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Yelne P, Mathurkar S, Kumar S. Concomitant Two-Temporal Cilioretinal Artery Occlusion (CLRAO) With Impending Central Retinal Vein Occlusion (CRVO) in a Young Adolescent With Protein C Deficiency: A Rare Case. Cureus 2024; 16:e60615. [PMID: 38894807 PMCID: PMC11185852 DOI: 10.7759/cureus.60615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 05/19/2024] [Indexed: 06/21/2024] Open
Abstract
We report structural changes in the retina of an adolescent diagnosed with the concomitant two temporal cilioretinal artery occlusion (CLRAO) with impending central retinal vein occlusion (CRVO) along with mild protein C deficiency. An 18-year-old girl came to the emergency room with sudden onset painless loss of vision in her right eye. On comprehensive ophthalmic examination, she had a pale superior-temporal retina with spongy macular edema corresponding to two temporal CLRAO and blurred disc margins with mild disc swelling and mild tortuosity of retinal veins all over the retina with few superficial hemorrhages in the right eye corresponding to impending CRVO. Optimal coherence tomography (OCT) showed thickening of the nerve fiber layer in the superior-temporal quadrant involving some part of the macula in the right eye. Perimetry showed a right eye visual field defect in the inferior nasal quadrant. Her coagulation profile was normal but her autoimmune profile was suggestive of mild protein C deficiency. Immediately she was started on anticoagulants. After one month, her visual acuity improved from finger counting close to face to 6/9 with treatment. Over a period of one month, retinal and OCT changes recovered with the same perimetry findings as earlier. This case shows how prompt treatment resulted in dramatic improvement in the form of good visual outcomes.
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Affiliation(s)
- Pallavi Yelne
- Medicine, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | | | - Sunil Kumar
- Medicine, Jawaharlal Nehru Medical College, Wardha, IND
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2
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Venkatesh R, Mangla R, Parmar Y, Chitturi SP, Yadav NK, Chhablani J. Abnormal retinal vessel filling in central retinal artery occlusion. Clin Exp Optom 2024:1-5. [PMID: 38184849 DOI: 10.1080/08164622.2023.2298781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 12/18/2023] [Indexed: 01/09/2024] Open
Abstract
CLINICAL RELEVANCE Central retinal artery occlusion (CRAO) is an ophthalmic emergency with a poor prognosis. Several initial CRAO presentation factors can influence the final visual outcome. Fluorescein angiography filling of retinal vessels in CRAO has not been studied in great detail. BACKGROUND The aim of this paper is to study the aberrant filling of the retinal vessels on fluorescein angiography in patients with CRAO and understand its clinical relevance. METHODS Cases of CRAO diagnosed between June 2017 and May 2022 and who had undergone a fundus fluorescein angiography were included. Comparisons were made between the cases with and without aberrant filling of the retinal vessel. RESULTS Twenty-two eyes of 22 patients (14 males and 8 females) with CRAO underwent fluorescein angiography. Ages of the patients ranged from 18 to 73 years, while time interval between development of acute onset vision problems and presentation to the retinal clinic ranged from a minimum of 1 day to a maximum of 30 days. Snellen visual acuity at presentation ranged from perception of light (PL +) to 6/6. On fluorescein angiography, aberrant flow of the fluorescein dye into the retinal vein was observed in four of the 22 (18%) eyes with CRAO. All these cases showed a patient's temporal cilioretinal artery. The cases with aberrant filling of the retinal vessels showed a better presenting visual acuity (6/6-6/60), lesser severity of inner retinal damage and a better final visual acuity (6/6-6/60) compared to CRAO cases without aberrant filling. CONCLUSION Aberrant filling of the retinal vein can be seen on fluorescein angiography in eyes with CRAO and a patent temporal cilioretinal artery. Such eyes with aberrant retinal vessel filling have a better visual prognosis.
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Affiliation(s)
- Ramesh Venkatesh
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, India
| | - Rubble Mangla
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, India
| | - Yash Parmar
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, India
| | | | - Naresh Kumar Yadav
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, India
| | - Jay Chhablani
- Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, Pittsburg, PA, USA
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Padhy SK, Sahu S. Cilioretinal Artery Occlusion Following Diagnostic Lumbar Puncture in a Patient of Idiopathic Intracranial Hypertension. J Neuroophthalmol 2023; 43:e175-e176. [PMID: 35234678 DOI: 10.1097/wno.0000000000001491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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4
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Vitiello L, Salerno G, Coppola A, Abbinante G, Gagliardi V, Pellegrino A. Simultaneous Branch Retinal Artery and Central Retinal Vein Occlusion Improved with No Ocular Therapy: A Case Report. Tomography 2023; 9:1745-1754. [PMID: 37736992 PMCID: PMC10514818 DOI: 10.3390/tomography9050139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/17/2023] [Accepted: 09/18/2023] [Indexed: 09/23/2023] Open
Abstract
A rarely described condition known as branch retinal artery occlusion (BRAO) with concurrent obstruction of the central retinal vein (CRVO) is characterized by diffuse retinal hemorrhages, dilated and tortuous retinal veins, macular and disc edema, cotton wool spots, and a generalized delay in arteriovenous transit on fluorescein angiography, together with a retinal whitening in the area of the affected retinal arterial branch. Although BRAO and CRVO may share underlying systemic risk factors, the pathogenesis of combined BRAO + CRVO is still unknown. We present a BRAO + CRVO case report concerning a 63-year-old white male who came to our observation complaining of sudden vision loss in his right eye. An increased risk for thrombotic event was revealed in this case, and the patient improved only with systemic anticoagulant therapy and in the absence of ocular therapy. We also explain all the clinical findings that are detectable using different diagnostic devices and analyze the scientific literature for other, similar clinical cases.
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Affiliation(s)
- Livio Vitiello
- Eye Unit, “Luigi Curto” Hospital, Azienda Sanitaria Locale Salerno, Polla, 84035 Salerno, Italy
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Hayreh SS, Hayreh SB. Uveal vascular bed in health and disease: lesions produced by occlusion of the uveal vascular bed and acute uveal ischaemic lesions seen clinically. Paper 2 of 2. Eye (Lond) 2023; 37:2617-2648. [PMID: 37185956 PMCID: PMC10482881 DOI: 10.1038/s41433-023-02417-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 05/06/2023] Open
Abstract
From studies on postmortem anatomical descriptions of the uveal vascular bed, it was generally concluded that occlusion of PCA or its branches should not produce an ischemic lesion. However, in vivo studies have recorded that the PCAs and their branches, right down to the terminal choroidal arterioles, and the choriocapillaris, have a segmental distribution in the choroid, and that PCAs and choroidal arteries function as end-arteries. This explains the basis of the occurrence of isolated inflammatory, ischemic, metastatic, and degenerative choroidal lesions, which are usually localized. Thus, in vivo studies have completely revolutionized our concept of the uveal vascular bed in disease.
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Affiliation(s)
- Sohan Singh Hayreh
- Departments of Ophthalmology and Visual Scence, College of Medicine, University of Iowa, Iowa City, 52242, USA
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Riazi-Esfahani H, Ebrahimiadib N, Hamzeh N, Fadakar K, Khalili Pour E. Henle fiber layer hemorrhage associated with combined central retinal vein occlusion and cilioretinal artery occlusion: a case report. J Med Case Rep 2023; 17:355. [PMID: 37598197 PMCID: PMC10440029 DOI: 10.1186/s13256-023-04100-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/24/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND The purpose of this study is to describe a patient who experienced simultaneous central retinal vein and cilioretinal artery occlusions, as well as perifoveal hemorrhage in the Henle fiber. CASE PRESENTATION A 67-year-old Iranian woman presented with a 3-day history of reduced vision in her left eye. Venous tortuosity and retinal hemorrhage were observed in the retina, together with whitened regions around the fovea, consistent with the diagnosis of central retinal vein occlusion in conjunction with cilioretinal artery occlusion. In structural and en face optical coherence tomography, star-shaped hemorrhages were observed around the fovea, which looked hyperreflective in the Henle fiber layer. CONCLUSIONS We present a case of central retinal vein occlusion exacerbated by cilioretinal occlusion and hemorrhage in the Henle fiber layer. The hemorrhage is most likely the result of increased intraluminal pressure in the deep capillary plexus.
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Affiliation(s)
- Hamid Riazi-Esfahani
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Kargar Street, Tehran, Iran
| | - Nazanin Ebrahimiadib
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Kargar Street, Tehran, Iran
| | - Nikoo Hamzeh
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Kargar Street, Tehran, Iran
| | - Kaveh Fadakar
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Kargar Street, Tehran, Iran
| | - Elias Khalili Pour
- Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Kargar Street, Tehran, Iran.
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Pinna A, Zinellu A, Serra R, Boscia G, Ronchi L, Dore S. Combined Branch Retinal Artery and Central Retinal Vein Occlusion: A Systematic Review. Vision (Basel) 2023; 7:51. [PMID: 37606497 PMCID: PMC10443287 DOI: 10.3390/vision7030051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/11/2023] [Accepted: 07/26/2023] [Indexed: 08/23/2023] Open
Abstract
We performed a systematic review and analyzed the current available data on branch retinal artery occlusion (BRAO) with simultaneous central retinal vein obstruction (CRVO), a rarely described occurrence. MEDLINE/PubMed and ISI Web of Sciences searches were performed according to MOOSE guidelines. Studies were considered eligible if they (1) described patients with simultaneous BRAO + CRVO and (2) had been published in peer-reviewed journals. We initially identified 239 records from databases. Ultimately, only 19 reports met the selection criteria. Twenty-nine patients (15 men, 14 women; mean age 43 ± 15 years) were analyzed. Seventeen (59%) patients presented vascular risk factors. Mean visual acuity at onset and final visual outcome were 20/83 and 20/45, respectively, an insignificant improvement. Vision improved in 48% of cases. A marked heterogeneity in treatment approach was found. Eight (28%) patients received no therapy, whereas for 21 (72%) a large variety of topical and/or systemic drugs was given. In the treated group, mean visual acuity at onset and final visual outcome were 20/90 and 20/44, respectively, a not statistically significant improvement. Results suggest that combined BRAO + CRVO occurs at a younger age than isolated BRAO or CRVO. At present, there is insufficient evidence to support any specific management to improve vision in simultaneous BRAO + CRVO.
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Affiliation(s)
- Antonio Pinna
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy;
- Ophthalmology Unit, Azienda Ospedaliero-Universitaria di Sassari, 07100 Sassari, Italy;
| | - Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (A.Z.); (R.S.)
| | - Rita Serra
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (A.Z.); (R.S.)
| | - Giacomo Boscia
- Eye Clinic Section, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy;
| | - Lorenza Ronchi
- Ophthalmology Unit, Azienda Ospedaliero-Universitaria di Sassari, 07100 Sassari, Italy;
| | - Stefano Dore
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy;
- Ophthalmology Unit, Azienda Ospedaliero-Universitaria di Sassari, 07100 Sassari, Italy;
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Romano F, Lamanna F, Gabrielle PH, Teo KYC, Battaglia Parodi M, Iacono P, Fraser-Bell S, Cornish EE, Nassisi M, Viola F, Agarwal A, Samanta A, Chhablani J, Staurenghi G, Invernizzi A. Update on Retinal Vein Occlusion. Asia Pac J Ophthalmol (Phila) 2023; 12:196-210. [PMID: 36912792 DOI: 10.1097/apo.0000000000000598] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/11/2022] [Indexed: 03/14/2023] Open
Abstract
Retinal vein occlusion represents the second leading cause of retinal vascular disorders, with a uniform sex distribution worldwide. A thorough evaluation of cardiovascular risk factors is required to correct possible comorbidities. The diagnosis and management of retinal vein occlusion have changed tremendously in the last 30 years, but the assessment of retinal ischemia at baseline and during follow-up examinations remains crucial. New imaging techniques have shed light on the pathophysiology of the disease and laser treatment, once the only therapeutic option, is now only one of the possible approaches with antivascular endothelial growth factors and steroid injections being preferred in most cases. Nowadays long-term outcomes are better than those achievable 20 years ago and yet, many new therapeutic options are under development, including new intravitreal drugs and gene therapy. Despite this, some cases still develop sight-threatening complications deserving a more aggressive (sometimes surgical) approach. The purpose of this comprehensive review is to reappraise some old but still valid concepts and to integrate them with new research and clinical data. The work will provide an overview of the disease's pathophysiology, natural history, and clinical features along with a detailed discussion on the advantages of multimodal imaging and of the different treatment strategies with the aim of providing retina specialists with the most updated knowledge in the field.
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Affiliation(s)
- Francesco Romano
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Francesca Lamanna
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | | | - Kelvin Y C Teo
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Department of Ophthalmology, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Maurizio Battaglia Parodi
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pierluigi Iacono
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Samantha Fraser-Bell
- Department of Ophthalmology, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Elisa E Cornish
- Department of Ophthalmology, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Marco Nassisi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Ophthalmological Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Viola
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Ophthalmological Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Aniruddha Agarwal
- Eye Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, US
- Department of Ophthalmology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Anindya Samanta
- Department of Ophthalmology and Visual Sciences, Texas Tech University Health Sciences Center, Lubbock, TX, US
| | - Jay Chhablani
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
- Department of Ophthalmology, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
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9
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Bahar MM, Ghalandarpoor-Attar SN, Shabani A, Hantoushzadeh S, Tabatabaei SA, Ghalandarpoor-Attar SM. Idiopathic combined retinal vessels occlusion in a pregnant woman: a case report. J Med Case Rep 2022; 16:191. [PMID: 35568885 PMCID: PMC9107689 DOI: 10.1186/s13256-022-03421-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 04/22/2022] [Indexed: 11/29/2022] Open
Abstract
Background Ocular vascular occlusion is an extremely rare event, especially in the young population. This diagnosis is always associated with active systemic diseases in young adults and needs thrombophilia workup. Nevertheless, we present the case of a pregnant woman suffering from idiopathic combined central retinal vein and cilioretinal artery occlusion. Case presentation A 36-year-old pregnant Iranian woman at the 36th week of her second pregnancy complained of subacute unilateral painless decreased vision of her left eye. She had experienced a transient vision loss that lasted several minutes, but attacks gradually became more frequent and finally persistent over a several-day period. Finally combined central retinal vein and cilioretinal artery occlusion was established. Her visual acuity improved to 4/10 in a month without any ocular intervention except for a short duration of prophylactic dose enoxaparin, and the acuity reached 8/10 without any complications in the third month follow-up visit. At 1 year follow-up, the visual acuity had not changed and no macular edema was seen. Conclusions Ocular vascular occlusion is extremely rare among young adults, and even rarer among pregnant women. According to this, any suspected retinal vascular event in this population should raise suspicion for underlying diseases such as hypertension, diabetes, autoimmune diseases, migraine, preeclampsia syndrome, and thrombophilia. However, as seen in this presented case, idiopathic ocular vascular occlusion events can occur also.
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Affiliation(s)
| | | | - Azadeh Shabani
- Obstetrics and Gynecology Department, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sedigheh Hantoushzadeh
- Obstetrics and Gynecology Department, Imam Khomeini Hospital Complex, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Tabatabaei
- Farabi Eye Hospital, Retinal Services, Tehran University of Medical Sciences, Tehran, Iran
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Jürgens L, Yaici R, Schnitzler CM, Fleitmann AK, Roth M, Schröder K, Guthoff R. Retinal vascular occlusion in pregnancy: three case reports and a review of the literature. J Med Case Rep 2022; 16:167. [PMID: 35449024 PMCID: PMC9022314 DOI: 10.1186/s13256-022-03369-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 02/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background Retinal arterial occlusive events in young patients are rare. However, because of physiological multifactorial adaptations during pregnancy, retinal vascular occlusive disease may occur spontaneously. In addition, a patent foramen ovale is a risk factor for an ischemic thromboembolic event. Since fluorescein angiography, a central tool in the evaluation of these occlusions, should be avoided during pregnancy, optical coherence tomography angiography, a novel technique, offers a good opportunity for visualizing vascular perfusion of retinal tissue. Case presentation Here we present a case series of three patients (Caucasian, nonsmoker) who visited our clinic owing to acute visual impairment and central scotoma. Using regular optical coherence tomography and optical coherence tomography angiography, retinal vascular occlusions were detected, thus initiating the evaluation of systemic risk factors. We report two patients (30 and 32 years old) who developed cilioretinal artery occlusion but whose etiology differed: one was of thromboembolic origin associated with patent foramen ovale, while the other was caused by hemodynamic blockade secondary to central retinal vein occlusion. In both cases, optical coherence tomography angiography revealed reperfusion of the cilioretinal artery occlusion. However, transient ischemia led to retinal atrophy after a few weeks. In the third patient (32 years old), 8 weeks after onset of scotoma, optical coherence tomography angiography revealed atrophy of the middle layers and impaired perfusion in the deep capillary plexus, and thus a paracentral acute middle maculopathy was diagnosed. All patients regained normal visual acuity and had otherwise uncomplicated pregnancies, and laboratory blood tests did not reveal any defects or alterations. Conclusions As shown here, optical coherence tomography angiography enables risk-free imaging of retinal vessel perfusion during pregnancy. Together with regular optical coherence tomography, it allows one to predict functional outcome according to the existing retinal occlusion-related atrophy.
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Affiliation(s)
- L Jürgens
- Department of Ophthalmology, University of Duesseldorf, Moorenstr. 5, D-40225, Düsseldorf, Germany
| | - R Yaici
- Department of Ophthalmology, University of Duesseldorf, Moorenstr. 5, D-40225, Düsseldorf, Germany
| | - C M Schnitzler
- Department of Ophthalmology, University of Duesseldorf, Moorenstr. 5, D-40225, Düsseldorf, Germany
| | - A K Fleitmann
- Department of Obstetrics and Gynaecology, University of Duesseldorf, Düsseldorf, Germany
| | - M Roth
- Department of Ophthalmology, University of Duesseldorf, Moorenstr. 5, D-40225, Düsseldorf, Germany
| | - K Schröder
- Department of Ophthalmology, University of Duesseldorf, Moorenstr. 5, D-40225, Düsseldorf, Germany
| | - R Guthoff
- Department of Ophthalmology, University of Duesseldorf, Moorenstr. 5, D-40225, Düsseldorf, Germany.
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Markakis MZ, Bontzos G, Nodarakis M, Dimopoulos D, Zacharioudakis A, Koutentakis P. Spontaneous Visual Acuity Recovery After Cilioretinal Artery Occlusion Combined With Central Retinal Vein Occlusion in a Young Patient. Cureus 2022; 14:e23476. [PMID: 35494954 PMCID: PMC9038575 DOI: 10.7759/cureus.23476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 11/05/2022] Open
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Parvus M, Pakravan M, Charoenkijkajorn C, Edmond J, Spinetti A, Lee AG. Meningococcal B vaccine–associated papillophlebitis and cilioretinal artery occlusion. Can J Ophthalmol 2022; 57:e182-e184. [DOI: 10.1016/j.jcjo.2022.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/14/2021] [Accepted: 01/09/2022] [Indexed: 11/26/2022]
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13
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Jønsson LH, Larsen M, Olsen EM, Skovgaard AM, Munch IC. Incidence of cilioretinal arteries in 11- to 12-year-old children and association with maternal smoking during pregnancy: the Copenhagen Child Cohort 2000 Eye Study. Acta Ophthalmol 2021; 99:e1162-e1167. [PMID: 33576174 DOI: 10.1111/aos.14780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 01/13/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE To estimate the incidence of cilioretinal arteries in a Danish child cohort and associations with birth parameters. METHODS The population-based Copenhagen Child Cohort 2000 Eye Study examined 1406 children aged 11-12 years. Colour fundus images of both eyes were graded for cilioretinal arteries in the three categories large temporal (defined as supplying the central macula), small temporal and nasal. Data on maternal smoking during pregnancy, gestational ageand birth weight were obtained from the Danish Medical Birth Registry. RESULTS A total of 463/1338 (35%) children were found to have one or more cilioretinal arteries per child. Large temporal cilioretinal arteries were present in 280/1338 (21%) of children and were associated with tobacco smoking during pregnancy, being present in 70/246 (28%) of children with mothers who were smoking during pregnancy, but only in 191/990 (19%) of children whose mothers did not smoke during pregnancy (p = 0.0022). After adjustments for potential confounders, the odds ratio of having one or more large temporal cilioretinal arteries was 1.72 (CI95% 1.19-2.47; p = 0.0035) in the smoking versus none smoking category. No other associations with birth parameters were found. CONCLUSION Cilioretinal arteries were present in more than one third of 11- to 12-year-old Danish children. Large temporal cilioretinal arteries were found in one fifth of children and were associated with maternal smoking during pregnancy. This finding suggests that the intrauterine environment may have an impact on the development of retinal vessels during foetal life.
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Affiliation(s)
- Lise Halmø Jønsson
- Institute of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Michael Larsen
- Institute of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
- Department of Ophthalmology Rigshospitalet Copenhagen Denmark
| | - Else Marie Olsen
- Institute of Public Health Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
- Centre for Clinical Research and Prevention Bispebjerg and Frederiksberg Hospital Frederiksberg Denmark
| | - Anne Mette Skovgaard
- National Institute of Public Health University of Southern Denmark Copenhagen Denmark
| | - Inger Christine Munch
- Centre for Clinical Research and Prevention Bispebjerg and Frederiksberg Hospital Frederiksberg Denmark
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14
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Diener R, Leclaire MD, Eckardt F, Lauermann JL, Alnawaiseh M, Eter N, Treder M. CILIORETINAL ARTERIES INFLUENCE OPTIC NERVE HEAD, PERIPAPILLARY, AND MACULAR VESSEL DENSITIES IN HEALTHY EYES: An Optical Coherence Tomography Angiography Study. Retina 2021; 41:2399-2406. [PMID: 33990118 DOI: 10.1097/iae.0000000000003208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND/PURPOSE To analyze the influence of a cilioretinal artery (CRA) on macular and peripapillary vessel density in healthy eyes as measured using optical coherence tomography angiography. METHODS A total of 83 eyes of 83 patients were included in this study. Optical coherence tomography angiography was performed using the RTVue XR Avanti with AngioVue (Optovue Inc). The macula was imaged with a 3 × 3-mm scan, whereas for the optic nerve head a 4.5 × 4.5-mm scan was taken. Optical coherence tomography angiography images of the optic nerve head were screened for the presence of a CRA. RESULTS In 31 eyes, a CRA was detected (37.3%). The vessel density in eyes with a CRA was significantly lower within the optic nerve head (P = 0.005) but higher in the peripapillary capillary network (P < 0.001) and (whole en face) macular superficial capillary plexus (P = 0.025), when compared with eyes with no CRA. CONCLUSION Our findings reveal that in eyes with a CRA, the vessel density in the peripapillary and macular superficial capillary plexus is increased, whereas the optic nerve head perfusion (as indicated by vessel density in the inside disk region) is decreased. This has to be considered when analyzing quantitative optical coherence tomography angiography parameters in scientific and clinical applications.
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Affiliation(s)
- Raphael Diener
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany; and
| | - Martin D Leclaire
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany; and
| | - Franziska Eckardt
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany; and
| | - Jost L Lauermann
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany; and
| | - Maged Alnawaiseh
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany; and
- Department of Ophthalmology, Fulda Medical Center, Fulda, Germany
| | - Nicole Eter
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany; and
| | - Maximilian Treder
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany; and
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15
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Ozsaygılı C, Bayram N, Ozdemir H. Cilioretinal artery occlusion with paracentral acute middle maculopathy associated with COVID-19. Indian J Ophthalmol 2021; 69:1956-1959. [PMID: 34146068 PMCID: PMC8374807 DOI: 10.4103/ijo.ijo_563_21] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
The purpose of the study is to describe cilioretinal artery (CILRA) occlusion that is presumed to be associated with COVID-19 without severe respiratory distress and inform ophthalmologists of unusual ocular presentations of COVID-19. Here, we present the first case of a patient with isolated CILRA occlusion and paracentral acute middle maculopathy (PAMM) after recently polymerase chain reaction-proven COVID-19. A 26-year-old female patient presented with a visual field defect in her left eye for 2 days and decreased vision compared to her right eye. It was learned that the patient had a laboratory-proven COVID-19 infection with mild respiratory symptoms that did not require hospitalization 2 weeks ago. Fundus examination revealed retinal edema in the left eye area supplied by the CILRA. Spectral-domain optical coherence tomography revealed a prominent hyperreflective band at the inner nuclear layer level. These findings led us to the diagnosis of isolated CILRA occlusion and PAMM associated with recent COVID-19. CILRA occlusion and PAMM could be associated with the inflammatory and procoagulant condition caused by the SARS-CoV-2 infection.
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Affiliation(s)
- Cemal Ozsaygılı
- Kayserı City Training and Research Hospital, Department of Ophthalmology, Kocasinan, Kayseri, Turkey
| | - Nurettin Bayram
- Kayserı City Training and Research Hospital, Department of Ophthalmology, Kocasinan, Kayseri, Turkey
| | - Hakan Ozdemir
- Department of Ophthalmology, Bezmialem Vakıf University Faculty of Medicine, İstanbul, Turkey
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16
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Kim YN, Shin JW, Park YJ, Lee JY, Kim JG, Yoon YH, Kim YJ. Glaucoma as a prognostic factor of central retinal vein occlusion: visual and anatomical outcomes and occurrence of ischaemic central retinal vein occlusion. Acta Ophthalmol 2021; 99:e523-e530. [PMID: 33113286 DOI: 10.1111/aos.14608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 08/09/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare the functional and anatomical outcomes of central retinal vein occlusion (CRVO) according to the presence of glaucoma before the onset of CRVO, and to assess whether pre-existing glaucoma affects the prognosis of CRVO in terms of development and conversion to ischaemic CRVO. METHODS In this retrospective cohort study, patients with treatment-naïve CRVO were enrolled between December 2009 and February 2019. The patients were classified into two groups according to the presence of pre-existing primary open-angle glaucoma at CRVO diagnosis. We reviewed medical records regarding basic demographics, ocular characteristics and treatments. The effects of pre-existing glaucoma on the occurrence of ischaemic CRVO were also investigated using Cox proportional hazard models. RESULTS Of 166 eyes from 166 patients, 26 (15.7%) had pre-existing glaucoma. The pre-existing glaucoma group revealed significantly older (69.4 ± 13.3 versus 56.5 ± 15.9) and lower BCVA at baseline (1.06 ± 0.75 versus 0.64 ± 0.58, logMAR) and final visits (1.56 ± 1.35 versus 0.64 ± 0.48, logMAR) (all p < 0.05) than non-glaucomatous group. In terms of perfusion status of CRVO, the glaucoma group showed higher incidence of ischaemic CRVO (30.8% versus 5.3%, p = 0.052) at initial and last visits as well as more disorganization of retinal inner layers (DRIL) at 3 months (76.0% versus 49.6%, p = 0.015). Pre-existing glaucoma (hazard ratio (HR) = 2.141, p = 0.014), lower vision at baseline (HR = 2.071, p = 0.001) and DRIL at 3 months (HR = 2.905, p = 0.011) were significant risk factors for the occurrence of ischaemic CRVO. CONCLUSION In patients with CRVO, pre-existing glaucoma was associated with poorer visual and anatomical outcomes, and played as a significant risk factor for the development and conversion to ischaemic CRVO with lower vision and presence of DRIL at early phase of CRVO.
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Affiliation(s)
- You Na Kim
- Department of Ophthalmology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Joong Won Shin
- Department of Ophthalmology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Yu Jeong Park
- Department of Ophthalmology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Joo Yong Lee
- Department of Ophthalmology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - June Gone Kim
- Department of Ophthalmology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Young Hee Yoon
- Department of Ophthalmology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Yoon Jeon Kim
- Department of Ophthalmology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
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17
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Liu Y, Chan MF, Stewart JM. Pulsating Cilioretinal Artery From Ocular Hypertension. JAMA Ophthalmol 2021; 139:e204108. [PMID: 33595610 DOI: 10.1001/jamaophthalmol.2020.4108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Yingna Liu
- University of California, San Francisco, Department of Ophthalmology, San Francisco.,Zuckerberg San Francisco General Hospital and Trauma Center, Department of Ophthalmology, San Francisco, California
| | - Matilda F Chan
- University of California, San Francisco, Department of Ophthalmology, San Francisco.,Zuckerberg San Francisco General Hospital and Trauma Center, Department of Ophthalmology, San Francisco, California.,Francis I. Proctor Foundation, University of California, San Francisco, San Francisco
| | - Jay M Stewart
- University of California, San Francisco, Department of Ophthalmology, San Francisco.,Zuckerberg San Francisco General Hospital and Trauma Center, Department of Ophthalmology, San Francisco, California
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18
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Khallouli A, Khelifi K, Saidane R, Choura R, Maalej A, Sassi RB. Hyperbaric oxygen treatment of central retinal vein occlusion with cilioretinal artery occlusion secondary to hormonal treatment: Case report and review. Diving Hyperb Med 2020; 50:431-436. [PMID: 33325028 DOI: 10.28920/dhm50.4.431-436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/16/2020] [Indexed: 11/05/2022]
Abstract
INTRODUCTION This report describes a case of central retinal vein occlusion (CRVO) and cilioretinal artery occlusion (CLRAO) after hormonal treatment for induction of ovulation that was successfully treated with hyperbaric oxygen. CASE REPORT A 48 year-old woman was admitted to our department for sudden blurred vision in her left eye. The patient had a history of 3-months hormonal treatment for induction of ovulation. The best corrected visual acuity was 7/10 (20/32) in the left eye and 10/10 (20/20) in the right eye. Fundus examination of the left eye revealed flame-shaped haemorrhages, whitening of the retina along the distribution of cilioretinal artery and tortuous retinal veins. Fluorescein angiography confirmed the combination of a non-ischaemic CRVO with CLRAO. The patient was treated with a 2 h session of hyperbaric oxygen at 253 kPa (2.5 atmospheres absolute) once daily for a total of 30 sessions. Best corrected visual acuity improved to 10/10 (20/20) in the left eye. CONCLUSIONS CRVO and CLRAO are both occlusive disorders. HBOT is a safe low-cost treatment modality that can be beneficial in some ocular pathologies. It can maintain oxygenation of the retina through the choroidal blood supply, decrease oedema and preserve compromised tissue adjacent to the ischaemic area.
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Affiliation(s)
- Asma Khallouli
- Department of Ophthalmology, Military Hospital of Tunis, Tunisia
| | - Khaled Khelifi
- Department of Ophthalmology, Military Hospital of Tunis, Tunisia
| | - Rahma Saidane
- Department of Ophthalmology, Military Hospital of Tunis, Tunisia
| | - Racem Choura
- Department of Ophthalmology, Military Hospital of Tunis, Tunisia.,Corresponding author: Dr Racem Choura, Department of Ophthalmology, Military Hospital of Tunis, Mont Fleury- 1008, Tunisia,
| | - Afef Maalej
- Department of Ophthalmology, Military Hospital of Tunis, Tunisia
| | - Raja Ben Sassi
- Department of Hyperbaric Oxygen Therapy, Military Hospital of Tunis, Tunisia
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19
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[Combined retinal vascular occlusion after overexertion in sport at a young age : An unusual case as interdisciplinary challenge]. Ophthalmologe 2020; 118:944-947. [PMID: 32930866 DOI: 10.1007/s00347-020-01222-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/11/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
This case report presents a unilateral visual impairment after overexertion in sport at a young age. A combined central retinal vein occlusion with a cilioretinal arterial branch occlusion was diagnosed. This clinical picture has been described in case series and does not usually have an embolic etiology. In the cardiovascular clarification a patent foramen ovale was found, which was surgically closed.
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20
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Lee JS, Kim JY, Jung C, Woo SJ. Iatrogenic ophthalmic artery occlusion and retinal artery occlusion. Prog Retin Eye Res 2020; 78:100848. [PMID: 32165219 DOI: 10.1016/j.preteyeres.2020.100848] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 01/19/2023]
Abstract
Iatrogenic ophthalmic artery occlusion (IOAO) is a rare but devastating ophthalmic disease that may cause sudden and permanent visual loss. Understanding the possible etiologic modalities and pathogenic mechanisms of IOAO may prevent its occurrence. There are numerous medical etiologies of IOAO, including cosmetic facial filler injection, intravascular procedures, intravitreal gas or drug injection, retrobulbar anesthesia, intraarterial chemotherapy in retinoblastoma. Non-ocular surgeries and vascular events in arteries that are not directly associated with the ophthalmic artery, can also cause IOAO. Since IOAO has a limited number of treatment modalities, which lead to poor final visual prognosis, it is imperative to acknowledge the information regarding medical procedures that are etiologically associated with IOAO. We accumulated all searchable and available IOAO case reports (our cases and previous reported cases from the literature), classified them according to their mechanisms of pathogenesis, and summarized treatment options and responses of each of the causes. Various sporadic cases of IOAO can be categorized into three mechanisms as follows: intravascular event, orbital compartment syndrome, and increased intraocular pressure. Embolic IOAO, which is considered the primary cause of the condition, was classified into three subgroups according to the pathway of embolic movement (retrograde pathway, anterograde pathway, pathway through collateral channels). Despite the practical limitations of treating spontaneous (non-iatrogenic) retinal artery occlusion, this article will contribute in predicting and improving the prognosis of IOAO by recognizing the treatable factors. Furthermore, it is expected to provide clues to future research associated with the treatment of retinal artery occlusion.
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Affiliation(s)
- Jong Suk Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jun Yup Kim
- Department of Neurology, Seoul National University College of Medicine, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Cheolkyu Jung
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
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21
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Arrigo A, Knutsson KA, Rajabjan F, Augustin VA, Bandello F, Parodi MB. Combined central retinal vein occlusion and branch retinal artery occlusion treated with intravitreal dexamethasone implant: A case report. Eur J Ophthalmol 2020; 31:NP74-NP76. [PMID: 32106703 DOI: 10.1177/1120672120909181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To report a case of combined central retinal vein occlusion and branch retinal artery occlusion in a 51-year-old male with a very good response to dexamethasone implant therapy. METHODS This is a descriptive case report based on data from clinical records, patient observation and follow-ups, and analysis of acquired diagnostic tests. RESULTS A 51-year-old man presented with sudden vision loss and best-corrected visual acuity of 20/40 in his left eye. A pale inferotemporal arterial branch course area along with increased vascular tortuosity, retinal hemorrhages, optic disk swelling, and macular edema were observed on slit lamp biomicroscopy examination. Right eye was normal. Diagnosis of combined central retinal vein occlusion and branch retinal artery occlusion in left eye was confirmed by fluorescein angiography and color fundoscopy, respectively. Optical coherence tomography confirmed subretinal fluid and intraretinal cysts with a prominent middle-limiting membrane in the inner synaptic portion of the outer plexiform layer, corresponding to areas of paracentral acute middle maculopathy. Intravitreal dexamethasone implant was administered to the patient. One month later, visual acuity was recovered with complete absorption of macular edema. Functional and anatomical stabilization were confirmed after 24 months. CONCLUSION Combined central retinal vein occlusion and branch retinal artery occlusion represents a rare condition, with variable functional outcomes due to the long-term complications such as macular edema. We hypothesize that prompt diagnosis and immediate intravitreal corticosteroid implant therapy reduced macular edema, thus contributing to arterial perfusion improvement, which in this case lead to a full sustainable recovery with limited functional and anatomical damage.
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Affiliation(s)
- Alessandro Arrigo
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Karl Anders Knutsson
- Cornea and Ocular Surface Unit, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Firuzeh Rajabjan
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Victor A Augustin
- Department of Ophthalmology, University Hospital Erlangen, Erlangen, Germany
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Maurizio Battaglia Parodi
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
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22
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da Fonseca MLG, Souza A, Pereira MB, Vianna RNG, Cravo LM, Demori E. Paracentral acute middle maculopathy associated with hypoperfusion of the cilioretinal artery and impending central retinal vein occlusion. Eur J Ophthalmol 2019; 31:NP46-NP48. [PMID: 31744321 DOI: 10.1177/1120672119885787] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Paracentral acute middle maculopathy is defined as ischemia of the deep retinal layers. We report an unusual case of paracentral acute middle maculopathy associated with hypoperfusion of the cilioretinal artery and impending central retinal vein occlusion in a young male with no previous comorbidities. CASE REPORT The patient was a 22-year-old male complaining about a sudden loss of vision in his right eye upon awakening. Fundus examination showed optic disk edema, and increased tortuosity of the retinal veins and a few retinal hemorrhages. Swept-source optical coherence tomography found a hyperreflective band that was more pronounced at the level of the inner nuclear layer of the retina. These findings led us to a diagnosis of paracentral acute middle maculopathy associated with hypoperfusion of the cilioretinal artery. CONCLUSION The finding of paracentral acute middle maculopathy on optical coherence tomography demands a proper investigation of its cause, because it has an intimate association with vascular diseases and is not an isolated entity. In our case, we could not identify the etiology of the unilateral event in this young male, although dehydration due to alcohol consumption and subsequent hypotension might have played a role in this ischemic event.
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Affiliation(s)
| | - Amanda Souza
- Retina and Vitreous Unit, Federal Fluminense University, Niterói, Brazil
| | | | | | | | - Erika Demori
- Retina and Vitreous Unit, Federal Fluminense University, Niterói, Brazil
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23
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Clinical Features of Combined Central Retinal Artery and Vein Occlusion. J Ophthalmol 2019; 2019:7202731. [PMID: 31687201 PMCID: PMC6803735 DOI: 10.1155/2019/7202731] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 09/17/2019] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To describe the clinical features of combined central retinal artery and vein occlusion (CCRAVO). METHODS This retrospective study included 33 admitted patients (33 eyes) who had CCRAVO. Clinical data, such as age, gender, best-corrected visual acuity (BCVA), intraocular pressure (IOP), findings on fundus color photography and fundus fluorescein angiography (FFA), and information about follow-up, were collected and analyzed. RESULTS The age of the patients with CCRAVO ranged from 22 to 78 years, with a mean of 48.8 ± 14.1 years. At presentation, BCVA of the involved eyes ranged from no light perception (NLP) to 20/20. In addition, 45.5% (15/33) of the eyes had BCVA of finger counting (FC) or below, whereas 12.1% (4/33) had BCVA of 20/60 or above. The IOP was lower in the involved eyes than in the fellow eyes (15.0 ± 3.0 mmHg vs. 16.4 ± 2.3 mmHg, p=0.03). Ophthalmoscopic examination showed changes in both central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO), including retinal hemorrhage, retinal ischemic whitening, optic disc hyperemia and/or edema, venous dilation and tortuosity, cotton wool spot (CWS), and Roth's spot. FFA showed prolonged arm-to-retina time (ART) and retinal arteriovenous passage time (RAP) (17.1 ± 4.9 s and 12.1 ± 8.8 s, respectively). Capillary nonperfusion (CNP) was seen in 21 eyes (63.6%), and in 14 (42.2%) of these, CNP was larger than 10 disc areas. At 2 to 3 weeks after presentation, BCVA improved in 23 eyes (71.9%) and further deteriorated in 5 eyes (15.6%). Retinal ischemic whitening improved in more than half of the eyes, whereas retinal hemorrhage increased in nearly half of the eyes. Follow-up ranged from 6 to 56 months. Seven patients were lost to follow-up. At final follow-up, six eyes had a visual acuity of 20/60 or greater, but 6 eyes had FC or worse. Four eyes developed neovascularization on follow-up. CONCLUSION CCRAVO is a sight-threatening entity. Manifestations of CRAO and CRVO can be seen simultaneously in the early stage of disease, and CRVO may play a more important role in the development of CCRAVO.
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24
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Unravelling the mechanism of combined cilioretinal artery and retinal vein occlusion: documentation of the oscillating blood flow column and a review of the literature. Can J Ophthalmol 2019; 54:e251-e254. [DOI: 10.1016/j.jcjo.2018.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 11/27/2018] [Indexed: 11/23/2022]
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25
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Schmidt-Erfurth U, Garcia-Arumi J, Gerendas BS, Midena E, Sivaprasad S, Tadayoni R, Wolf S, Loewenstein A. Guidelines for the Management of Retinal Vein Occlusion by the European Society of Retina Specialists (EURETINA). Ophthalmologica 2019; 242:123-162. [PMID: 31412332 DOI: 10.1159/000502041] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 07/10/2019] [Indexed: 11/19/2022]
Abstract
The high prevalence of cardiovascular disease particularly in the elderly population is associated with retinal vascular disease. Retinal vein occlusions represent severe disturbances of the hypoxia-sensitive neurosensory retina. Acute and excessive leakage leads to the diagnostic hallmarks of retinal hemorrhage and edema with substantial retinal thickening. Advanced diagnostic tools such as OCT angiography allow to evaluate retinal ischemia and identify the risk for late complications and will soon reach clinical routine besides fluorescein angiography. Accordingly, the duration of non-perfusion is a crucial prognostic factor requiring timely therapeutic intervention. With immediate inhibition of vascular leakage, anti-VEGF substances excel as treatment of choice. Multiple clinical trials with optimal potential for functional benefit or a lesser regenerative spectrum have evaluated aflibercept, ranibizumab, and bevacizumab. As retinal vein occlusion is a chronic disease, long-term monitoring should be individualized to combine maintenance with practicability. While steroids may be considered in patients with systemic cardiovascular risk, surgery remains advisable only for very few patients. Destructive laser treatment is an option if reliable monitoring is not feasible. Ophthalmologists are also advised to perform a basic systemic workup to recognize systemic concomitants. The current edition of the EURETINA guidelines highlights the state-of-the-art recommendations based on the literature and expert opinions in retinal vein occlusion.
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Affiliation(s)
| | | | - Bianca S Gerendas
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Edoardo Midena
- Department of Ophthalmology, University of Padua, Padua, Italy
| | - Sobha Sivaprasad
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Ramin Tadayoni
- Department of Ophthalmology, Lariboisière Hospital Paris, Paris, France
| | - Sebastian Wolf
- Department of Ophthalmology, Inselspital, University of Bern, Bern, Switzerland
| | - Anat Loewenstein
- Department of Ophthalmology Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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26
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Chan EW, Eldeeb M, Sun V, Thomas D, Omar A, Kapusta MA, Galic IJ, Chen JC. Disorganization of Retinal Inner Layers and Ellipsoid Zone Disruption Predict Visual Outcomes in Central Retinal Vein Occlusion. Ophthalmol Retina 2019; 3:83-92. [PMID: 30929820 DOI: 10.1016/j.oret.2018.07.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/08/2018] [Accepted: 07/16/2018] [Indexed: 05/24/2023]
Abstract
PURPOSE To assess the associations and predictive value of spectral-domain (SD) OCT inner and outer retinal structural parameters and visual acuity (VA) outcomes in macular edema (ME) secondary to central retinal vein occlusion (CRVO). DESIGN Retrospective, longitudinal cohort study. PARTICIPANTS Eighty-four patients with ME secondary to CRVO receiving pro re nata anti-vascular endothelial growth factor (VEGF) therapy at 3 tertiary-level retina referral centers. METHODS In all participants, VA, demographic and clinical parameters, and SD OCT images from baseline, 3 months, and 12 months were reviewed. Spectral-domain OCT-based morphologic features in the 1500-μm foveal zone were analyzed by masked graders for disorganization of the retinal inner layers (DRIL), ellipsoid zone (EZ) and external limiting membrane disruption, cone outer segment tip (COST) visibility, cysts, subretinal and intraretinal fluid, and epiretinal membranes. MAIN OUTCOME MEASURES Spectral-domain OCT-based retinal structural parameters and VA outcomes. RESULTS In multivariate analyses adjusting for baseline VA, worsening VA over 1 year was associated with 1-year increases in DRIL (point estimate, 0.06 per 100 μm; P < 0.001) and EZ disruption (0.07 per 100 μm; P = 0.023), but decreased COST visibility (-0.09 per 100 μm; P = 0.018). A 3-month increase in DRIL (0.05 per 100 μm; P = 0.003) and EZ disruption (0.10 per 100 μm; P < 0.001) were the only factors predicting VA worsening over 1 year, after controlling for baseline VA. A multivariate model including 3-month evolution in DRIL, EZ disruption, and VA accounted for 86.3% of variability in 1-year VA change. Absolute differences between predicted and actual 1-year VA were within 2 lines in 80.9%. When DRIL increased by 250 μm or more over 3 months, no eyes showed VA improvement of 1 line or more in 1 year. When EZ disruption decreased by 250 μm or more over 3 months, no eyes worsened by 1 line or more over 1 year. CONCLUSIONS Early recovery over 3 months in both DRIL and EZ parameters are key drivers of 1-year VA outcomes. Predictive models incorporating 3-month changes in DRIL and EZ disruption support their usefulness as potential robust determinants of future VA.
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Affiliation(s)
- Errol W Chan
- Department of Ophthalmology, McGill University, Montreal, Canada; Montreal Retina Institute, Montreal, Canada
| | | | - Vincent Sun
- Department of Ophthalmology, McGill University, Montreal, Canada
| | - Doneal Thomas
- CaMos Statistical Analyses Center, McGill University Health Centre Research Institute, Montreal, Canada
| | | | - Michael A Kapusta
- Department of Ophthalmology, McGill University, Montreal, Canada; Eye Health MD, Montreal, Canada
| | - Ivan J Galic
- Department of Ophthalmology, McGill University, Montreal, Canada; Montreal Retina Institute, Montreal, Canada
| | - John C Chen
- Department of Ophthalmology, McGill University, Montreal, Canada; Montreal Retina Institute, Montreal, Canada.
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27
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Christodoulou P, Katsimpris I. Treatment controversies in a rare case of a simultaneous branch retinal artery and vein occlusion secondary to hyperhomocysteinemia and hypertension. Int J Ophthalmol 2018; 11:2024-2026. [PMID: 30588441 PMCID: PMC6288539 DOI: 10.18240/ijo.2018.12.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 07/09/2018] [Indexed: 11/23/2022] Open
Affiliation(s)
- Panayiotis Christodoulou
- General Hospital of Patras "Agios Andreas", Ophthalmology Clinic, Kalavriton 37, Patras 26335, Greece
| | - Ioannis Katsimpris
- General Hospital of Patras "Agios Andreas", Ophthalmology Clinic, Kalavriton 37, Patras 26335, Greece
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28
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Pichi F, Fragiotta S, Freund KB, Au A, Lembo A, Nucci P, Sebastiani S, Gutierrez Hernandez JC, Interlandi E, Pellegrini F, Dolz-Marco R, Gallego-Pinazo R, Orellana-Rios J, Adatia FA, Munro M, Abboud EB, Ghazi N, Cunha Souza E, Amer R, Neri P, Sarraf D. Cilioretinal artery hypoperfusion and its association with paracentral acute middle maculopathy. Br J Ophthalmol 2018; 103:1137-1145. [PMID: 30257961 DOI: 10.1136/bjophthalmol-2018-312774] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/04/2018] [Accepted: 09/04/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To study the multimodal imaging findings of a large series of eyes with cilioretinal artery obstruction (CILRAO) and describe the systemic associations. METHODS Multicentre, retrospective chart review from 12 different retina clinics worldwide of eyes with CILRAO, defined as acute retinal whitening in the distribution of the cilioretinal artery, were identified. The clinical, systemic information and multimodal retinal imaging findings were collected and analysed. RESULTS A total of 53 eyes of 53 patients with CILRAO were included in the study. In 100% of eyes, fundus photography illustrated deep retinal whitening corresponding to the course of the cilioretinal artery. Twenty-eight patients (52.8%) presented with isolated CILRAO (baseline best-corrected visual acuity (BCVA) 20/50, final BCVA 20/25) associated with nocturnal hypotension, 23 patients (43.4%) with CILRAO secondary to central retinal vein occlusion (CRVO) (baseline BCVA 20/40, final BCVA 20/20) and two patients with CILRAO due to biopsy-proven giant cell arteritis (GCA) (baseline BCVA 20/175, final BCVA 20/75). With spectral domain optical coherence tomography (SD-OCT), a hyper-reflective band involving the inner nuclear layer (ie, paracentral acute middle maculopathy or PAMM) was noted in 51 eyes (28/28 eyes with isolated CILRAO and 23/23 eyes with CILRAO+CRVO) corresponding to the retinal whitening. In the two eyes with CILRAO+GCA, SD-OCT illustrated hyper-reflective ischaemia of both the middle and inner retina. CONCLUSIONS Isolated CILRAO and CILRAO secondary to CRVO are the result of hypoperfusion or insufficiency, rather than occlusion, of the cilioretinal artery and are associated with PAMM or selective infarction of the the inner nuclear layer. With GCA, there is complete occlusion of the cilioretinal artery producing ischaemia involving both the middle and inner retina associated with worse visual outcomes.
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Affiliation(s)
- Francesco Pichi
- Cleveland Clinic Abu Dhabi, Eye Institute, Abu Dhabi, United Arab Emirates .,Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Serena Fragiotta
- Vitreous Retina Macula Consultants of New York, New York City, New York, USA
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York City, New York, USA
| | - Adrian Au
- Stein Eye Institute, University of California, Los Angeles, California, USA.,Greater Los Angeles VA Healthcare Center, Los Angeles, California, USA
| | - Andrea Lembo
- San Giuseppe Hospital, University Eye Clinic, Milan, Italy
| | - Paolo Nucci
- San Giuseppe Hospital, University Eye Clinic, Milan, Italy
| | - Stefano Sebastiani
- University Eye Clinic of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | | | | | | | | | | | - Jorge Orellana-Rios
- New York Eye and Ear Infirmary of Mount Sinai, New York City, New York, USA.,University of Antofagasta, Antofagasta, Chile
| | | | - Monique Munro
- Mitchell Eye Center and Rockyview, Calgary, Alberta, Canada
| | - Emad B Abboud
- Cleveland Clinic Abu Dhabi, Eye Institute, Abu Dhabi, United Arab Emirates
| | - Nicola Ghazi
- Lebanese American University, Medical Center, Rizk Hospital, Beirut, Lebanon
| | | | | | - Piergiorgio Neri
- Cleveland Clinic Abu Dhabi, Eye Institute, Abu Dhabi, United Arab Emirates
| | - David Sarraf
- Stein Eye Institute, University of California, Los Angeles, California, USA.,Greater Los Angeles VA Healthcare Center, Los Angeles, California, USA
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Martel A, Martiano D, Fisch AL, Pinon F, Baillif S. Combined central retinal vein and cilioretinal artery occlusion related to acute intra-ocular pressure rise of previously unknown pigment dispersion syndrome. J Fr Ophtalmol 2018; 41:e161-e164. [PMID: 29673629 DOI: 10.1016/j.jfo.2017.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 07/16/2017] [Accepted: 08/16/2017] [Indexed: 11/19/2022]
Affiliation(s)
- A Martel
- Department of ophthalmology, centre hospitalier universitaire (CHU) de Nice, 06100 Nice, France.
| | - D Martiano
- Department of ophthalmology, centre hospitalier universitaire (CHU) de Nice, 06100 Nice, France
| | - A-L Fisch
- Department of ophthalmology, centre hospitalier universitaire (CHU) de Nice, 06100 Nice, France
| | - F Pinon
- Department of ophthalmology, centre hospitalier universitaire (CHU) de Nice, 06100 Nice, France
| | - S Baillif
- Department of ophthalmology, centre hospitalier universitaire (CHU) de Nice, 06100 Nice, France
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Grzybowski A, Elikowski W, Gaca-Wysocka M. Cardiovascular risk factors in patients with combined central retinal vein occlusion and cilioretinal artery occlusion: Case report. Medicine (Baltimore) 2018; 97:e9255. [PMID: 29505511 PMCID: PMC5943110 DOI: 10.1097/md.0000000000009255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
RATIONALE To analyze cardiovascular risk factors and comorbidity of acute unilateral visual loss due to combined central retinal vein occlusion (CRVO) and cilioretinal artery occlusion (CLRAO). PATIENT CONCERNS Among patients with retinal vein or artery occlusion hospitalized at the Department of Ophthalmology between January 2011 and August 2017, subjects with combined CRVO/CLRAO were selected. All of them underwent ophthalmologic and cardiologic examination, including fluorescein angiography, optical coherence tomography, 12-lead electrocardiogram, transthoracic and transesophageal echocardiography, carotid Doppler sonography, cerebral magnetic resonance imaging, and a panel of laboratory tests. DIAGNOSES Four subjects with coexisting CRVO and CLRAO were found among 146 patients with retinal vein or artery occlusion. There were no other types of concomitance of CRVO and retinal artery occlusion. INTERVENTIONS All patients were treated with low molecular heparin in a full dose for 2 weeks, then with 1 mg/kg once daily for the next 2 weeks, followed by acetylsalicylic acid 75 mg/kg/d. Other medication included long-term statins, angiotensin-converting-enzyme inhibitor in 3 patients and beta-blocker in one patient. OUTCOMES All patients with CRVO/CLRAO presented multiple cardiovascular risk factors, including hypertension, obesity, hyperlipidemia, chronic nicotine addiction, and a positive family history of coronary artery disease or stroke. In all of them, echocardiography revealed left ventricular hypertrophy and atherosclerotic lesions in the descending aorta; in addition, 3 patients had insignificant atherosclerotic plaques in the carotid artery. Also, in 3 subjects, focal ischemic cerebral changes were diagnosed. LESSONS Patients with combined CRVO and CLRAO present numerous cardiovascular risk factors and abnormalities on imaging examinations, which should be routinely evaluated and treated.
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Affiliation(s)
- Andrzej Grzybowski
- Department of Ophthalmology, Poznań City Hospital, Poznań
- University of Warmia and Mazury, Olsztyn
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31
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Ravani R, Chawla R, Jain S, Kumar A. "Dye front reciprocation" in combined central retinal vein occlusion with cilioretinal artery infarction. Indian J Ophthalmol 2017; 65:1211-1212. [PMID: 29133654 PMCID: PMC5700596 DOI: 10.4103/ijo.ijo_552_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Raghav Ravani
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rohan Chawla
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Shreyans Jain
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Kida T. Mystery of Retinal Vein Occlusion: Vasoactivity of the Vein and Possible Involvement of Endothelin-1. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4816527. [PMID: 28904960 PMCID: PMC5585553 DOI: 10.1155/2017/4816527] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 07/13/2017] [Indexed: 01/24/2023]
Abstract
Retinal vein occlusion (RVO) is a common vascular disease of retina; however, the pathomechanism leading to RVO is not yet clear. In general, increasing age, hypertension, arteriosclerosis, diabetes mellitus, dyslipidemia, cardiovascular disorder, and cerebral stroke are systemic risk factors of RVO. However, RVO often occur in the unilateral eye and sometimes develop in young subjects who have no arteriosclerosis. In addition, RVO show different variations on the degrees of severity; some RVO are resolved without any treatment and others develop vision-threatening complications such as macular edema, combined retinal artery occlusion, vitreous hemorrhage, and glaucoma. Clinical conditions leading to RVO are still open to question. In this review, we discuss how to treat RVO in practice by presenting some RVO cases. We also deliver possible pathomechanisms of RVO through our clinical experience and animal experiments.
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Affiliation(s)
- Teruyo Kida
- Department of Ophthalmology, Osaka Medical College, Takatsuki, Japan
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33
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Bakri SS, Jomar D, Alsulaiman SM, Abouammoh MA. Combined cilioretinal artery and hemi-retinal vein occlusion in Sturge Weber syndrome: Expanding the clinical spectrum. Saudi J Ophthalmol 2017; 32:234-237. [PMID: 30224889 PMCID: PMC6137699 DOI: 10.1016/j.sjopt.2017.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 05/19/2017] [Accepted: 07/31/2017] [Indexed: 11/17/2022] Open
Abstract
A 9-year-old boy with the diagnosis of Sturge-Weber Syndrome, and port-wine stain involving the right side of the face, presented with acute visual loss of the right eye. Examination revealed a high intraocular pressure and a combined cilioretinal artery and inferior hemi-retinal vein occlusion in the right eye. Systemic work-up was negative. After controlling the intraocular pressure, gradual improvement of vision was noticed with simultaneous disappearance of signs of vascular occlusion.
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Affiliation(s)
- Sawsan S Bakri
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Deema Jomar
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Marwan A Abouammoh
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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34
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Sengupta S, Pan U. Combined branch retinal vein and branch retinal artery occlusion - clinical features, systemic associations, and outcomes. Indian J Ophthalmol 2017; 65:238-241. [PMID: 28440254 PMCID: PMC5426130 DOI: 10.4103/ijo.ijo_340_16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 03/13/2017] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Retinal vascular occlusions affecting both the arterial and venous systems are rare events. Combined branch retinal artery (BRAO) and vein (BRVO) occlusion are exceedingly rare and not well characterized. METHODS Six patients with combined BRAO and BRVO underwent a comprehensive eye examination, fundus fluorescein angiography, optical coherence tomography, and cardiovascular evaluation. RESULTS Mean age at presentation was 54 ± 7.8 years (range: 39-60), and five of the six were men. Patients had a combination of systemic comorbidities such as diabetes (5), hypertension (4), dyslipidemia (5), and hyperhomocysteinemia (1). All had unilateral combined occlusion characterized by narrowing and cattle tracking of blood in arteries and dilated tortuous veins in the involved quadrant. Fluorescein angiography demonstrated complete capillary drop out and a clear demarcation between the perfused and nonperfused retina. Presenting vision ranged from 6/9 to 1/60 Snellen's, and final vision depended on the macular perfusion status. All eyes were treated with angiography-guided sectoral laser photocoagulation, and three eyes required intravitreal bevacizumab due to macular edema or retinal neovascularization. CONCLUSIONS Combined BRAO and BRVO is rare, may have unique underlying pathogenetic mechanisms, is associated with multiple systemic comorbidities and can yield good visual outcome if macula remains well perfused.
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Affiliation(s)
| | - Utsab Pan
- Vitreoretina Services, Aravind Eye Hospital, Puducherry, India
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35
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Vodopivec I, Cestari DM, Rizzo JF. Management of Transient Monocular Vision Loss and Retinal Artery Occlusions. Semin Ophthalmol 2016; 32:125-133. [DOI: 10.1080/08820538.2016.1228417] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Ivana Vodopivec
- Massachusetts Eye and Ear Infirmary, Neuro-Ophthalmology Service, Boston, MA, USA
| | - Dean M. Cestari
- Massachusetts Eye and Ear Infirmary, Neuro-Ophthalmology Service, Boston, MA, USA
| | - Joseph F. Rizzo
- Massachusetts Eye and Ear Infirmary, Neuro-Ophthalmology Service, Boston, MA, USA
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36
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Capuano V, Sellam A, Miere A, Souied EH, Querques G. [Simultaneous cilioretinal artery and superior hemiretinal vein occlusions: What is the role of hyperhomocysteinemia?]. J Fr Ophtalmol 2016; 39:e279-e281. [PMID: 27745896 DOI: 10.1016/j.jfo.2015.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 10/23/2015] [Accepted: 11/12/2015] [Indexed: 11/27/2022]
Affiliation(s)
- V Capuano
- Department of Ophthalmology, University of Paris-Est-Creteil, centre hospitalier intercommunal de Creteil, 40, avenue de Verdun, 94000 Creteil, France
| | - A Sellam
- Department of Ophthalmology, University of Paris-Est-Creteil, centre hospitalier intercommunal de Creteil, 40, avenue de Verdun, 94000 Creteil, France
| | - A Miere
- Department of Ophthalmology, University of Paris-Est-Creteil, centre hospitalier intercommunal de Creteil, 40, avenue de Verdun, 94000 Creteil, France
| | - E H Souied
- Department of Ophthalmology, University of Paris-Est-Creteil, centre hospitalier intercommunal de Creteil, 40, avenue de Verdun, 94000 Creteil, France
| | - G Querques
- Department of Ophthalmology, University of Paris-Est-Creteil, centre hospitalier intercommunal de Creteil, 40, avenue de Verdun, 94000 Creteil, France.
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Abstract
PURPOSE To investigate systematically various fundus changes in branch retinal arteriolar occlusion (BRAO) and their natural history. METHODS The study comprised a cohort of 123 consecutive patients (135 eyes) with BRAO. Ophthalmic evaluation at initial and follow-up visits included recording visual acuity, visual fields, and detailed anterior segment and fundus examinations, and at initial visit fluorescein fundus angiography. RESULTS Probability estimates of retinal infarct still present were 89% 1 week after BRAO onset, 69% after 2 weeks, 67% after 3 weeks, 34% after 1 month, and 13% after 3 months. Optic disk pallor in the involved region developed in 21% within 1 month from onset, in 42% by 2 months, and in 65% by 3 months. Retinal arteriolar attenuation developed in 19% within 1 month from onset, and in 28% by 6 months. Arteriolar sheathing developed in 19% within 1 month and 25% within 12 months. Arteriolar emboli were found in 58%; 65% of those were at initial visit, in BRAO seen within 1 week of onset. CONCLUSION Most common cause of BRAO is embolism from the heart or carotid arteries; emboli usually get impacted at the arteriolar bifurcation. Migration and disappearance of retinal emboli is a common finding. Evolution of the retinal and optic disk changes is described.
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Sridhar J, Shahlaee A, Rahimy E, Hong BK, Khan MA, Maguire JI, Dunn JP, Mehta S, Ho AC. Optical Coherence Tomography Angiography and En Face Optical Coherence Tomography Features of Paracentral Acute Middle Maculopathy. Am J Ophthalmol 2015; 160:1259-1268.e2. [PMID: 26386158 DOI: 10.1016/j.ajo.2015.09.016] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 09/10/2015] [Accepted: 09/10/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To characterize the optical coherence tomography (OCT) angiography, en face OCT, and microperimetry features of paracentral acute middle maculopathy in both the acute phase and after resolution, and to propose a classification of distinct subtypes of this entity. DESIGN Retrospective observational case series. METHODS Clinical histories, high-resolution digital color imaging, spectral-domain OCT images, fluorescein angiography, OCT angiography images, and en face OCT images of 16 patients with paracentral acute middle maculopathy were evaluated. Microperimetry was available in 6 patients. RESULTS The most common referring diagnoses were isolated branch retinal arterial occlusion (5/16), combined central retinal vein and cilioretinal artery occlusion (4/16), and isolated central retinal vein occlusion (4/16). All patients demonstrated hyperreflective plaque-like lesions at the level of the inner nuclear layer on spectral-domain OCT, with no fluorescein angiographic correlate. OCT angiography demonstrated variable areas of capillary dropout within the superficial and deep retinal capillary plexi in these areas. En face OCT highlighted confluent areas of middle retina hyperreflectivity corresponding to these lesions. Three distinct en face OCT patterns were observed: arteriolar, fern-like, and globular. Microperimetry demonstrated relative scotomas mapping to the area of middle retinal hyperreflectivity seen on en face OCT. CONCLUSIONS Paracentral acute middle maculopathy may be best evaluated with the use of en face OCT imaging, which corresponds to subjective and objective visual field defects. En face OCT appearance may be used to classify paracentral acute maculopathy into distinct subtypes.
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40
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Kumar V, Chandra P, Kumar A. Central retinal vein occlusion with cillioretinal artery occlusion in hyperhomocysteinemia. BMJ Case Rep 2015; 2015:bcr-2015-212259. [PMID: 26315361 DOI: 10.1136/bcr-2015-212259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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41
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Cilioretinal Artery Territory Infarction Associated With Papilledema in a Patient With Neurofibromatosis Type 2. J Neuroophthalmol 2015; 36:58-60. [PMID: 26295608 DOI: 10.1097/wno.0000000000000279] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Cilioretinal artery territory infarction can occur in isolation or in association with other vascular compromise of the retinal circulation. Our patient, an 18-year-old woman with neurofibromatosis type 2, developed a cilioretinal artery territory infarction in the setting of papilledema. Our case, together with one previous report, suggests that cilioretinal artery territory infarction in the context of papilledema, although rare, is a real entity.
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Abstract
PURPOSE To investigate systematically the retinal and optic disk changes in central retinal vein occlusion (CRVO) and their natural history. METHODS This study comprised 562 consecutive patients with CRVO (492 nonischemic [NI-CRVO] and 89 ischemic CRVO [I-CRVO] eyes) seen within 3 months of onset. Ophthalmic evaluation at initial and follow-up visits included recording visual acuity, visual fields, and detailed anterior segment and fundus examinations and fluorescein fundus angiography. RESULTS Retinal and subinternal limiting membrane hemorrhages and optic disk edema in I-CRVO were initially more marked (P < 0.0001) and took longer to resolve (P < 0.015) than that in NI-CRVO. Initially, macular edema was more marked in I-CRVO than that in NI-CRVO (P < 0.0001) but did not significantly differ in resolution time (P = 0.238). Macular retinal epithelial pigment degeneration, serous macular detachment, and retinal perivenous sheathing developed at a higher rate in I-CRVO than that in NI-CRVO (P < 0.0001). Ischemic CRVO had more retinal venous engorgement than NI-CRVO (P = 0.003). Fluorescein fundus angiography showed significantly more fluorescein leakage, retinal capillary dilatation, capillary obliteration, and broken capillary foveal arcade (P < 0.0001) in I-CRVO than NI-CRVO. Resolution time of CRVO was longer for I-CRVO than NI-CRVO (P < 0.0001). CONCLUSION Characteristics and natural history of fundus findings in the two types of CRVO are different.
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43
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Ozturk T, Takes O, Saatci AO. Dexamethasone implant (ozurdex) in a case with unilateral simultaneous central retinal vein and branch retinal artery occlusion. Case Rep Ophthalmol 2015; 6:76-81. [PMID: 25873891 PMCID: PMC4376922 DOI: 10.1159/000377668] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Simultaneous branch retinal artery and vein occlusion is a rare condition that may cause severe visual loss, and its treatment is often unrewarding. Herein, we report a case with simultaneous central retinal vein and branch retinal artery occlusion; it was successfully treated with a single dexamethasone intravitreal implant. The affected eye attained a visual acuity level of 20/25 from the visual acuity of hand motions at presentation with a residual, but relatively diminished, altitudinal scotoma during a follow-up period of 6 months.
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Affiliation(s)
- Taylan Ozturk
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
| | - Omer Takes
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
| | - A Osman Saatci
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
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Abstract
PURPOSE To investigate the clinical features of central retinal vein occlusion (CRVO) in relation to the presence of a prominent middle limiting membrane (p-MLM) sign on presenting optical coherence tomography, which may suggest macular ischemia and poor visual outcome. METHODS Fifty consecutive eyes with acute CRVO of <1 month of symptom duration before presentation were retrospectively reviewed. A hyperreflective line located in the outer plexiform layer (p-MLM) in optical coherence tomography was used as a sign of acute ischemia. Cases with p-MLM were grouped and compared with the group of eyes with no p-MLM sign (non-MLM group) for clinical features including visual acuities, central fovea thickness, and CRVO types. RESULTS Among the 50 eyes, 14 (28%) eyes showed a p-MLM sign, 21 (42%) eyes did not, and others had equivocal findings. Eyes with p-MLM sign presented worse initial and final best-corrected visual acuity compared with the non-MLM group (1.10 ± 0.72 vs. 0.47 ± 0.49 logMAR in the initial best-corrected visual acuity, P = 0.007; and 1.08 ± 0.86 vs. 0.32 ± 0.41 logMAR in the final best-corrected visual acuity, P = 0.044) in patients with a follow-up duration of 6 months or longer. The p-MLM group eyes showed a higher tendency toward being classified as ischemic type CRVO (57.1 vs. 4.8%, P = 0.001). CONCLUSION Central retinal vein occlusion showing p-MLM on optical coherence tomography had worse visual outcome with higher incidence of being classified into ischemic type CRVO.
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45
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Okamoto N, Matsumoto C, Shimomura Y. Sequential occlusion of the branch retinal artery and branch retinal vein in a patient with hypertension: an interventional case report. Clin Ophthalmol 2014; 8:2121-3. [PMID: 25378899 PMCID: PMC4207580 DOI: 10.2147/opth.s73550] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background There are some cases that reported central retinal vein occlusion accompanied by ciliary artery occlusion, however, combined branch retinal artery and vein occlusion is a rare condition that has been infrequently reported. We describe in this report one case of retinal vein occlusion and branch retinal artery occlusion occurring simultaneously. Case presentation A 50 year-old woman presented with acute visual loss in her right eye. Fundus photography showed retinal ischemia and tortuous, dilated retinal veins in the right eye. With early phase fluorescein angiography, retinal arteries revealed areas absent of branches. Late phase fluorescein angiography demonstrated that areas absent of branches were still present. Conclusion It is a rare case of branch retinal artery and vein occlusion.
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Affiliation(s)
- Norio Okamoto
- Department of Ophthalmology, Kinki University Faculty of Medicine, Osakasayama City, Osaka, Japan
| | - Chota Matsumoto
- Department of Ophthalmology, Kinki University Faculty of Medicine, Osakasayama City, Osaka, Japan
| | - Yoshikazu Shimomura
- Department of Ophthalmology, Kinki University Faculty of Medicine, Osakasayama City, Osaka, Japan
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Rahimy E, Sarraf D, Dollin ML, Pitcher JD, Ho AC. Paracentral acute middle maculopathy in nonischemic central retinal vein occlusion. Am J Ophthalmol 2014; 158:372-380.e1. [PMID: 24794089 DOI: 10.1016/j.ajo.2014.04.024] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 04/23/2014] [Accepted: 04/23/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE To better characterize a novel spectral-domain optical coherence tomography (OCT) presentation, termed paracentral acute middle maculopathy, to describe this finding in patients with nonischemic central retinal vein occlusion (CRVO), and to support a proposed pathogenesis of intermediate and deep retinal capillary ischemia. DESIGN Retrospective observational case series. METHODS Clinical histories, high-resolution digital color imaging, red-free photography, fluorescein angiography, near-infrared reflectance, and spectral-domain OCT images of 484 patients with acute CRVO from 2 centers were evaluated for the presence of coexisting paracentral acute middle maculopathy. RESULTS Of 484 patients diagnosed with CRVO, 25 (5.2%) demonstrated evidence of concurrent paracentral acute middle maculopathy. Patients averaged 51 years of age and presented with complaints of paracentral scotomas. All patients demonstrated hyper-reflective plaquelike lesions at the level of the inner nuclear layer by spectral-domain OCT and showed corresponding dark-gray lesions on near-infrared reflectance and perivenular deep retinal whitening on color fundus photography. There was no fluorescein angiographic correlate to these lesions. On follow-up spectral-domain OCT imaging, the lesions had resolved into areas of inner nuclear layer atrophy with persistence of scotomas. CONCLUSIONS Paracentral acute middle maculopathy refers to characteristic hyper-reflective spectral-domain OCT lesions involving the middle layers of the retina at the level of the inner nuclear layer that may develop in response to ischemia of the intermediate and deep capillary plexuses. This series is the largest to describe this spectral-domain OCT finding to date, and it is the first to associate it with nonischemic CRVO.
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Affiliation(s)
- Ehsan Rahimy
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - David Sarraf
- Retinal Disorders and Ophthalmic Genetics Division, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California; Greater Los Angeles Veterans Affairs Healthcare Center, Los Angeles, California
| | - Michael L Dollin
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - John D Pitcher
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Allen C Ho
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.
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Ocular vascular occlusive disorders: natural history of visual outcome. Prog Retin Eye Res 2014; 41:1-25. [PMID: 24769221 DOI: 10.1016/j.preteyeres.2014.04.001] [Citation(s) in RCA: 188] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 04/10/2014] [Accepted: 04/11/2014] [Indexed: 11/23/2022]
Abstract
Ocular vascular occlusive disorders collectively constitute the most common cause of visual disability. Before a disease can be managed, it is essential to understand its natural history, so as to be able to assess the likely effectiveness of any intervention. I investigated natural history of visual outcome in prospective studies of 386 eyes with non-arteritic anterior ischemic optic neuropathy (NA-AION), 16 eyes with non-arteritic posterior ischemic optic neuropathy, 697 eyes with central retinal vein occlusion (CRVO), 67 eyes with hemi-CRVO (HCRVO), 216 eyes with branch retinal vein occlusion (BRVO), 260 eyes with central retinal artery occlusion (CRAO), 151 eyes with branch retinal artery occlusion (BRAO) and 61 eyes with cilioretinal artery occlusion (CLRAO). My studies have shown that every one of these disorders consists of multiple distinct clinical sub-categories with different visual findings. When an ocular vascular occlusive disorder is caused by giant cell arteritis, which is an ophthalmic emergency, it would be unethical to do a natural history study of visual outcome in them, because in this case early diagnosis and immediate, intensive high-dose steroid therapy is essential to prevent any further visual loss, not only in the involved eye but also in the fellow, normal eye. In NA-AION in eyes seen ≤2 weeks after the onset, visual acuity (VA) improved in 41% of those with VA 20/70 or worse, and visual field (VF) improved in 26% of those with moderate to severe VF defect. In non-ischemic CRVO eyes with VA 20/70 or worse, VA improved in 47% and in ischemic CRVO in 23%; moderate to severe VF defect improved in 79% in non-ischemic CRVO and in 27% in ischemic CRVO. In HCRVO, overall findings demonstrated that initial VA and VF defect and the final visual outcome were different in non-ischemic from ischemic HCRVO - much better in the former than the latter. In major BRVO, in eyes with initial VA of 20/70 or worse, VA improved in 69%, and moderate to severe VF defect improved in 52%. In macular BRVO with 20/70 or worse initial VA, it improved in 53%, and initial minimal-mild VF defect was stable or improved in 85%. In various types of CRAO there are significant differences in both initial and final VA and VF defects. In CRAO eyes seen within 7 days of onset and initial VA of counting fingers or worse, VA improved in 82% with transient non-arteritic CRAO, 67% with non-arteritic CRAO with cilioretinal artery sparing, 22% with non-arteritic CRAO. Central VF improved in 39% of transient non-arteritic CRAO, 25% of non-arteritic CRAO with cilioretinal artery sparing and 21% of non-arteritic CRAO. Peripheral VF improved in non-arteritic CRAO in 39% and in transient non-arteritic CRAO in 39%. In transient CRAO, finally peripheral VFs were normal in 93%. In non-arteritic CRAO eyes initially 22% had normal peripheral VF and in the rest it improved in 39%. Final VA of 20/40 or better was seen in 89% of permanent BRAO, and in 100% of transient BRAO and non-arteritic CLRAO. In permanent BRAO eyes, among those seen within 7 days of onset, central VF defect improved in 47% and peripheral VF in 52%, and in transient BRAO central and peripheral VFs were normal at follow-up. My studies showed that AION, CRVO, BRVO, CRAO and BRAO, each consist of multiple distinct clinical sub-categories with different visual outcome. Contrary to the prevalent impression, these studies on the natural history of visual outcome have shown that there is a statistically significant spontaneous visual improvement in each category. The factors which influence the visual outcome in various ocular vascular occlusive disorders are discussed.
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Gokce G, Metin S, Erdem U, Sobaci G, Durukan AH, Cagatay HH, Ekinci M. Late hyperbaric oxygen treatment of cilioretinal artery occlusion with nonischemic central retinal vein occlusion secondary to high altitude. High Alt Med Biol 2014; 15:84-8. [PMID: 24673536 DOI: 10.1089/ham.2013.1086] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIM To report a case of cilioretinal artery occlusion (CRAO) with central retinal vein occlusion (CRVO) after a journey to high altitude region and the use of late period hyperbaric oxygen (HBO) therapy successfully. CASE REPORT A previously healthy 48-year-old lowlander woman was admitted to our department for sudden blurred vision in her right eye started at 2 weeks prior to examination. The patient had a history of 1-month exposure to high altitude that finished a day before the onset of her complaints. The best corrected visual acuity (BCVA) was 10/20 in the right eye (RE) and 10/10 in the left eye. Fundus examination of the RE revealed whitening of the retina along the distribution of cilioretinal artery, sparing fovea, flame-shaped hemorrhages, and roth spots with minimally dilated and tortuous retinal veins. Visual field analysis revealed centrocecal scotoma. The patient was treated by a daily session of 2 h of HBO at 2.5 atmosphere absolute for 11 days. BCVA rised to a level of 20/20 for the RE and the scotomas were disappeared immediately after using of the HBO treatment. CONCLUSION CRVO related CRAO should be regarded as a rare complication of exposure to high altitude and HBO seems to be the treatment of choice of high altitude related co-occurence of CRVO and CRAO in the late period.
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Affiliation(s)
- Gokcen Gokce
- 1 Department of Ophthalmology, Sarikamis Military Hospital , Kars, Turkey
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Schmidt D. Comorbidities in combined retinal artery and vein occlusions. Eur J Med Res 2013; 18:27. [PMID: 23947749 PMCID: PMC3751822 DOI: 10.1186/2047-783x-18-27] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 07/26/2013] [Indexed: 11/10/2022] Open
Abstract
Background Several general diseases cause blindness in patients with simultaneous combined retinal artery and vein occlusion. Methods/patients We examined 14 patients with acute unilateral visual loss due to combined retinal artery and venous occlusions. All 14 patients presented at the Polyclinic over a period of about 3 years. Fluorescein angiography was carried out in 12 patients to confirm the diagnosis. Ten patients underwent Doppler sonography and 11 echocardiography. Results Concerning systemic diseases, 11 of our 14 patients presented several cardiovascular risk factors, i.e., immunocytoma and arterial hypertension and hypercholesterolemia in one patient; another patient had chronic bronchitis, tachycardia and hypercholesterolemia. Six patients presented coagulation anomalies, and eight patients had arterial hypertension. Doppler sonography revealed normal carotid arteries in nine of ten patients. In 8 of 11 patients, echocardiography displayed no cardiac abnormalities. Ophthalmoscopy revealed no emboli in any of these patients. Conclusion Unilateral simultaneous combined incomplete retinal artery and venous occlusions should be considered as one entity. Eleven of our patients presented comorbidities reflecting several cardiovascular risk factors. Immunological diseases, malignancies and coagulopathies can cause this ocular disorder, resulting in blindness. No emboli were found in any of these patients. Patients suffering from acute visual loss must be examined for the presence of systemic diseases to enable therapy at an early stage.
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Affiliation(s)
- Dieter Schmidt
- University-Augenklinik, Killianstr, 5, Freiburg D-79106, Germany.
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