Résumé
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.
Sujets)
Adulte , Complexe d'Eisenmenger/complications , Proaccélérine/génétique , Femelle , Angiographie fluorescéinique , Fond de l'oeil , Valvulopathies/chirurgie , Implantation de valve prothétique cardiaque , Humains , Hypertension artérielle maligne/complications , Mâle , Valve atrioventriculaire gauche , Mutation , Papille optique/imagerie diagnostique , Polyglobulie/complications , Artère centrale de la rétine/imagerie diagnostique , Artère centrale de la rétine/imagerie diagnostique , Occlusion artérielle rétinienne/diagnostic , Occlusion artérielle rétinienne/étiologie , Occlusion artérielle rétinienne/physiopathologie , Occlusion artérielle rétinienne/thérapie , Thromboembolie/complications , Échographie-doppler couleurRésumé
Best's vitelliform macular dystrophy is a hereditary form of progressive macular dystrophy that can be complicated by choroidal neovascularization. Authors report successful treatment of choroidal neovascularization with intravitreal bevacizumab in one such eye in an ‘adult’ Indian male with visual improvement. A 23-year-old male presented with diminution of vision in the right eye for the past sixteen months. Visual acuity was 20/400 in the that eye. After three consecutive intravitreal injections of bevacizumab (1.25 mg/0.05 ml), vision improved to 20/120. Seven months following the last injection of bevacizumab, fundus appeared stable and visual acuity was maintained. No drug-related ocular or systemic side effects were encountered. To the best of our knowledge (PubMed search), this is the first report of its kind in an adult Indian patient. Intravitreal bevacizumab appears to be a promising and cost-effective modality of treatment in such eyes with potential for improvement in vision. However, a long-term follow-up is warranted.