584-590

Author(s):

V. N. Trubilin ◽

E. G. Poluninа ◽

V. V. Kurenkov ◽

K. V. Chinenova ◽

A. S. Yatsun ◽

...

Keyword(s):

Clinical Case ◽

Vision Loss ◽

Central Retinal Artery Occlusion ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Central Retinal Artery ◽

Ophthalmological Examination ◽

Arterial Blood ◽

Retinal Artery ◽

The Right

Central retinal artery occlusion (CRAO) is a relatively rare form of acute retinal arterial ischemia that results in unilateral vision loss. The incidence of transient vision loss is estimated at approximately 14 cases per 100,000 people per year, while the incidence of CRAO is approximately 1–2 cases per 100,000 people. In the foreign literature, there are more and more publications about the development of iatrogenic vision loss after dermal cosmetic injections. We would like to present a clinical case that should be interesting for both practicing ophthalmologists and specialists of related specialties, especially for cosmetologists. Patient M., 42 years old, came to us with complaints of a sharp loss of vision to light perception in the right eye. From the anamnesis, it is known that two hours earlier, the patient was injected into the temporal region (plasma, anesthetic, epinephrine) in the cosmetology office. Lightning-fast deterioration of vision occurred at the time of the drug administration. The patient arrived at the clinic 2 hours after the onset of complaints. We conducted an ophthalmological examination of the patient, the diagnosis was made: occlusion of the central artery of the retina of the right eye, and immediately performed standard emergency therapy. After a course of conservative treatment in an ophthalmological hospital, a persistent decrease in visual functions and a violation of arterial blood circulation in the central retinal artery basin remained. The progressive increase in the number of minimally invasive cosmetic procedures in recent years, in particular, injections of dermal fillers, is associated with rare, but often fatal complications. This clinical situation should attract the attention of practicing ophthalmologists and cosmetologists to these types of complications, and improve the quality and speed of emergency medical care.

Download Full-text

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.

Download Full-text

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.

Download Full-text

Migrainous infarction of the eye: Two cases of monocular ischemic complications associated with retinal migraine

Cephalalgia ◽

10.1177/03331024211056286 ◽

2021 ◽

pp. 033310242110562

Author(s):

Nikita Chhabra ◽

Chia-Chun Chiang ◽

Marie A Di Nome ◽

Odette Houghton ◽

Rachel E Carlin ◽

...

Keyword(s):

Visual Loss ◽

Vision Loss ◽

Central Retinal Artery Occlusion ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Monocular Vision ◽

Ischemic Optic Neuropathy ◽

Migrainous Infarction ◽

Ischemic Complications ◽

History Of

Background Retinal migraine is defined by fully reversible monocular visual phenomena. We present two cases that were complicated by permanent monocular vision deficits. Cases A 57-year-old man with history of retinal migraine experienced persistent monocular vision loss after one stereotypical retinal migraine, progressing to finger-count vision over 4 days. He developed paracentral acute middle maculopathy that progressed to central retinal artery occlusion. A 27-year-old man with history of retinal migraine presented with persistent right eye superotemporal scotoma after a retinal migraine. Relative afferent pupillary defect and superotemporal visual field defect were noted, consistent with ischemic optic neuropathy. Conclusion Retinal migraine can complicate with permanent monocular visual loss, suggesting potential migrainous infarction of the retina or optic nerve. A thorough cerebrovascular evaluation must be completed, which was unrevealing in our cases. Acute and preventive migraine therapy may be considered in retinal migraine patients, to mitigate rare but potentially permanent visual loss.

Download Full-text

Central retinal artery and vein occlusion as a complication of persistent hyaloid artery – a case report

BMC Ophthalmology ◽

10.1186/s12886-020-01702-8 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Mirjana Bjeloš ◽

Ana Križanović ◽

Mladen Bušić ◽

Biljana Kuzmanović Elabjer

Keyword(s):

Case Report ◽

Central Retinal Artery Occlusion ◽

Retinal Artery Occlusion ◽

Neovascular Glaucoma ◽

Artery Occlusion ◽

Central Retinal Artery ◽

Venous Stasis ◽

Vein Occlusion ◽

Arterial Inflow ◽

Retinal Artery

Abstract Background In this case report, we present for the first time central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO) as a complication of persistent hyaloid artery (PHA). Case presentation In August 2019, a six-year-old male patient manifested right eye (RE) excessive tearing, conjunctival injection and pain. On examination, RE demonstrated light perception and intraocular pressure of 36 mmHg. The diagnoses of neovascular glaucoma, CRVO and CRAO were established as affirmed with fluorescein angiography (FA). PHA was not reported. Extensive work-up and family history were unremarkable. The child was born on term after uncomplicated twin pregnancy. In December 2019, he was referred to our Centre. Transillumination revealed fully dilated, non-reactive RE pupil, clear lens and tubular remnant of HA containing blood cells in its lumen freely rotating in the anterior vitreous. Conclusions PHA results from failure of apoptosis during gestation. It can easily be observed during the red reflex screening at neonatal wards. We hypothesized that PHA twisting led to torsion of the residual primordial common bulb, branching off to HA and CRA with CRAO occurring first. The consequential CRVO presumably advanced by venous stasis due to decrease in arterial inflow. Liquid vitreous appears as early as 4 years of age enabling PHA to whirl more freely. Thus, in case of PHA, we advocate FA to be performed and if connection with retinal artery is proven, parents should be informed on the possible devastating complications and prompt surgical treatment should be considered.

Download Full-text

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.

Download Full-text

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.

Download Full-text

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.

Download Full-text

Intra-Arterial Thrombolytic Therapy Is Not a Therapeutic Option for Filler-Related Central Retinal Artery Occlusion

Facial Plastic Surgery ◽

10.1055/s-0037-1621730 ◽

2018 ◽

Vol 34 (03) ◽

pp. 325-329 ◽

Cited By ~ 8

Author(s):

Yi-Chun Chen ◽

Hsiu-Mei Wu ◽

Shih-Jen Chen ◽

Han-Jui Lee ◽

Jiing-Feng Lirng ◽

...

Keyword(s):

Thrombolytic Therapy ◽

Vision Loss ◽

Therapeutic Option ◽

Central Retinal Artery Occlusion ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Central Retinal Artery ◽

Dermal Filler ◽

Facial Filler ◽

Retinal Artery

AbstractCosmetic facial filler-related central retinal artery occlusion (CRAO) is a devastating complication of facial hyaluronic acid (HA) injection and can be managed by intra-arterial thrombolytic therapy (IATT). The authors report on a 20-year-old woman who developed unilateral CRAO due to facial HA injection and who, despite prompt IATT, lost vision. A review of the related literature found 14 other female patients who developed cosmetic facial filler-related CRAO and accepted IATT management. In no case was vision loss clinically improved. IATT is not an effective preventive treatment of dermal filler-associated CRAO. The authors suggest careful preprocedural patient selection to prevent this complication.

Download Full-text