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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 3: Color fundus photograph of the right eye shows gross retinal edema involving the superior half of the fundus, albeit sparing the fovea
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Figure 0013: Case 3: Color fundus photograph of the right eye shows gross retinal edema involving the superior half of the fundus, albeit sparing the fovea

Mentions: A 28-year-old lady reported with sudden, painless visual loss in right eye since five days. Diagnosed to have systemic hypertension, rheumatic mitral valve regurgitation and chorea, she was under treatment for the same [Table 2]. Vision was 20/60 in the right eye and 20/20 in the left. Anterior segment examination was unremarkable. Right fundus revealed retinal edema involving superior half, sparing fovea with no embolus [Fig. 13 and 14]. Left eye was normal. Findings of FFA [Fig. 15], multifocal ERG [Fig. 16] and color Doppler study of the right eye [Fig. 17] are summarized in Table 1. A summary of systemic investigations and treatment is included in Table 2. The patient was detected to have Factor V Leiden mutation (Real time Polymerase Chain Reaction, RT PCR) and was also advised a regular follow-up with cardiologist and hematologist.


Hemi-central retinal artery occlusion in young adults.

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

Case 3: Color fundus photograph of the right eye shows gross retinal edema involving the superior half of the fundus, albeit sparing the fovea
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0013: Case 3: Color fundus photograph of the right eye shows gross retinal edema involving the superior half of the fundus, albeit sparing the fovea
Mentions: A 28-year-old lady reported with sudden, painless visual loss in right eye since five days. Diagnosed to have systemic hypertension, rheumatic mitral valve regurgitation and chorea, she was under treatment for the same [Table 2]. Vision was 20/60 in the right eye and 20/20 in the left. Anterior segment examination was unremarkable. Right fundus revealed retinal edema involving superior half, sparing fovea with no embolus [Fig. 13 and 14]. Left eye was normal. Findings of FFA [Fig. 15], multifocal ERG [Fig. 16] and color Doppler study of the right eye [Fig. 17] are summarized in Table 1. A summary of systemic investigations and treatment is included in Table 2. The patient was detected to have Factor V Leiden mutation (Real time Polymerase Chain Reaction, RT PCR) and was also advised a regular follow-up with cardiologist and hematologist.

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