Late onset branch retinal artery occlusion following coronary angiography

Branch Retinal Artery Occlusion after Percutaneous Coronary Intervention

We report a case of branch retinal artery occlusion (BRAO) that occurred after percutaneous coronary intervention (PCI). A 59-year-old man with no other previous diseases presented visual acuity deterioration in the left eye 24 hours after PCI. Fundus examination revealed ischemia at the temporal branch of the retinal artery associated with inner layer edema. Prompt treatment was performed with ocular digital massage and paracentesis of the anterior chamber. However, at discharge, the patient had a persistent visual loss with a central scotoma that persisted at 35-day follow-up without improvement of the visual acuity. The patient did not suffer from any other systemic complications. Retinal infarction should be considered a potential complication of PCI. Patients and health care providers should be aware of any visual signs. Permanent visual disability can be prevented by immediate diagnosis and prompt intervention.

Iatrogenic ophthalmic artery occlusion and retinal artery occlusion

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.

[Central retinal artery occlusion following coronary angiography: a case report]

We report the case of a 74-year-old man referred in ophthalmology for acute central visual loss in his right eye 2 hours after a coronary angiography. Visual acuity was limited to light perception RE and 20/20 LE. Fundus examination revealed a central retinal artery occlusion with retinal edema and a cherry-red spot in the right eye. Fluorescein angiography confirmed that the central retinal artery was not filling. Despite selective ophthalmic artery fibrinolysis, visual acuity remained very low. Embolic occlusion is the most probable etiology in this complication. Central retinal artery occlusion is a serious but very rare complication of coronary angiography.

Simultaneous multiple branch retinal artery occlusions after diagnostic cardiac catheterization

PURPOSE

We describe a 53-year-old man with a decrease in visual acuity in the left eye 2 weeks after diagnostic cardiac catheterization.

DESIGN

Interventional case report.

METHODS

A 53-year-old man with a decrease in visual acuity in the left eye 2 weeks after diagnostic cardiac catheterization underwent ophthalmoscopic, angiographic, and laboratory evaluations. Both funduscopy and fluorescein angiography confirmed the diagnosis of simultaneous multiple branch retinal artery occlusions in the left eye.

RESULTS

The left eye had a mildly positive (1+) relative afferent pupillary defect. Slit-lamp biomicroscopy was unremarkable except for 2+ nuclear cataract bilaterally. Intraocular pressure was 12 mmHg in the right eye and 11 mmHg in the left eye by applanation tonometry. Funduscopy revealed a normal right eye.

CONCLUSION

This case report of multiple branch retinal artery occlusions due to cholesterol embolus after diagnostic cardiac catheterization is extremely rare. Visual symptoms after cardiac catheterization should alert both ophthalmologists and cardiologists to this potential post-cardiac catheterization complication.

Approach to ophthalmologic emergencies

This article presents evaluation and treatment approaches to ophthalmologic conditions that are likely to be encountered in a primary care office. These conditions can be organized by diagnostic category, symptoms, and location of complaint. By using one ora combination of these categories, the practitioner can provide appropriate, timely, and effective ophthalmologic evaluation and treatment. Acute conditions are categorized according to urgency of intervention.