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Hemi-central retinal artery occlusion in young adults.

Rishi P, Rishi E, Sharma T, Mahajan S - Indian J Ophthalmol (2010 Sep-Oct)

Bottom Line: The third patient had Leiden mutation while the fourth patient had Eisenmenger's syndrome.Clinical examination and fundus fluorescein angiography revealed a bifurcated central retinal artery at emergence from the optic nerve head, in all cases.The prognosis depends upon arterial recanalisation and etiology of the thromboembolic event.

View Article: PubMed Central - PubMed

Affiliation: Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Tamil Nadu, India.

ABSTRACT
Amongst the clinical presentations of retinal artery occlusion, hemi-central retinal artery occlusion (Hemi-CRAO) is rarely described. This case series of four adults aged between 22 and 36 years attempts to describe the clinical profile, etiology and management of Hemi-CRAO. Case 1 had an artificial mitral valve implant. Polycythemia and malignant hypertension were noted in Case 2. The third patient had Leiden mutation while the fourth patient had Eisenmenger's syndrome. Clinical examination and fundus fluorescein angiography revealed a bifurcated central retinal artery at emergence from the optic nerve head, in all cases. Color Doppler examination of the central retinal artery confirmed branching of the artery behind the lamina cribrosa. It is hypothesized that bifurcation of central retinal artery behind the lamina cribrosa may predispose these hemi-trunks to develop an acute occlusion if associated with underlying risk factors. The prognosis depends upon arterial recanalisation and etiology of the thromboembolic event.

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Case 1. Multifocal ERG of right eye showed normal implicit times and reduced amplitudes. This corresponds to the underlying pathology of retinal vascular occlusion
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Figure 0006: Case 1. Multifocal ERG of right eye showed normal implicit times and reduced amplitudes. This corresponds to the underlying pathology of retinal vascular occlusion

Mentions: A 26-year-old gentleman presented with sudden, partial visual field loss in right eye. He had a prosthetic mitral valve implanted, 14 years back. Vision was 20/20 in both eyes. Anterior segment was essentially normal. Right fundus [Fig. 1] showed two central retinal artery hemi-trunks instead of main central artery [Fig. 2]. Supero-temporal arteriolar attenuation was noted; upper hemi-trunk was shorter. Retinal pigment epithelial alteration was noted; foveal reflex was dull. Left eye was normal. Findings of fundus fluorescein angiography (FFA) [Fig. 3], visual field examination [Fig. 4], optical coherence tomogram (OCT) [Fig. 5], multifocal electroretinogram (mfERG) [Fig. 6] and color Doppler study of right eye [Fig. 7] are summarized in Table 1. A summary of systemic investigations and treatment is included in Table 2. A cardiology consult was sought; patient was advised to continue current treatment [Table 2] with regular follow-up.


Hemi-central retinal artery occlusion in young adults.

Rishi P, Rishi E, Sharma T, Mahajan S - Indian J Ophthalmol (2010 Sep-Oct)

Case 1. Multifocal ERG of right eye showed normal implicit times and reduced amplitudes. This corresponds to the underlying pathology of retinal vascular occlusion
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2992922&req=5

Figure 0006: Case 1. Multifocal ERG of right eye showed normal implicit times and reduced amplitudes. This corresponds to the underlying pathology of retinal vascular occlusion
Mentions: A 26-year-old gentleman presented with sudden, partial visual field loss in right eye. He had a prosthetic mitral valve implanted, 14 years back. Vision was 20/20 in both eyes. Anterior segment was essentially normal. Right fundus [Fig. 1] showed two central retinal artery hemi-trunks instead of main central artery [Fig. 2]. Supero-temporal arteriolar attenuation was noted; upper hemi-trunk was shorter. Retinal pigment epithelial alteration was noted; foveal reflex was dull. Left eye was normal. Findings of fundus fluorescein angiography (FFA) [Fig. 3], visual field examination [Fig. 4], optical coherence tomogram (OCT) [Fig. 5], multifocal electroretinogram (mfERG) [Fig. 6] and color Doppler study of right eye [Fig. 7] are summarized in Table 1. A summary of systemic investigations and treatment is included in Table 2. A cardiology consult was sought; patient was advised to continue current treatment [Table 2] with regular follow-up.

Bottom Line: The third patient had Leiden mutation while the fourth patient had Eisenmenger's syndrome.Clinical examination and fundus fluorescein angiography revealed a bifurcated central retinal artery at emergence from the optic nerve head, in all cases.The prognosis depends upon arterial recanalisation and etiology of the thromboembolic event.

View Article: PubMed Central - PubMed

Affiliation: Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Tamil Nadu, India.

ABSTRACT
Amongst the clinical presentations of retinal artery occlusion, hemi-central retinal artery occlusion (Hemi-CRAO) is rarely described. This case series of four adults aged between 22 and 36 years attempts to describe the clinical profile, etiology and management of Hemi-CRAO. Case 1 had an artificial mitral valve implant. Polycythemia and malignant hypertension were noted in Case 2. The third patient had Leiden mutation while the fourth patient had Eisenmenger's syndrome. Clinical examination and fundus fluorescein angiography revealed a bifurcated central retinal artery at emergence from the optic nerve head, in all cases. Color Doppler examination of the central retinal artery confirmed branching of the artery behind the lamina cribrosa. It is hypothesized that bifurcation of central retinal artery behind the lamina cribrosa may predispose these hemi-trunks to develop an acute occlusion if associated with underlying risk factors. The prognosis depends upon arterial recanalisation and etiology of the thromboembolic event.

Show MeSH
Related in: MedlinePlus