Efficacy of Thrombolytic, Laser, Anti-VEGF and Surgical Treatment in Retinal Artery Occlusion and Related Complications

Artery Occlusion ◽

Arterial Blood Flow ◽

Treatment Methods ◽

Arterial Blood ◽

Anti Vegf ◽

Retinal artery occlusion (RAO) is characterized by the sudden interruption of arterial blood flow in the retinal circulation and subsequent ischemic retinal injury. Retinal artery occlusion is divided into sub-forms such as central retinal artery occlusion (CRAO) and branch retinal artery occlusion (BRAO). Patients with CRAO present with sudden, painless, and unilateral complete visual loss, while patients with BRAO present with partial or complete visual loss in relation to visual field damage. Thromboembolism is the non-arteritic form and the predominant mechanism in RAO; the form defined as arteritic RAO constitutes approximately 5% and is associated with inflammatory changes. Retinal artery occlusion is an ophthalmologic emergency where the most important factor in its treatment is time and the early interventions are very important. The conventional treatment methods aim to restore perfusion by reducing intraocular pressure or vasodilatation and to reduce ischemic damage. In order to achieve more accurate results in treatment, methods to directly open the obstruction caused by thromboembolism have been tried. These include thrombolytic therapy, laser, and surgical treatment. At the same time, studies on the efficacy of anti-VEGF treatment in emerging complications are ongoing.

Central Retinal Artery Occlusion Associated with Atrial Septal Defect: A Case Report

Journal of Lumbini Medical College ◽

10.22502/jlmc.v7i1.281 ◽

2019 ◽

Vol 7 (1) ◽

Cited By ~ 1

Author(s):

Sharad Gupta ◽

Manoj Aryal ◽

Yogita Rajbhandari ◽

Ajay Adhikari ◽

Vinit Kumar Kamble ◽

...

Keyword(s):

Atrial Septal Defect ◽

Septal Defect ◽

Young Female ◽

Artery Occlusion ◽

Central Retinal Artery ◽

Arterial Blood Flow ◽

Arterial Blood ◽

Introduction: Central retinal artery occlusion (CRAO) is characterized by sudden obstruction of the arterial blood flow in the retinal circulation with consequent ischemic damage to the retina resulting in vision loss. An interesting case of unilateral CRAO associated with atrial septal defect (ASD) in a young female is reported here. Case: A young female presented to emergency department with history of sudden and painless loss of vision in her right eye for one day. Her visual acuity at the time of presentation was perception of light in right eye and 6/6 in left eye. On examination, anterior segments of both the eyes were normal. However, relative afferent pupillary defect was positive in her right eye. On fundus examination, right eye showed pale retina and cherry red spot whereas left eye was unremarkable. Findings were suggestive of right eye CRAO. Ocular massage was done and oral carbonic anhydrase inhibitor was given. Patient was referred to a cardiologist for further evaluation and establishment of the etiology. All tests were within reference limit except a large ASD (secundum type with left to right shunt) with a diameter of 28 mm was revealed on transthoracic echocardiogram. Conclusion: The association between ASD and CRAO is rare. Intracardiac shunts through defect may predispose the disease. Detailed cardiac evaluation is mandatory to rule out possible causes to prevent ocular or systemic embolic events and associated morbidity.

A Cardiac Pseudoaneurysm as a Thromboembolic Source: Acute Visual Loss due to Cardiac Emboli

Case Reports in Cardiology ◽

10.1155/2020/3192957 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Fernando Montenegro Sá ◽

Sara I. L. Fernandes ◽

Rita J. R. Carvalho ◽

Luís M. G. Santos ◽

José A. S. Antunes ◽

...

Keyword(s):

Aortic Valve ◽

Visual Loss ◽

Transoesophageal Echocardiography ◽

Artery Occlusion ◽

Central Retinal Artery ◽

Acute Visual Loss ◽

History Of ◽

Acute visual loss is rarely caused by a heart condition. This manuscript transcribes a case report of a 36-year-old patient with a 2-year history of aortic valve replacement due to bicuspid aortic valve endocarditis that presents to the emergency department with an acute right eye visual loss. After ophthalmologic investigation identified a central retinal artery occlusion, a transthoracic echocardiography was performed to search for a possible cardiac embolus, despite the patient presenting INR values of 2-2.5 for the last year. A mitral-aortic intervalvular fibrosa pseudoaneurysm was identified. A transoesophageal echocardiography was then performed, identifying a small clot logged inside the pseudoaneurysm that protruded to the left ventricle outflow tract. After INR-adjusted warfarin treatment to levels between 3 and 4, the pseudoaneurysm was surgically closed. This is a rare case since the likely source of embolism to the central retinal artery was the thrombus logged inside the pseudoaneurysm despite a standardly accepted therapeutic INR.

Central Retinal Artery Occlusion Associated with Sildenafil Overdose

Case Reports in Ophthalmological Medicine ◽

10.1155/2021/2006271 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

Mojtaba Abrishami ◽

Seyedeh Maryam Hosseini ◽

Hamid Mohseni ◽

Majid Razavi ◽

Amir Ghaffarian Mashhadi Nejad ◽

...

Keyword(s):

Visual Loss ◽

Artery Occlusion ◽

Central Retinal Artery ◽

Limited Area ◽

Predisposing Factor ◽

Cherry Red Spot ◽

Retinal Artery ◽

The Right

Background. To report a patient with central retinal artery occlusion (CRAO) associated with sildenafil overdose. Case Presentation. A forty-two-year-old male presented three hours after sudden painless visual loss in the right eye. BCVA was counting finger in two meters, and relative afferent pupillary defect was positive. Fundus examination revealed retinal whiteness except in a limited area of papillomacular bundle and cherry red spot. He consumed two 100 mg film-coated sildenafil tablet (Vizarsin, Krka, d.d., Novo mesto, Slovenia) twelve hours apart, and the last one was six hours before visual loss. He was diagnosed with CRAO with cilioretinal artery sparing. Although we did not find any emboli, anterior chamber paracentesis was done. Four weeks later, BCVA improved to 20/80, with resolving of retinal edema. Cardiovascular, carotid arteries, and neurologic evaluations were negative for any predisposing factor. Conclusion. CRAO is a vision threatening condition that might be associated with the overdose of sildenafil.

Vision loss in giant cell arteritis

Practical Neurology ◽

10.1136/practneurol-2021-002972 ◽

2021 ◽

pp. practneurol-2021-002972

Author(s):

Laura Donaldson ◽

Edward Margolin

Keyword(s):

Optic Nerve ◽

Optic Neuropathy ◽

Visual Loss ◽

Artery Occlusion ◽

Central Retinal Artery ◽

Ischaemic Optic Neuropathy ◽

Ciliary Arteries ◽

Almost two-thirds of patients with giant cell arteritis (GCA) develop ocular symptoms and up to 30% suffer permanent visual loss. We review the three most common mechanisms for visual loss in GCA, describing the relevant ophthalmic arterial anatomy and emphasising how ophthalmoscopy holds the key to a rapid diagnosis. The short posterior ciliary arteries supply the optic nerve head, while the central retinal artery and its branches supply the inner retina. GCA has a predilection to affect branches of posterior ciliary arteries. The most common mechanism of visual loss in GCA is anterior arteritic optic neuropathy due to vasculitic involvement of short posterior ciliary arteries. The second most common cause of visual loss in GCA is central retinal artery occlusion. When a patient aged over 50 years has both anterior ischaemic optic neuropathy and a central retinal artery occlusion, the diagnosis is GCA until proven otherwise, and they should start treatment without delay. The least common culprit is posterior ischaemic optic neuropathy, resulting from vasculitic involvement of the ophthalmic artery and its pial branches. Here, the ophthalmoscopy is normal acutely, but MR imaging of the orbits usually shows restricted diffusion in the optic nerve.