Surgical mobilization of an arterial embolus in cilioretinal artery occlusion

We describe an effective surgical approach for the management of cilioretinal artery occlusion. A 23?G pars plana vitrectomy assisted with two soft tip cannulas was performed. One cannula pressed the cilioretinal artery branch directed toward the macula, distal to the location of the embolus, whereas the other cannula was used to gently swipe over the cilioretinal artery proximal to the occlusion. Anatomical and functional outcomes were evaluated by fundus examination, fluorescein angiography, Goldmann visual field, and best?corrected visual acuity (BCVA). It was possible to mobilize the embolus by mechanical displacement with 23?G soft?tip cannulas and disintegrate it, preventing the passage toward the branch directed to the macula. Restoration of retinal circulation was confirmed by fluorescein angiogram. The patient recovered his previous documented BCVA and visual field. The described technique can be considered as a new possibility for achieving a solution to cilioretinal artery occlusion or any other retinal artery occlusion

Obstrucción de la arteria central de retina con persistencia de flujo de la arteria cilioretiniana en un paciente con obstrucción embólica de arteria carótida. Reporte de caso / Central retinal artery occlusion with cilioretinal artery flow persistence in a patient with carotid artery embolic occlusion. Case report

Objetivo: Describir el caso de un paciente con obstrucción de la arteria central de la retina (OACR) con persistencia de flujo ciliorretinal y su relación con la patología cardiovascular. Caso clínico: Paciente varón de 64 años, con antecedentes de hipertensión arterial sistémica, consultó por cuadro de visión tubular brusca en ojo derecho (OD) de 3 días de evolución. Se constató una agudeza visual (AV) de 20/25 en el ojo afectado. A la fundoscopía se destaca palidez retinal que respeta el área macular con la presencia de vasos optociliares, compatible con OACR con permeabilidad de la arteria ciliorretinal. Se realizó manejo multidisciplinario con cardiología y medicina interna para control y tratamiento de factores de riesgo. Materiales y métodos: Se realizó Angiografía bajo fluoresceína (AGF), campo visual (CV) y tomografía de coherencia óptica (TCO) macular, además se realiza estudio de fuente embólica con Ecodoppler carotídeo. Resultados: AGF revela un llenado precoz durante la fase coroidea y un retraso en la fase arterial. El CV del OD muestra conservación del área circunscrita entre los 10 grados centrales. La TCO macular muestra un engrosamiento dependiente del edema sin afectación central. Ecodoppler carotídeo revela obstrucción de 20 - 40 % en las arterias carótidas comunes, arterias carótidas internas y arterias vertebrales. Conclusión: La OACR se presenta en 1 en 10.000 casos en centros terciarios. La causa más frecuente es embólica de origen carotídeo. La arteria cilioretiniana permanece permeable en el 25% de las OACR y solo el 10% respeta de manera total el haz papilomacular, conservando agudeza visual central. Es considerada una emergencia oftalmológica debido a la pérdida de visión que produce y representa una alta mortalidad en los pacientes afectados, debiendo hacer un estudio completo y descarte de patología concomitantes que requieran tratamiento oportuno.

Purpose: To describe the case of a patient with obstruction of the central retinal artery (CRAO) with persistence of cilioretinal fl ow and its relationship with cardiovascular pathology. Clinical case: Male patient, 64 years old, with a history of systemic arterial hypertension, consultation for sudden tubular vision in the right eye (RE) of 3 days of evolution. The visual acuity (VA) was 20/25 in the eye aff ected. The fundoscopy highlights were retinal pallor that respects the macular area with the presence of optociliary vessels, this case was compatible with an CRAO with permeability of the ciliary artery. Multidisciplinary management is carried out with cardiology and internal medicine for the control and treatment of risk factors. Materials and methods: Fluorescein angiography (FA), visual field (VF) and macular optic cohort tomography (OCT) were performed, as well as an embolic source study with carotid Ecodoppler was done. Results: AGF reveals early fi lling during the choroidal phase and a delay in the arterial phase. Th e VD of the RE shows conservation of the circumscribed area between the 10 central grades. Macular TCO shows a thickening dependent on edema without central involvement. Carotid echodoppler reveals obstruction of 20-40% in the common carotid arteries, internal carotid arteries and vertebral arteries. Conclusion: The CRAO is presented in 1 in 10,000 cases in tertiary centers. The most frequent cause is embolic of carotid origin. Th e cilioretinal artery remains permeable in 25% of the CRAOS and only 10% fully respects the papillomacular bundle, conserving central visual acuity. It is considered an ophthalmological emergency due to the loss of vision that produces and represents a high mortality in the aff ected patients, having to make a complete study and discard concomitant pathologies that require timely treatment.

Combined Central Retinal Vein and Cilioretinal Artery Occlusion in a Patient Who Underwent Allogeneic Renal Transplantation.

A high incidence of venous thromboembolism has been reported in patients who have had renal transplantation especially within the early postoperative period. Herein, the management of a 31- year-old renal graft recipient with the diagnosis of combined left central retinal vein occlusion (CRVO) and cilioretinal artery occlusion (CRAO) is presented. Although detailed work-up for inherited as well as acquired thrombophilic disorders was performed in our case, none of the definite prothrombotic and predisposing risk factors for venous thromboembolism was identified. The case under review or the index case had a remarkable visual recovery within 3 weeks after the referral, since anterior chamber paracentesis was immediately scheduled after performing ocular massage in order to achieve acute resolution of venous stasis.

Cilioretinal artery occlusion following intranasal cocaine insufflations.

Cocaine is used to produce a euphoric effect by abusers, who may be unaware of the devastating systemic and ocular side effects of this drug. We describe the first known case of cilioretinal artery occlusion after intranasal cocaine abuse.

Isolated Cilioretinal Artery Occlusion in Pseudoexfoliation Syndrome: A Case Report

PURPOSE: To report a case of isolated cilioretinal artery occlusion associated with pseudoexfoliation syndrome. METHODS: A 66-year-old female presented with acute vision loss of the right eye. Three months prior, she had been diagnosed as having pseudoexfoliation glaucoma of both eyes, and the intraocular pressure of both eyes had been well-controlled with topical medication. RESULTS: The presenting visual acuity in her right eye was 20/100. Fundus examinations showed sectoral retinal whitening on superior macula. Fluorescein angiography revealed delayed filling of the cilioretinal artery, consistent with cilioretinal artery occlusion. No significant findings were identified by carotid doppler examination or echocardiography. After 8 weeks, retinal changes were completely resolved with improvement of her right vision to 20/25. CONCLUSIONS: Isolated cilioretinal artery occlusion may develop as an intraocular manifestation of pseudoexfoliation syndrome.

Cilioretinal Artery Occlusion Following the Intranasal Injection of Corticosteroid

PURPOSE: To report a case of cilioretinal artery occlusion following the intranasal injection of corticosteroids. METHODS: A 52-year-old man was referred to the ophthalmologic clinic due to a marked loss of vision in his right eye immediately after endoscopic sinus surgery. At that time, his vision was noted to be counting fingers in the right eye. His pupil was mid-dilated, fixed, and did not respond to light on examination. On ophthalmoscopy, macula edema with retinal ischemia, and a cherry-red spot were seen in the posterior pole of the retina. Ocular massage was carried out immediately after ophthalmologic examination. Three days later, visual acuity in the right eye improved to 0.15. Fluorescein angiography revealed filling defects of the cilioretinal artery and peripheral branches of the retinal arteries. In addition, areas of nonperfusion were observed. RESULTS: During the follow-up periods, macula edema resolved and visual acuity in the right eye improved to 1.2 after 3 months. Fluorescein angiogram was repeated and showed that the filling defects had disappeared. CONCLUSIONS: Retinal artery occlusion can occur after an intranasal injection of corticosteroids due to embolization of retinal circulation. This condition can be improved without complications by no other specific therapy.

Unusual Manifestation of Central Retinal Vein Occlusion and Associated Open Angle Glaucoma

Central retinal vein occlusion(CRVO)is characterized by rapid, painless decrease in visual acuity, edema of the optic disc and retina, marked dilatation and tortuosity of the retinal veins, and extensive retinal hemorrhages in all quardrants.Many ocular and systemic conditions associated with CRVO include diabetes, hypertension, collagen vascular disorder, hyperviscosity syndrome and open-angle glaucoma.When no systemic vascular disease is present in younger patients, the prognosis is known to be good. We experienced a case of CRVO with cilioretinal artery occlusion and open-angle glaucoma in young woman with one month treatment with thrombolytic agents, beta-blocker and carbonic anhydrase inhibitors. CRVO was resolved however intraocular pressure could not be controlled. She underwent trabeculectomy and then developed prolonged hypotony and hypotony maculopathy. It is not clear how long an eye can tolerate hypotony maculopathy before the visual loss is irreversible, but return of good vision has been reported when the overfiltration was reversed within 6 months of the onset of the complication. Hypotony state was sustained more than 8 months but hypotony maculopathy was resolved with visual improvement.

A Case of Cilioretinal Artery Occlusion Associated with Central Retinal Vein Occlusion

A cilioretinal artery occlusion associated with a central retinal vein occlusion is a rare condition and has been reported to have a good visual prognosis. We report a young patient with this condition who also demonstrated prolonged filling of the branch retinal arteries with fluorescein angiography. Her initial visual acuity was 0.03 in the affected eye. Two months later, normal central retinal artery inflow resumed. Her visual acuity has improved to 0.5 over the three years' follow-up.

A Clinical Study of 36 Cases of Retinal Artery Occlusion

Blockage of the retinal artery system may occur in the form of central retinal arterial obstruction, branch retinal arterial obstruction, or combination of aforementioned. It may be related to known pre-existing systemic disease or it may be the initial manifestation of a previous undiagnosed systemic abnormality. The authors evaluatea the clinical course of 35 cases of retinal artery occlusion at Department of Ophthalmology, Pusan Paik Hospital Inje Mgdical College from September, 1979 to June, 1988.