Acute Branch Retinal Artery Occlusion Research Articles

Intravenous Thrombolysis in Acute Branch Retinal Artery Occlusion Based on the Stroke Green Channel: A Case Report

Retinal artery occlusion is an acute-onset eye disease that seriously impairs vision, and is a critical condition in ophthalmology. The effect of traditional ophthalmology treatment methods are not ideal. It is difficult to recanalize blocked blood vessels early, but thrombolysis can be given within an effective time window to dissolve the thrombus, improve retinal blood perfusion and restore the function of the retinal inner layer cells. Under the protection of the green channel for stroke, we performed intravenous thrombolysis for patients with branch retinal artery obstruction, and achieved satisfactory results, and the patients were cured.

Multimodal imaging in IRVAN syndrome presenting with Branch Retinal Artery Occlusion.

To describe multimodal imaging findings in a patient with idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome presenting with branch retinal artery occlusion (BRAO). A 33-year-old woman presented with acute BRAO in the right eye. A diagnosis of underlying IRVAN syndrome was made based on the presence of arteriolar aneurysms on the optic disc and along major arterioles and faint retinal hard exudates in both eyes. Eight months later, best-corrected visual acuity was 20/25 in the right eye and 20/20 in the left eye. The hard exudates had increased, and there were extensive areas of peripheral retinal capillary nonperfusion without new vessels. Optical coherence tomography (OCT) showed a localized retinal thinning corresponding to the prior BRAO. Fundus autofluorescence showed nodulo-linear periarterial hypoautofluorescence. OCT angiography (OCTA) showed localized ischemic changes, mainly involving the deep capillary plexus, corresponding to the area of resolved BRAO. It also clearly delineated the optic disc aneurysms. The patient received bilateral scatter laser photocoagulation directed to areas of peripheral capillary nonperfusion. Over a 6-month follow-up period, visual acuity remained unchanged, and there was no evidence of disease progression. Multimodal imaging, including fundus autofluorescence, OCT, and OCTA can provide additional valuable information in the evaluation of IRVAN syndrome complicated with BRAO.

RASH PROVOKES CATASTROPHIC ANTIPHOSPHOLID SYNDROME

SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Catastrophic Antiphospholipid Syndrome (CAPS) is a rare life-threatening condition characterized by acute thrombosis in multiple organ systems leading to ischemia and/or organ failure in the presence of positive antiphospholipid antibodies. Approximately fifty percent of patients who present with CAPS do not initially have a prior diagnosis of antiphospholipid syndrome. We present a case of a patient who was found to have CAPS after originally presenting to the hospital for a drug induced rash. CASE PRESENTATION: A 55-year-old male with psoriasis presented to the hospital with a painful diffuse erythematous and pustular rash covering his entire body two days after receiving general anesthesia and cefazolin for an elective circumcision. He was admitted to the burn unit and punch biopsy revealed Acute Generalized Exanthematous Pustulosis (AGEP). Two days after his initial presentation, he lost vision in his right eye and was found to have an acute branch retinal artery occlusion. Throughout the next day, he became hypotensive, somnolent, and confused and he was found to have a dilated right pupil. Imaging revealed a left middle cerebral artery stroke. He developed acute renal failure and a non-ST-elevation myocardial infarction. He was started on pressor support for shock and ultimately required intubation due to increased work of breathing. Autoimmune and vasculitis workup were unremarkable. Repeat MRI was performed which revealed three new infarcts in the right frontal lobe and basal ganglia. Due to concern for endocarditis, a transesophageal echocardiogram was performed and was negative for vegetation. Bilateral lower extremity ultrasound was negative for deep venous thrombosis. Thrombotic workup was remarkable for a positive lupus anticoagulant, hexagonal phase phospholipid, and dilute Russell’s viper venom time screen. He was treated with methylprednisolone, plasma exchange, and a heparin infusion for suspected Catastrophic Antiphospholipid Syndrome. His overall condition began improving within 24 hours and he was eventually extubated. DISCUSSION: CAPS is difficult to diagnose with a need for high clinical suspicion especially in the setting of concomitant illnesses. For this patient with AGEP after cefazolin use, clinical diagnosis became even more difficult as the patient had such significant physical exam findings. Fortunately, the patient was diagnosed quickly enough to receive proper treatment and have significant improvement. CONCLUSIONS: This case demonstrates the importance of a high clinical suspicion to facilitate and receive prompt treatment with plasma exchange and a heparin infusion in order to improve a patient's chances of survival given the increased morbidity and mortality associated with CAPS. Reference #1: Nayer A, Ortega LM. Catastrophic antiphospholipid syndrome: a clinical review. J Nephropathol. 2014;3(1):9-17. DISCLOSURES: No relevant relationships by Nathan Brewster, source=Web Response No relevant relationships by Aaron Czysz, source=Web Response No relevant relationships by Kareem Godil, source=Web Response No relevant relationships by Breanna Goldner, source=Web Response No relevant relationships by Alaynna Kears, source=Web Response

Risk of acute stroke in patients with retinal artery occlusion: a systematic review and meta-analysis.

To estimate the incidence of acute cerebral ischaemia detected by magnetic resonance imaging (MRI) in acute central retinal artery occlusion (CRAO), branch retinal artery occlusion (BRAO) and transient monocular vision loss (TMVL). Studies reporting the incidence of acute cerebral ischaemia, detected by MRI, within 7 days from diagnosis of acute CRAO, BRAO and TMVL up to January 2019 were systematically searched for on Pubmed, Medline and Cochrane Library. Meta-analysis was performed using random effects model. The primary outcome was the pooled estimate of incidence of acute cerebral ischaemia in CRAO, BRAO and TMVL cohorts including both neurologically symptomatic and asymptomatic patients, expressed as a proportion along with 95% confidence intervals (CIs). The pooled estimate of incidence of asymptomatic acute cerebral ischaemia represented a secondary outcome measure. For the primary outcome, the pooled proportion of acute cerebral ischaemia was 0.30 (CI 0.24-0.36) in the CRAO cohort, and 0.25 (CI 0.16-0.37) in the BRAO cohort, without statistical heterogeneity. The rate of acute cerebral ischaemia was 11.8% in the TMVL cohort. For the secondary outcome, the pooled proportion of asymptomatic acute cerebral ischaemia was 0.22 (CI 0.16-0.28) in the CRAO cohort, 0.29 (CI 0.20-0.41) in the BRAO cohort and 0.08 (CI 0.05-0.15) in the TMVL cohort, with no statistical heterogeneity. 30% of patients with acute CRAO and 25% of patients with acute BRAO presented an acute cerebral ischaemia on MRI. Such high rates support a care pathway of prompt referral of such patients for neurological evaluation and brain imaging.

Optical Coherence Tomography Angiography in Branch Retinal Artery Occlusion.

Optical coherence tomography angiography (OCTA) is a non-invasive alternative method used in the diagnosis and follow-up of acute branch retinal artery occlusion to show changes secondary to ischemia. We report a case with acute branch retinal artery occlusion. A 52-year-old man presented with a complaint of sudden-onset visual loss in the right lower quadrant of the left eye for the previous three days. Best-corrected visual acuity was 0.4 temporally. Inferonasal visual field deficit was detected with confrontation. Pupillary light reactions were normal in both eyes and there was no relative afferent pupillary defect. Dilated fundus examination revealed retinal lesion suggesting superior temporal branch retinal artery occlusion. He was treated with dextran 40 and pentoxifylline. Follow-up fundus fluorescein angiography could not performed because of chronic renal failure; OCTA demonstrated superficial and deep capillary non-perfusion areas and telangiectases in areas corresponding to the artery occlusion.

Cerebral Small Vessel Disease in Branch Retinal Artery Occlusion.

We investigated the pathophysiology of branch retinal artery occlusion (BRAO) by evaluating the retina, brain, and carotid artery in patients with BRAO. This study was a retrospective registry study. We used 46 eyes from 46 patients with acute BRAO and evaluated the medical history, including previous cardiovascular disease, and compared brain magnetic resonance images (MRI) and carotid artery stenosis state between the embolic BRAO group and nonembolic BRAO group. We measured differences in cerebrovascular characteristics, including brain MRI, according to the existence of retinal emboli. The embolic BRAO group tended to have a significantly higher likelihood of cardiovascular disease history, including ischemic heart disease and smoking history (P = 0.018 and P < 0.001, respectively). In addition, the embolic group had a higher frequency of acute cerebral infarctions and stenotic carotid arteries (P = 0.017 and P = 0.028, respectively). Although the overall frequency of cerebral small vessel disease (SVD) did not differ between embolic and nonembolic groups, the nonembolic BRAO group showed a significantly higher prevalence of cerebral SVD without large vessel pathology (P = 0.008). Patients with BRAO showed different cerebrovascular characteristics following retinal emboli, including brain MRI findings. The results suggest that we must consider SVD etiology as well as large vessel disease mechanisms in the pathophysiology of BRAO.

Acute Branch Retinal Artery Occlusion and OCT Angiography Imaging

Acute Branch Retinal Artery Occlusion and OCT Angiography Imaging

Ischemic Injury of the Papillomacular Bundle Is a Predictive Marker of Poor Vision in Eyes With Branch Retinal Artery Occlusion

To propose a novel prognostic feature of spectral-domain optical coherence tomography (SDOCT) in macula-involving branch retinal artery occlusion (BRAO). Retrospective comparative case study. We analyzed 66 eyes diagnosed with acute BRAO involving the macula from our hospital RAO registry. At presentation, a detailed ophthalmic and medical history was obtained from all patients, and all underwent a comprehensive ophthalmic evaluation, which included visual acuity examination, fundus photography, fluorescein angiography, and SDOCT. This evaluation was performed at each follow-up visit. The 66 eyes diagnosed with acute BRAO involving the macula were divided into 2 groups according to initial vision: Good Vision (≥20/40, 29 eyes, 44%) and Poor Vision (<20/40, 37 eyes, 56%). The Poor Vision group was further divided into Improvement (18 eyes, 27%) and Nonimprovement (19 eyes, 28%) groups, according to visual recovery at the final examination. Among multiple OCT parameters, the involvement of papillomacular bundle, but not that of the central fovea, was consistently observed in the Poor Vision group (P < .001) and more significantly in the Nonimprovement group (P < .001). Papillomacular bundle involvement features included signs of inner retinal ischemia, including inner retinal thickening, inner retinal hyperreflectivity, and loss of layer-by-layer integrity. Loss of layer-by-layer integrity was seen consistently in the Nonimprovement group. Quantitative analysis of inner retinal thickness also supported this association. In eyes with macula-involving BRAO, ischemic injury of the papillomacular bundle at the acute stage, as seen on OCT, correlates closely with poor vision and can explain the poor visual prognosis.

A Case of Idiopathic Pediatric Acute Branch Retinal Artery Occlusion Involving the Macular Area

A Case of Idiopathic Pediatric Acute Branch Retinal Artery Occlusion Involving the Macular Area

Evidence of Recurrent Microvascular Occlusions Associated with Acute Branch Retinal Artery Occlusion Demonstrated with Spectral-Domain Optical Coherence Tomography

Aleman, Tomas S. MD; Tapino, Paul J. MD; Brucker, Alexander J. MDEditor(s): Toth, Cynthia A.; Martel, Joseph; Yiu, Glenn Author Information

In vivo identification of alteration of inner neurosensory layers in branch retinal artery occlusion

Background/aimsTo characterise the extension and progression of alteration of neurosensory layers following acute and chronic branch retinal artery occlusion (BRAO) in vivo using spectral-domain optical coherence tomography.MethodsIn this observational case...

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

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.

Longitudinal analysis of retinal changes after branch retinal artery occlusion using optical coherence tomography

Background Branch retinal artery occlusion (BRAO) causes inner retinal ischemia leading to permanent inner retinal dysfunction and visual field loss in affected retinal sectors. Optical coherence tomography (OCT) offers a novel way to evaluate in vivo retinal morphologic changes in BRAO in both acute and longitudinal phases. This case report describes OCT findings in BRAO at acute presentation and at follow-up, including the longitudinal evaluation of retinal and peripapillary retinal nerve fiber layer (RNFL) thickness. Case report A 58-year-old white man with an acute branch retinal artery occlusion was examined by OCT at initial presentation and at 2, 4, and 8 months. At initial presentation, OCT line scan showed thickening and hyper-reflectivity of the inner retina with shadowing of photoreceptor and retinal pigment epithelial layers. At 2 months, hyper-reflectivity and thickening were reduced. At 4 months, the inner retina showed no hyper-reflectivity and was attenuated. Peripapillary RNFL thickness was reduced in corresponding sectors. Findings at the 8-month follow-up were unchanged from the 4-month visit. Conclusions OCT provides useful information regarding the evolution of inner retinal attenuation in BRAO. Differential diagnosis of sectoral peripapillary RNFL thinning should include previous BRAO.

Optical Coherence Tomography Findings in Branch Retinal Artery Occlusion

To report the optical coherence tomography (OCT) findings in a 35-year-old man with acute inferior branch retinal artery occlusion. OCT findings in acute branch retinal artery occlusion were evaluated. OCT disclosed diffuse thickening of the neurosensory retina in the inferior perifoveolar area. Increased reflectivity was noted in the inner retinal layers rom the surface of the retina to the photoreceptor layers. Decreased reflectivity was observed from the photoreceptor layers and the retinal pigment epithelium secondary to the shadowing effect. Foveolar depression, photoreceptor layer in the fovae, and retinal pigment epithelium underneath the fovea were normal. OCT findings in the superior perifoveolar area were also normal. In the retinal artery occlusion, denaturation and breakdown of the normally transparent intracellular protein and an increase in the intracellular fluid cause ischemic whitening of the retina. Otherwise there is no retinal thickening secondary to the accumulation of serous fluid escaping from retinal capillaries into the extracellular space. The OCT findings support these descriptions.