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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 2: Negative-negative waveform for scotopic response and a loss of oscillatory potentials were recorded in the ERG for the left eye. This corresponds to inner retinal ischemia consequent to retinal vascular occlusion
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Figure 0012: Case 2: Negative-negative waveform for scotopic response and a loss of oscillatory potentials were recorded in the ERG for the left eye. This corresponds to inner retinal ischemia consequent to retinal vascular occlusion

Mentions: A 36-year-old gentleman reported with sudden visual loss in left eye. He had a similar problem two months back with spontaneous improvement, for which he did not seek any treatment. Vision was 20/20 in right eye and no perception of light in left. Anterior segment examination was normal. Right eye was normal. Left fundus revealed patchy areas of retinal edema over posterior pole and bifurcated central retinal artery [Figs. 8 and 9]. Generalized arteriolar attenuation, box-carring of vessels and cherry red spot at fovea were seen. Treatment was initiated immediately [Table 2]. However, fundus appearance remained same. He was referred to the physician. Next day, the patient reported perception of light in that eye. A platelet-fibrin embolus could be made out in infero-temporal arcade. Findings of FFA [Fig. 10 a and b], visual field examination [Fig. 11], ERG [Fig. 12] and color Doppler study of the right eye are summarized in Table 1. A summary of systemic investigations and treatment is included in Table 2. Five days later, vision recovered to 20/125. On the tenth day, it improved to 20/40 and after six months it was 20/20. The patient also had regular follow-ups with the hematologist and cardiologist.


Hemi-central retinal artery occlusion in young adults.

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

Case 2: Negative-negative waveform for scotopic response and a loss of oscillatory potentials were recorded in the ERG for the left eye. This corresponds to inner retinal ischemia consequent to retinal vascular occlusion
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0012: Case 2: Negative-negative waveform for scotopic response and a loss of oscillatory potentials were recorded in the ERG for the left eye. This corresponds to inner retinal ischemia consequent to retinal vascular occlusion
Mentions: A 36-year-old gentleman reported with sudden visual loss in left eye. He had a similar problem two months back with spontaneous improvement, for which he did not seek any treatment. Vision was 20/20 in right eye and no perception of light in left. Anterior segment examination was normal. Right eye was normal. Left fundus revealed patchy areas of retinal edema over posterior pole and bifurcated central retinal artery [Figs. 8 and 9]. Generalized arteriolar attenuation, box-carring of vessels and cherry red spot at fovea were seen. Treatment was initiated immediately [Table 2]. However, fundus appearance remained same. He was referred to the physician. Next day, the patient reported perception of light in that eye. A platelet-fibrin embolus could be made out in infero-temporal arcade. Findings of FFA [Fig. 10 a and b], visual field examination [Fig. 11], ERG [Fig. 12] and color Doppler study of the right eye are summarized in Table 1. A summary of systemic investigations and treatment is included in Table 2. Five days later, vision recovered to 20/125. On the tenth day, it improved to 20/40 and after six months it was 20/20. The patient also had regular follow-ups with the hematologist and cardiologist.

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