ABSTRACT
Acute transient or permanent retinal arterial ischemia is ocular and systemic emergency requiring immediate diagnosis and treatment. Transient monocular vision loss is transient retinal arterial ischemia which leaves no permanent deficits. Central retinal arterial occlusion and branch retinal arterial occlusion lead to permanent visual function deficits in the majority of patients. Current treatment include lowering intraocular pressure, dilating blood vessels, hyperbaric oxygen therapy, intravenous or intra-arterial thrombolysis and so on, but there is still no standard treatment procedure. High risk groups should receive primary prevention measures in order to reduce the incidence of the disease. Patients with acute retinal arterial ischemia are at high risk of subsequent stroke and adverse cardiovascular events. Relevant risk factors should be identified in time, the primary disease should be treated actively, and appropriate secondary prevention measures should be taken to improve the prognosis. This review summarizes the recent treatment and prevention procedures of acute retinal arterial ischemia, to provide references for the management of these diseases.
ABSTRACT
A 74-year-old male presented to us with a history of vision loss for 36 hours in the right eye (RE). The RE had a visual acuity of hand movements. The fundus revealed a pale retina, cattle tracking in the retinal vessels, and a cherry-red spot at the macula. The patient was a known case of pyoderma gangrenosum (PG) and had received intravenous methylprednisolone and cyclophosphamide at the onset of visual symptoms. An emergency anterior chamber paracentesis was performed following unsuccessful attempts of ocular massage. The patient improved to 6/9 in the RE 4 months after paracentesis. The patient had an aggressive course of PG, for which he needed a combination of oral steroid, immunomodulator therapy and biologicals. An association between central retinal arterial occlusion and PG has not been reported before, according to the best of authors' knowledge.
ABSTRACT
To introduce a case of Centeral Retinal Artery Occlusion in Gas Tamponade State after Viterctomy for the treatment of Retinal Detachment. A 47-year-old male patient with histories of LASEK surgery 15 years ago and cataract surgery 8 years ago visited our clinic with complaints of sudden visual disturbance in his right eye. He was diagnosed as regmatgenous retinal detachment and underwent pars plana vitrectomy, endolaser photocoagulation, 14% C3F8 gas tamponade, and subtenon triamcinolone injection. After the surgery, the retina was well attached and the visual acuity was improved from finger count 30cm at post-operative day 1 to 0.08 after the 2 weeks of surgery. Intraocular pressure was maintained 20~25 mmHg by Brimonidine/timolol eye drop treatment. The best corrected visual acuity was reduced to hand motion at post-operative day 15. Retinal arteriol attenuation and pale optic disc with 1/3 gas filled vitreous cavity was identified at post-operative day 30. Post-operative 2 years, visual acuity was non light perception with severe narrowing of arteriole and diffuse retinal pigment epithelial atrophy; no retinal vascular flow was observed on fluorescein angiography. Gas tamponade state after viterctomy for the treatment of retinal detachment at high myopia may be risk factors of central retinal artery occlusion.
Subject(s)
Humans , Male , Middle Aged , Arterioles , Atrophy , Cataract , Fingers , Fluorescein Angiography , Hand , Intraocular Pressure , Keratectomy, Subepithelial, Laser-Assisted , Light Coagulation , Myopia , Retina , Retinal Artery Occlusion , Retinal Artery , Retinal Detachment , Retinaldehyde , Risk Factors , Triamcinolone , Visual Acuity , VitrectomyABSTRACT
Rhino-orbito-cerebral mucormycosis is the most acutely fatal fungal infection. Diabetes mellitus is the most common underlying condition and other predisposing factors include severe burn, blood dyscrasia, renal disease, sepsis, leukemia and immunosuppresive therapy. The organism has the propensity to invade the blood vessels, producing arteritis, thrombosis and secondary ishemia and tissue necrosis. The authors report two cases of rhino-orbito-cerebral mucormycosis accompanying central retinal arterial occlusion and ophthalmoplegia in a 62-year-old woman and a 52-year-old man with diabetes mellitus.