Central retinal artery occlusion following cardiac catheterization

Successfully treated hemi-central retinal artery occlusion following cardiac catheterization; case report

Introduction and importance

Here we report a case of a middle-aged man who complained of blurred vision in his left eye 1 h post cardiac catheterization and proved to have central retinal artery occlusion, a dangerous but potentially treatable sight-threatening complication of cardiac-catheterization. The patient was successfully treated through an Ophthalmological surgical intervention.

Case presentation

A 49- year-old male patient admitted to the coronary care unit as a case of non-ST-elevation-myocardial infarction. The patient underwent cardiac catheterization and stenting of the right coronary artery. One hour later, he complained of blurred vision in his left eye.

Clinical discussion

Ophthalmological examination showed an inferior visual field defect in the left eye. Fundus fluorescein angiography revealed that the patient had a hemi-central retinal artery occlusion, a rare complication of cardiac catheterization. A pars plana vitrectomy eye surgery was performed with an excellent result.

Conclusion

This case highlights the importance of early recognition and treatment of central retinal artery occlusion post cardiac catheterization

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Rarely, central retinal occlusion can complicate cardiac catheterization.

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Meaningful spontaneous recovery in vision in cases of central retinal artery occlusion occurs in less than 10%.

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What is peculiar about our case is that prompt surgical intervention resulted in an unexpectedly excellent result.

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The case highlights the need for prompt diagnosis and referral of patients with visual symptoms post cardiac catheterization.

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.

En Face Optical Coherence Tomography Imaging of Deep Capillary Plexus Abnormalities in Paracentral Acute Middle Maculopathy

The authors describe a case of para-central acute middle maculopathy (PAMM) in a 75-year-old man who had recently undergone cardiac catheterization. Imaging with simultaneous en face optical coherence tomography (OCT) and OCT angiography (OCTA) revealed signal abnormalities localized to the deep capillary plexus. This case highlights the ability of OCTA to image and localize retinal disease by vascular distribution, previously difficult with conventional fluorescein angiography, and lends evidence to the belief that PAMM is caused by vascular injury to the intermediate and deep capillary plexus.

A case of central retinal artery occlusion after chiropractic manipulation of the neck

Here we report a case of central retinal artery occlusion after chiropractic manipulation on the neck. A 49-year old man presented at the hospital because of sudden visual loss in his right eye after chiropractic neck manipulation. He had received chiropractic manipulation of the neck by a chiropractor eight days prior. When he first visited us, his best corrected visual acuity in his right eye was hand motion. A full ophthalmic examination was performed. There was cherry-red spot in the macula in his right eye. We performed a fluorescein angiogram and cervical color Doppler. The arterio-venous transit time in the fluorescein angiogram was delayed, and we detected stenosis of the right internal carotid artery with diffuse atherosclerotic plaques in the right common carotid artery. We prescribed ginko biloba extract (Tanamin). Three years after his first visit, the best corrected visual acuity of his right eye was 20 / 200.

Clinical significance of retinal emboli during diagnostic and therapeutic cardiac catheterization in patients with coronary artery disease

BACKGROUND

Cardiac catheterization may cause retinal embolization, a risk factor for cerebrovascular emboli and stroke. We describe the incidence of clinically silent and apparent retinal emboli following diagnostic and interventional coronary catheterization and associated risk factors.

METHODS

Three hundred selected patients attending a tertiary referral center for diagnostic and therapeutic cardiac catheterization were studied. Retinal examination and examination of the visual field and acuity were done before and after catheterization by a retinal specialist.

RESULTS

There were 5 case of retinal embolus before catheterization, and 19 patients (incidence 6.3%) developed new retinal arteriolar emboli after catheterization. Only 1 patient developed clinically apparent changes in vision. Two conventional risk factors (age and hypertension) were significantly associated with new retinal emboli. The risk of retinal emboli was also significantly associated with operator expertise.

CONCLUSIONS

Retinal embolism was found after coronary catheterization in 6.3% of our patients. This finding indicates that the retinal, and possibly the cerebral circulation, may be compromised more frequently than is clinically apparent as a complication of coronary catheterization. Age and hypertension are independent predictors of retinal embolism.

[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.

Central retinal artery occlusion following transcatheter balloon aortic valvuloplasty in an adolescent with aortic valvular stenosis

A 12-year-old girl with aortic valvular stenosis underwent transcatheter balloon aortic valvuloplasty (BAV) using a femoral artery approach. Anticoagulation with heparin during the procedure was used. The patient noted sudden onset of concentric constriction of the visual field in the right eye 40 min after BAV. Brain magnetic resonance imaging and cervical ultrasound revealed no abnormality. Funduscopic examination showed white swelling around the macular region, indicating ischemia, consistent with central retinal artery occlusion (CRAO). CRAO should be recognized as a rare and serious complication associated with BAV even among the pediatric population. This requires careful evaluation of anticoagulation during the left heart procedures.

The eye in cardiac and cardiovascular disease

There is an extensive range of cardiac and cardiovascular disease that can have ophthalmic manifestations and only the most commonly occurring examples are discussed below. The eye in diabetes is discussed in a separate article in this series.