Bilateral Central Retinal Artery Occlusion Research Articles

Giant Cell Arteritis With Bilateral Central Retinal Artery Occlusion and Tongue Necrosis

Giant Cell Arteritis With Bilateral Central Retinal Artery Occlusion and Tongue Necrosis

BLIND-SIDED BY BLACK FUNGUS: CRAO IN CAM

Importance: There has been an outbreak of COVID-19 associated rhino-orbito-cerebral mucormycosis (CAM) in many parts of developing world. The clinical prole, mortality rate, risk factors associated with it has been studied. A case series highlighting association of Central Retinal Artery Occlusion (CRAO) in CAM has not been reported yet. To report a case series of Central Retinal Artery Occlusion (CRAO) in 15 pati Objective: ents with history of COVID19 infection associated mucormycosis (CAM). This is a retrospective observational study of Design: 15 cases of rhino-cerebroorbital mucormycosis (ROCM) which presented to our tertiary referral centre between March 2021 and June 2021. All patients had unilateral or bilateral CRAO. Tertiary care multispecialty hospital in western India. Setting: Participants: All patients diagnosed with CAM and having unilateral or bilateral CRAO. Main outcome measure: The COVID-19 disease induced inammatory homeostasis changes that predispose to thrombotic disease in both venous and arterial circulation in CAM. Overall prognosis appears to be poor with mortality rate of 14- 50% in various studies. Fifteen patients were studied of Results: which 13 were male and rest females. The mean age of patients was 55.6 + 12.13 years (Range: 39 –78 years). Majority had uncontrolled Type 2 Diabetes Mellitus. Tissue and radiological diagnosis of mucormycosis was made in all patients. Twelve patients had unilateral CRAO and 3 patients had bilateral CRAO. Diabetes and systemic ster Conclusions and relevance: oids have proven to be risk factors for development of CRAO in CAM. Early ophthalmic screening should be initiated in COVID-19 patients with systemic co-morbidities, to reduce the immediate and late sequelae.

PS-R01-8: BLOOD PRESSURE CONTROL WAS IMPROVED BY A CHANGE IN THE TIMING OF ANTIHYPERTENSIVE MEDICATION IN A PATIENT WITH NOCTURNAL HYPERTENSION

A 75-year-old-man was referred to our outpatient clinic due to inadequate blood pressure control despite antihypertensive drug treatment. He had dyslipidemia, type 2 diabetes mellitus, and a history of carotid artery stenosis, bilateral central retinal artery occlusion, and lower extremity artery disease. He took losartan potassium 50 mg, hydrochlorothiazide 12.5 mg, cilnidipine 10 mg, and nifedipine CR 40 mg in the morning. Home blood pressure monitoring was performed by using a cuff oscillometric device that could be set to measure blood pressure automatically during sleep. The patient was instructed to measure his morning blood pressure twice after waking, evening blood pressure twice before bedtime, and night-time systolic blood pressure (2:00, 3:00, 4:00, and 5:00 AM) for 7 consecutive days. Mean values were 161 mmHg for morning systolic blood pressure, 134 mmHg for evening systolic blood pressure, and 141 mmHg for night-time systolic blood pressure. After the home blood pressure monitoring, the timing of administration of nifedipine CR 40 mg was shifted from morning dosing to bedtime dosing. One month later, home blood pressure monitoring was performed again using the same schedule as before. Mean values were decreased from 161 mmHg to 135 mmHg for morning systolic blood pressure and from 141 mmHg to 127 mmHg for nigh-time systolic blood pressure. Blood pressure control was improved only by altering the timing of the administration of one antihypertensive drug from morning dosing to bedtime dosing without increasing the dosage of antihypertensive drug or adding a new antihypertensive drug class.

Simultaneous bilateral central retinal artery occlusion in a patient with dilated cardiomyopathy.

Simultaneous bilateral central retinal artery occlusion in a patient with dilated cardiomyopathy.

Managing Tetraplegia with Blindness: Rehabilitation Approach

Background and aim: Spinal cord injury, especially tetraplegia, would severely disable an individual. The rare postoperative complication of cervical spine surgery, which caused bilateral blindness, would be catastrophic to a tetraplegic patient. Methods: A 60-year-old man sustained traumatic cervical cord injury (C2 AIS C) and underwent cervical decompression with dome laminoplasty of C3 – C6. He, unfortunately, developed bilateral central retinal artery occlusion, a rare postoperative complication leading to bilateral visual loss. Approximately 1-month post-injury, he was admitted to a rehabilitation ward with impairments of incomplete tetraplegia, non-perception of light in both eyes, orthostatic hypotension, neurogenic bladder, neurogenic bowel, neuropathic pain, multiple pressure injuries, and adjustment disorder with depressed mood. Results: Although the patient required caregiver assistance in most activities, functional improvement was observed by teaching him to incorporate other intact senses such as proprioception, stereognosis, and auditory sense. After 4 weeks of rehabilitation, the patient improved to C4 AIS D. His bed mobility required minimal assistance, transferred with the assistance of one person, was able to feed and groom with an assistive device. The rehabilitation process was complicated because the patient could not actively participate in therapy without assistance from his caregiver due to bilateral blindness and reduced sensation over all his limbs despite having adequate motor power for acquiring a certain level of independence in mobility and self-care. When vision loss presents together with sensory impairments, the impact of disability multiplies. Orientation and Mobility (O&M) training and sensory education were further strengthened with repeated verbal instructions to compensate for the loss of visual and sensory feedback to help the patient regain mobility and daily living skills. Three months post-rehabilitation, he was able to perform stand transfer with a walking frame under close supervision. Conclusion: Although total blindness with tetraplegia has severely disabled the patient, O&M strategies with remaining intact senses can be used to facilitate functional improvement.

A case of presumed bilateral central retinal artery occlusion following methanol poisoning

<br>It is well established that methanol poisoning induces commonly acute toxic optic neuropathy. Herein, we describe a case of unusual ocular manifestation. A 35-year-old male presented with painless, bilateral, and simultaneous sudden onset of severe visual loss following methanol poisoning. The visual acuity was 20/200 in the right eye and limited to a finger count in the left eye. Fundus color photography showed a bilateral sub-total central retinal artery occlusion (CRAO). A methanolemia carried out following the hemodialysis returned to 0.2g/l. To the best of our knowledge, this is the first case reporting CRAO after methanol poisoning. Our report under-scores the importance of early ophthalmic examination of patients with acute methanol poisoning and suggests that it could induce acute CRAO because of retinal artery vasospasm.<br>

Bilateral central retinal artery occlusion: Endovenous and intra-arterial thrombolysis in a patient with a subsequent diagnosis of antiphospholipid antibody syndrome

Bilateral central retinal artery occlusion: Endovenous and intra-arterial thrombolysis in a patient with a subsequent diagnosis of antiphospholipid antibody syndrome

Bilateral central retinal artery occlusion in a child due to hyperhomocystinemia

Bilateral central retinal artery occlusion in a child due to hyperhomocystinemia

A Case of Bilateral Central Retinal Artery Occlusion in a Post-COVID Rhino-Orbital-Cerebral Mucormycosis Patient

Central retinal artery occlusion (CRAO) is a multifactorial disease, where inflammation and hypercoagulability are the major risk factors. It is a rare occurrence in this geographical area in patients diagnosed with sinus mucormycosis infection, which has emerged as one of the most fulminant, opportunistic secondary infection during post-COVID era. We report a case of a bilateral CRAO, in a 66-year-old, post-COVID, diabetic patient. A complete eye examination followed by radiological imaging of brain, orbit, and paranasal sinuses were done. Multidisciplinary approach was contemplated to reach a diagnosis of bilateral rhino-orbital-cerebral mucormycosis (ROCM). Intravenous liposomal amphotericin-B injection was started as a part of systemic management and an aggressive sinus debridement of both sides with amphotericin-B wash was also done. Despite an early diagnosis and intervention, the patient succumbed to her illness. All post-COVID patients presenting with the complaints of blurring of vision should be meticulously examined for the presence of any retinal abnormality in both the eyes as this may be a manifestation of an underlying secondary fungal infection. Early diagnosis of ROCM and management will help in reducing complications.

Neurological impact of eosinophilic granulomatosis with polyangiitis.

Nervous system (NS)affectionmay occur in Eosinophilic Granulomatosis with Polyangiitis (EGPA), butitsclinical manifestations and pathophysiologyare rarely described. Our aims are to characterizecentralandperipheralNS (CNS/PNS) involvement and comparebiologicalmarkers inEGPApatients with and without neurological manifestations. Retrospective observational study, including EGPA patients with and without neurological manifestations. Demographics, clinical data, andimmunological markers were analyzed. Descriptive and inferential statistics were performed. Sixteenpatientswereincluded;11 (68.8%) ofwhom were male, with a mean age of 63.38years;8 with (Group 1) and 8 without (Group 2) neurologicalfindings.Neurological impairment preceded EGPA diagnosis in 5 patients, and occurred during follow-up in 3 patients after a median of 4.0years.CNS manifestations observed were stroke (n = 2), bilateralcentral retinal artery occlusion(n = 1), and compressive dorsal myelopathy due to extradural granulation tissue (n = 1). PNSmanifestationswere axonal polyneuropathy (n = 3), sensorineural hearing loss (n = 3), and multiplex mononeuropathy (n = 1). Two patients had both PNS and CNS involvement. There were no statistical differences regarding biological markers [eosinophil count, myeloperoxidase (MPO) antibodies titers] between the 2 groups.One patient from Group 1 wasunresponsive to treatmentandpermanent neurological sequelaewere observed in 7 cases. EGPA-related NS involvement can be heterogeneousandisresponsible for long-term sequelae. In our sample,themainneurological scenarios wereperipheral neuropathy, VIIIcranial nerve neuropathy,ischemic lesions and compressivemyelopathy.Patientswith andwithoutneurological manifestations did notdiffer ineosinophilic count and MPO titer.

Bilateral central retinal artery occlusion in a patient with diagnosed Takayasu's arteritis

Bilateral central retinal artery occlusion in a patient with diagnosed Takayasu's arteritis

Concurrent Bilateral Central Retinal Artery Occlusion Secondary to Sickle Cell Crisis

Vascular occlusive crisis with a concurrent vision loss on both eyes is one of the most devastating disability for sickle cell disease patients. Reportedly occlusive crisis in the eyes is usually temporary whereas if not appropriately managed can result in permanent vision loss. A carefully managed sickle cell crisis could prevent multiple disabilities including blindness and stroke. We report a case of a 24-year-old female with a history of sickle cell disease who had acute bilateral vision loss during a sickle crisis and recovered significantly with a timely emergent erythrocytapheresis.

Bilateral central retinal artery occlusion as a premonitory presentation in giant cell arteritis

Central retinal artery occlusion (CRAO) is an ophthalmologic emergency. Carotid artery atherosclerosis, cardiogenic emboli, hypertension, smoking, diabetes, and giant cell arteritis (GCA) are the contributing risk factors for CRAO. It is imperative to rule out GCA in patients aged above 50 years as it can cause severe visual loss involving both eyes, if not treated promptly, making diagnosis critical. Elevated C-reactive protein and erythrocyte sedimentation rate with a raised platelet count favor GCA as a probable diagnosis. Typical granulomatous inflammation on temporal artery biopsy confirms the diagnosis. The vision loss is permanent, but early steroid therapy is effective in preventing further visual loss.

Rare Case of Granulomatosis With Polyangiitis Presenting With Simultaneous Bilateral Acute Central Retinal Artery Occlusion and Profound Mixed Hearing Loss

Granulomatosis with polyangiitis (GPA) is an uncommon disease entity characterized by necrotizing granulomatous inflammation and pauci-immune vasculitis of predominantly medium and small vessels. It mainly effects the upper respiratory tract and the renal system. It rarely engulfs other systems like the eye and hearing apparatus. We hereby report an interesting case involving simultaneous involvement of bilateral central retinal artery and hearing loss as presenting illness in a case of GPA.

Bilateral Sequential Central Retinal Artery Occlusion due to Giant Cell Arteritis

A patient presented with acute, painless loss of vision in each eye occurring successively over a few days. He was diagnosed with bilateral central retinal artery occlusions (CRAO) and immediately underwent treatment for possible giant cell arteritis (GCA) while the etiology of CRAO was being determined. Further workup initially proved ambiguous in many respects for GCA verses other types of vasculitis. Definitive diagnosis of GCA was achieved with temporal artery biopsy, though this too demonstrated characteristics of other vasculitides. While awaiting pathology results, empiric treatment for GCA should continue uninterrupted to prevent progression or relapse, as GCA carries a significant risk of vision loss and visual recovery is exceedingly rare. Ultimately, the diagnosis relies heavily on clinical correlation.

Bilateral central retinal artery occlusion in a case of eclampsia

Bilateral central retinal artery occlusion in a case of eclampsia

Idiopathic bilateral central artery occlusion in a young woman

Central retinal artery occlusion (CRAO) is uncommon among children and young adults. Bilateral CRAO before the age of 18years are extremely rare. We present a case of an idiopathic bilateral CRAO in a young healthy female.

Catastrophic antiphospholipid syndrome presenting as bilateral central retinal artery occlusions.

A previously healthy 22-year-old African American woman presented with bilateral vision loss associated with headache. Her ocular examination was significant for bilateral retinal arterial “boxcarring,” retinal whitening, retinal hemorrhages, and cherry red spots. She was diagnosed with bilateral central retinal artery occlusions and was hospitalized due to concomitant diagnosis of stroke and hypercoagulable state. She was also found to be in heart failure and kidney failure. Rheumatology was consulted and she was diagnosed with catastrophic antiphospholipid syndrome in association with systemic lupus erythematosus. Approximately 7 months after presentation, the patient's vision improved and remained stable at 20/200 and 20/80.

Bilateral Central Retinal Artery Occlusion (CRAO) after Opium Consumption

Bilateral Central Retinal Artery Occlusion (CRAO) after Opium Consumption

Sudden blindness due to bilateral central retinal artery occlusion in a patient on eltrombopag

Sudden blindness due to bilateral central retinal artery occlusion in a patient on eltrombopag