The diagnosis and treatment of central retinal artery occlusion with severe cardio-cerebrovascular disease: a case report.

ABSTRACT

Background: Central retinal artery occlusion (CRAO) is an acute eye disease that seriously damages vision. Patients with CRAO often have a combination of various cardio-cerebrovascular diseases (CCVDs), and CRAO patients often ignore their cardio-cerebrovascular disorders because of their ocular symptoms. In addition, there are few reports about CRAO patients with CCVDs received effective interventions implemented. We report the diagnosis and treatment of a Chinese CRAO patient with CCVD who received timely multidisciplinary interventional therapy to provide ideas for clinical ophthalmologists in the diagnosis and treatment of similar diseases. Case Description A 76-year-old male patient, who had previously been diagnosed with hypertension, was admitted to hospital due to a sudden decrease in vision in his right eye for >2 days with a severe headache. After fundus photography, he was diagnosed with CRAO in the right eye. His cerebral angiography revealed multiple stenoses at arteries of his neck and brain included the right ophthalmic artery. Neurosurgery was attempted to perform a thrombolysis of the right ophthalmic artery while performing the angiography, but failed to find the opening of the right ophthalmic artery. However, through electrocardiogram (ECG) monitoring during the operation, we found that the patient had frequent ventricular premature beats, so the Department of Cardiology performed coronary arteriography for him which revealed severe stenosis of the left anterior descending (LAD) artery. The cardiologists performed a percutaneous coronary intervention (PCI) at the same time as the coronary angiography. Some 2 months later, the patient was admitted to the Neurosurgery Department to implant stent at the left vertebral artery. After stent implantation, his headache symptom improved significantly and his right eye vision improved. Conclusions: Through timely cerebral angiography and ophthalmic examinations, the patient was diagnosed with CRAO combined with CCVD, and after received multidisciplinary interventional therapy, the patient's right eye vision and headache symptom improved and more severe cardio-cerebrovascular adverse events were avoided. In treating CRAO patients, in addition to aggressive eye treatment, the systemic cardio-cerebrovascular situation of each patient should also be assessed, a timely diagnosis made, and effective interventions implemented to reduce morbidity- and mortality-related cardio-cerebrovascular events.