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Spectral domain optical coherence tomography findings of acute branch retinal artery occlusion from calcific embolus.

Shah VA, Wallace B, Sabates NR - Indian J Ophthalmol (2010 Nov-Dec)

Bottom Line: An 82-year-old female presented with sudden painless decrease in vision in the right eye after awakening.She could see the "superior half" of her vision from the right eye only.The high reflectivity of the material and underlying optical shadowing could be characterized as calcific emboli.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, University of Missouri Kansas City School of Medicine and Vision Research Center at Truman Medical Center, Kansas City, MO 64108, USA. drvinayshah@yahoo.com

ABSTRACT
An 82-year-old female presented with sudden painless decrease in vision in the right eye after awakening. She could see the "superior half" of her vision from the right eye only. On examination, best-corrected vision was 20/300 in the right eye and 20/30 in the left eye. The fundus in the right eye revealed recent superotemporal branch retinal artery occlusion (BRAO) with calcified plaque at the disc. Spectral domain optical coherence tomography (OCT) (OTI Ophthalmic Technologies, Inc.), revealed hyperreflectivity and increased thickness of the inner retinal layers of the superior compared to the inferior retina. Imaging at the optic disc revealed the blocked artery containing a highly reflective material. The high reflectivity of the material and underlying optical shadowing could be characterized as calcific emboli.

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(A) Right Eye fundus photo revealing whitening of the superior retina with a calcified plaque at the disc within the supero temporal artery (arrow); (B) Spectral domain optical coherence tomography OCT/SLO, OTI Ophthalmic Technologies Inc, Ontario, Canada) revealed hyperreflectivity and increased thickness of the inner retinal layers in the superior compared to inferior retina. Note the decreased reflectivity of the outer retinal layers (including retinal pigment epithelial layer) in the superior retina as compared to inferior retina probably due to optical shadowing.
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Figure 0001: (A) Right Eye fundus photo revealing whitening of the superior retina with a calcified plaque at the disc within the supero temporal artery (arrow); (B) Spectral domain optical coherence tomography OCT/SLO, OTI Ophthalmic Technologies Inc, Ontario, Canada) revealed hyperreflectivity and increased thickness of the inner retinal layers in the superior compared to inferior retina. Note the decreased reflectivity of the outer retinal layers (including retinal pigment epithelial layer) in the superior retina as compared to inferior retina probably due to optical shadowing.

Mentions: An 82-year-old female was admitted to the “stroke unit” with sudden painless decrease in vision in the right eye after awakening from her afternoon nap the previous day. Patient denied any headache, jaw pain, recent weight loss, amaurotic episodes, or any other neurologic symptoms. She still could see the “superior half” of her vision from the right eye. Past medical history was significant for hypertension, hypothyroid, aortic and mitral valve calcification, cerebrovascular accidents, and atrial fibrillation for which she was taking coumadin. Past ocular history was significant for blepharospasm. On examination, best-corrected visual acuity (BCVA) (Snellen) was 20/300 in the right eye and 20/30 in the left eye. Confrontation visual field revealed a loss of inferior visual field in the right eye and was full in the left eye. There was a relative afferent pupillary defect in the right eye. Anterior segment examination was unremarkable in both eyes. Dilated fundus examination in the left eye was remarkable for myelinated nerve fiber around the disc with a cup-to-disc ratio of 0.20. Fundus examination in the right eye was suggestive of recent superotemporal BRAO with calcified plaque at the disc within the superotemporal artery [Fig. 1A]. Fluorescein angiography confirmed the superotemporal BRAO.


Spectral domain optical coherence tomography findings of acute branch retinal artery occlusion from calcific embolus.

Shah VA, Wallace B, Sabates NR - Indian J Ophthalmol (2010 Nov-Dec)

(A) Right Eye fundus photo revealing whitening of the superior retina with a calcified plaque at the disc within the supero temporal artery (arrow); (B) Spectral domain optical coherence tomography OCT/SLO, OTI Ophthalmic Technologies Inc, Ontario, Canada) revealed hyperreflectivity and increased thickness of the inner retinal layers in the superior compared to inferior retina. Note the decreased reflectivity of the outer retinal layers (including retinal pigment epithelial layer) in the superior retina as compared to inferior retina probably due to optical shadowing.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2993984&req=5

Figure 0001: (A) Right Eye fundus photo revealing whitening of the superior retina with a calcified plaque at the disc within the supero temporal artery (arrow); (B) Spectral domain optical coherence tomography OCT/SLO, OTI Ophthalmic Technologies Inc, Ontario, Canada) revealed hyperreflectivity and increased thickness of the inner retinal layers in the superior compared to inferior retina. Note the decreased reflectivity of the outer retinal layers (including retinal pigment epithelial layer) in the superior retina as compared to inferior retina probably due to optical shadowing.
Mentions: An 82-year-old female was admitted to the “stroke unit” with sudden painless decrease in vision in the right eye after awakening from her afternoon nap the previous day. Patient denied any headache, jaw pain, recent weight loss, amaurotic episodes, or any other neurologic symptoms. She still could see the “superior half” of her vision from the right eye. Past medical history was significant for hypertension, hypothyroid, aortic and mitral valve calcification, cerebrovascular accidents, and atrial fibrillation for which she was taking coumadin. Past ocular history was significant for blepharospasm. On examination, best-corrected visual acuity (BCVA) (Snellen) was 20/300 in the right eye and 20/30 in the left eye. Confrontation visual field revealed a loss of inferior visual field in the right eye and was full in the left eye. There was a relative afferent pupillary defect in the right eye. Anterior segment examination was unremarkable in both eyes. Dilated fundus examination in the left eye was remarkable for myelinated nerve fiber around the disc with a cup-to-disc ratio of 0.20. Fundus examination in the right eye was suggestive of recent superotemporal BRAO with calcified plaque at the disc within the superotemporal artery [Fig. 1A]. Fluorescein angiography confirmed the superotemporal BRAO.

Bottom Line: An 82-year-old female presented with sudden painless decrease in vision in the right eye after awakening.She could see the "superior half" of her vision from the right eye only.The high reflectivity of the material and underlying optical shadowing could be characterized as calcific emboli.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, University of Missouri Kansas City School of Medicine and Vision Research Center at Truman Medical Center, Kansas City, MO 64108, USA. drvinayshah@yahoo.com

ABSTRACT
An 82-year-old female presented with sudden painless decrease in vision in the right eye after awakening. She could see the "superior half" of her vision from the right eye only. On examination, best-corrected vision was 20/300 in the right eye and 20/30 in the left eye. The fundus in the right eye revealed recent superotemporal branch retinal artery occlusion (BRAO) with calcified plaque at the disc. Spectral domain optical coherence tomography (OCT) (OTI Ophthalmic Technologies, Inc.), revealed hyperreflectivity and increased thickness of the inner retinal layers of the superior compared to the inferior retina. Imaging at the optic disc revealed the blocked artery containing a highly reflective material. The high reflectivity of the material and underlying optical shadowing could be characterized as calcific emboli.

Show MeSH
Related in: MedlinePlus