Bilateral Central Retinal Artery Occlusion Research Articles

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

A case of Churg-Strauss syndrome complicated with bilateral central retinal artery occlusion

A 56-year-old Japanese woman treated for bronchial asthma came to our hospital because of sudden vision loss of the left eye and plantar numbness of the right foot. Central retinal artery occlusion (CRAO) was diagnosed. Vision loss of the right eye also appeared, and the numbness of the right foot worsened. She was diagnosed with Churg-Strauss syndrome (CSS) due to bronchial asthma, eosinophilia, and vasculitis (CRAO and numbness). Her symptoms were unresponsive to systemic corticosteroid therapy, but improved when cyclophosphamide pulse was added. Vision disorders are uncommon manifestations of CSS. Close co-ordination with ophthalmologists is important for diagnosis and treatment.

A case of Churg-Strauss syndrome complicated with bilateral central retinal artery occlusion

A 56-year-old Japanese woman treated for bronchial asthma came to our hospital because of sudden vision loss of the left eye and plantar numbness of the right foot. Central retinal artery occlusion (CRAO) was diagnosed. Vision loss of the right eye also appeared, and the numbness of the right foot worsened. She was diagnosed with Churg-Strauss syndrome (CSS) due to bronchial asthma, eosinophilia, and vasculitis (CRAO and numbness). Her symptoms were unresponsive to systemic corticosteroid therapy, but improved when cyclophosphamide pulse was added. Vision disorders are uncommon manifestations of CSS. Close co-ordination with ophthalmologists is important for diagnosis and treatment.

Bilateral central retinal artery occlusion and vein occlusion complicated by severe choroidopathy in systemic lupus erythematosus

Severe retinal vascular occlusions resulting in blindness is a rare occurrence in patients with systemic lupus erythematosus (SLE). Herein, we report a case of a 33-year-old female who developed combined central retinal artery occlusion, retinal vein occlusion, and choroidopathy and rapidly became completely blind in both eyes within a week. The electroretinogram revealed a severely attenuated a-wave and b-wave, indicating a profound dysfunction of both choroidal and retinal circulation, respectively. The current case demonstrates objectively the functional impact of severe choroidopathy in SLE for the first time. Patients with unilateral blindness due to combined retinal/choroidal vascular obstructions should be monitored carefully to ensure adequate anticoagulant therapy in an attempt to guard the vision in the fellow eye.

Ocular manifestations of Takayasu arteritis

AbstractPurpose Takayasu arteritis is an inflammatory vascular disease of aorta and its branches. Ophthalmologic manifestations can occur up to 68% of patients and can be inaugural. The objective of this series is to describe the typical and atypical ocular manifestations of the diseaseMethods Bicentric (Pitié‐Salpêtrière and Lariboisière Hospitals) and multidisciplinary retrospective study conducted between 2004 and 2012, describing ocular manifestations of patients with Takayasu arteritis.Results Seven patients, 3 men and 4 women, were included. Mean age was 51(range:31‐70 years). Five patients had previously a confirmed diagnosis of Takayasu (71% type V) and 2 presented with inaugural ocular involvement. Most of the patients were asymptomatic(42%). We identified 5 typical manifestations , including 3 Takayasu retinopathy (42%),1 hypertensive retinopathy(15%) and 1 mixed retinopathy (15%). Atypical manifestations included a bilateral central retinal artery occlusion, a branch retinal vein occlusion and a transient monocular blindness. Treatment consisted of systemic administration of corticosteroids and immunosuppressors, symptomatic and secondary preventive therapy (laser photocoagulation on ischemic areas). Takayasu arteritis causes various ophthalmic manifestations such as traditional hypoperfusion retinopathy and hypertensive retinopathy. Atypical cases have been described, such as venous or arterial occlusions, ischemic neuropathy, and for the first time in our series a case of inaugural bilateral central retinal artery occlusion.Conclusion Takayasu arteritis should be considered in young patients with atypical vascular or inflammatory retinal manifestations. Collaboration with internists is mandatory in order to diagnose systemic involvement and propose the best therapeutic approach.

Bilateral central retinal artery occlusions in an infant with hyperhomocysteinemia

A previously healthy 7-week-old boy developed bilateral central retinal artery occlusions in the presence of hyperhomocysteinemia and elevated serum methylmalonic acid and was found to have a transcobalamin receptor mutation. Retinal arterial occlusion is uncommon in young patients and typically prompts a systemic workup. In cases of atypical retinal arterial occlusion, hyperhomocysteinemia should be investigated.

Bilateral central retinal artery occlusions and hughes syndrome.

The purpose of this study to report a case of bilateral retinal artery occlusions in a patient with systemic lupus erythematosus and antiphospholipid antibodies. A 28-year-old woman with systemic lupus erythematosus presented with sudden painless bilateral vision loss. Clinical examination and flourescein angiography were performed, and a diagnosis of bilateral central retinal artery occlusions was made. Laboratory evaluations were ordered. Laboratory evaluation revealed the presence of antiphospholipid antibodies.The patient was treated with corticosteroids, azathioprine, aspirin, and warfarin. The patient's visual acuity gradually improved over 2 weeks and then remained stable for 6 months without any further thrombotic events. The presence of bilateral retinal artery occlusions in a young patient should prompt an immediate evaluation for antiphospholipid antibodies, especially if the patient has been previously diagnosed with systemic lupus erythematosus. Correctly diagnosing patients with antiphospholipid antibodies is important because it implies the need for long-term anticoagulative and antiaggregative therapies to reduce the patient's risk of recurrent, life-threatening, thrombotic events.

SIMULTANEOUS BILATERAL CENTRAL RETINAL ARTERY OCCLUSION IN CHURG–STRAUSS SYNDROME

Retinal vascular abnormalities are rare in patients with Churg-Strauss syndrome. We present the findings in a patient with Churg-Strauss syndrome who developed bilateral central retinal artery occlusion simultaneously. Case report. A 68-year-old Japanese man developed acute bilateral vision decrease to counting finger in the right eye and hand movements in the left eye. Ophthalmoscopic and angiographic examinations revealed a central retinal artery occlusion with choroidal circulatory disturbances in both the eyes. The patient had bronchial asthma, hypereosinophilia, radiographically determined migratory pulmonary opacities, and paranasal sinus abnormalities, thus fulfilling the American College of Rheumatology criteria for Churg-Strauss syndrome. Antineutrophil cytoplasmic antibody was absent. High-dose steroid therapy was used, but after 6 weeks, his visual acuity in the right eye did not improve, and the vision in the left eye was no light perception. Later, vitreous hemorrhage was developed in the left eye followed by retinal detachment associated with proliferative retinopathy. Bilateral central retinal artery occlusion can occur in patients with antineutrophil cytoplasmic antibody-negative Churg-Strauss syndrome. The cause of the central retinal artery occlusion is not known, but consideration for prophylactic steroid therapy may be recommended in antineutrophil cytoplasmic antibody-negative cases to prevent potential visual loss.

Churg–Strauss syndrome complicated by central retinal artery occlusion: case report and a review of the literature

A 68-year-old man was admitted with rapid visual loss. Churg-Strauss syndrome (CSS) was diagnosed, based upon the symptoms of asthma, eosinophilia, interstitial pneumonitis, and positive myeloperoxidase-anti neutrophil cytoplasmic antibody (MPO-ANCA). Light reflexes were absent and vision was completely lost in both eyes. Bilateral central retinal artery occlusion (CRAO) was observed by fluorescence angiography. Steroid pulse along with an anticoagulant improved the visual acuity to light perception and hand motion. CSS-associated CRAO should be considered when acute visual loss occurs.

Catastrophic antiphospholipid antibody syndrome and cocaine abuse associated with bilateral retinal vascular occlusions.

To describe a case of bilateral central retinal vein occlusion and central retinal artery occlusion associated with antiphospholipid antibody syndrome and cocaine abuse. A single case report of a 44-year-old woman with a history of cocaine abuse, vasculitis, and 3 spontaneous abortions who developed painless complete loss of vision in both eyes concurrently with progressive motor and sensory polyneuropathy. The patient underwent an extensive laboratory, radiographic, ophthalmologic, and pathologic workup. Diagnosis of catastrophic antiphospholipid antibody syndrome was made based on established clinical and laboratory criteria, including a positive Russell's viper venom test, history of three spontaneous abortions and evidence of microvascular and macrovascular venous occlusions, and multiorgan failure. Urine toxicology screen was positive for cocaine metabolites. Her clinical course was remarkable for progressive mononeuritis multiplex and quadriplegia. She had no light perception on presentation, and fundus examination revealed extensive preretinal, intraretinal, and subretinal hemorrhages. Fluorescein angiography revealed complete occlusion of central retinal arteriolar and venular flow and retinal hemorrhages in both eyes. Bilateral central retinal vein occlusion and central retinal artery occlusion have been rarely reported in the literature and are often associated with underlying thrombotic risk factors, such as antiphospholipid antibody syndrome. Workup for underlying hypercoagulability and/or cocaine use should be considered in atypical and bilateral cases of central vein or artery occlusion. In this case, bilateral central retinal artery and vein occlusions developed as manifestations of catastrophic antiphospholipid antibody syndrome, which has not been previously reported.

Bilateral central retinal artery occlusion in a patient with primary central nervous system lymphoma

Dear Editor Primary intraocular lymphoma (PIOL), a subset of primary central nervous system lymphoma (PCNSL), is the commonest neoplastic masquerade syndrome, often leading to delay in diagnosis and poor prognosis [1]. We report a case of bilateral central retinal artery occlusion (CRAO) preceding ocular recurrence of PCNSL. A 58-year-old male had a left frontal lobe tumour debulked in September 2007. Histology showed a diffuse large B-cell lymphoma in keeping with PCNSL. Staging eye examination at the time was negative. In spite of methotrexate-based chemotherapy, the CNS lymphoma progressed, requiring total brain radiotherapy. Further scanning in February 2008 showed complete response to treatment. His concurrent medical problems included steroid-induced diabetes, hypertension and pulmonary embolism for which he was on low molecular weight heparin. He presented to the ophthalmic department with a 4-week history of right-sided painless visual loss in March 2008. Eye examination revealed no perception of light in the right eye, afferent pupillary defect, pale oedematous retina, a cherry red spot, and segmentation of blood within the retinal vessels caused by CRAO. Left visual acuity was 6/60; fundoscopy revealed background diabetic retinopathy, and age-related macular degeneration. History, clinical examination, and investigations were negative for giant cell arteritis (normal erythrocyte sedimentation rate, C-reactive protein, and blood count). The patient returned 1 month later with painful right rubeotic glaucoma, hyphaema, and vitreous haemorrhage restricting fundoscopy. B-scan ultrasonography revealed a highly reflective choroidal mass, measuring 15.9 × 18.1 mm and 4 mm in height, associated with retinal detachment (Fig. 1). Lymphomatous infiltration was suspected. A substantial vitreous biopsy was negative. Staging magnetic resonance imaging excluded intracerebral recurrence, optic nerve/sheath, and systemic involvement. Despite topical treatment the right eye remained painful and was enucleated. Histopathological examination revealed a necrotic tumour with viable peripheral rim, with sheets of lymphoid cells replacing the retina and confined to the subretinal space. Immunohistochemical staining showed the tumor cells were positive for CD20, MUM-1, BCL-2 with patchy staining for CD30, and were negative for BCL6 and CD10.The proliferation fraction with Ki-67 was high (95%). This confirmed diffuse large B-cell lymphoma identical to the original brain biopsy. A thrombus was identified within a central vessel, in keeping with CRAO. The retina was necrotic, with no vascular invasion. The optic nerve was atrophic, and free from tumour infiltration. Left vision subsequently decreased to perception of light in September 2008. Examination confirmed CRAO. Two weeks later, the retinal oedema decreased and pale retinal creamy lesions with retinal exudation and vitritis became evident, suggesting left ocular lymphoma. Further staging and lumbar puncture confirmed significant recurrent CNS lymphoma, but no evidence of optic nerve/sheath infiltration. A course of palliative left orbital irradiation was completed in November 2008. Unfortunately, the patient died in January. Declaration of interest The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Sequential bilateral central retinal artery occlusions in a female carrier of Fabry disease

Sequential bilateral central retinal artery occlusions in a female carrier of Fabry disease

Loss of vision after anaesthesia for nonophthalmic surgery: a persistent problem

Loss of vision after anaesthesia for nonophthalmic surgery: a persistent problem

Bilateral central retinal artery occlusion in a patient with acute pancreatitis.

To illustrate a case of bilateral simultaneous central retinal artery occlusion in a patient with acute pancreatitis. This patient presented to the emergency room with a 4-day history of acute painless bilateral loss of vision and was then immediately referred to the on-call ophthalmologist. This patient is a 47-year-old white man with a chronic history of alcohol abuse. Laboratory workup and computed tomography abdominal imaging were diagnostic of acute pancreatitis. It is postulated that the resultant complement activation with subsequent leukoembolization along with the combined effect of other variables led to microvascular damage resulting in bilateral central retinal artery occlusion.

Bilateral combined central retinal artery and vein occlusion in systemic lupus erythematosus resulting in complete blindness

Bilateral combined central retinal artery and vein occlusion in systemic lupus erythematosus resulting in complete blindness

Bilateral Central Retinal Artery Occlusion Associated with Moyamoya Syndrome in a Sickle Cell Disease Patient

We report a case of bilateral central retinal artery occlusion associated with sickle cell disease and moyamoya syndrome. In a review of the literature, the relationship of sickle cell disease to moyamoya syndrome and of moyamoya syndrome to central retinal artery occlusion is discussed. The utility of magnetic resonance imaging in this case is highlighted.

Bilateral simultaneous central retinal artery occlusion following head injury

To report a case of bilateral simultaneous central retinal artery occlusion (CRAO) following head injury in a young 29-year-old man. A 29-year-old man presented with head injury following road traffic accident. Posterior segment evaluation revealed CRAO in both eyes. The patient was treated for CRAO in the form of immediate ocular massage, paracentesis, intravenous mannitol and transdermal isosorbide dinitrate patch. Despite treatment the vision continued to be no perception of light. Systemic investigations were unremarkable. Color Doppler of carotid arteries showed plaque in left carotid bulb and thrombus in right internal carotid artery. Bilateral simultaneous CRAO following head trauma has not been reported earlier. Thorough ocular examination is recommended in all cases of head injury.

Bilateral CRAO and CRVO From Thrombotic Thrombocytopenic Purpura: OCT Findings and Treatment With Triamcinolone Acetonide and Bevacizumab

A patient with thrombotic thrombocytopenic purpura secondary to adult-onset Still's disease presented with bilateral combined central retinal artery occlusion and central retinal vein occlusion, a rare complication reported only once before. Fundus appearance and fluorescein angiography were similar to the previous case. Optical coherence tomography findings demonstrated aspects consistent with both central retinal artery occlusion and central retinal vein occlusion. Treatment of one eye with intravitreal triamcinolone acetonide (4 mg) was not effective in improving visual acuity. Treatment of both eyes with intravitreal bevacizumab (1.25 mg) and panretinal photocoagulation was effective in eliminating iris neovascularization, although the patient lost all visual function.

Bilateral Simultaneous Central Retinal Artery Occlusions in Wegener Granulomatosis

A 46-year old woman developed simultaneous central retinal artery occlusions (CRAOs) in Wegener granulomatosis (WG). She had presented six years earlier with xerostomia, skin rash, and arthralgias and received a diagnosis of Sjogren syndrome. Anti-neutrophilic cytoplasmic antibody (ANCA) was negative. Months prior to the CRAOs, she had developed hearing loss, proptosis, and scleritis that were not responsive to prednisone 50 mg/d. The CRAOs occurred while she was being treated at this dose level. ANCA was now positive. This is the 12th case of CRAO in WG and the 6th case of bilateral CRAOs reported in the English literature. It emphasizes that serious irreversible visual complications may occur even when the patient is being treated with substantial corticosteroid doses.

Bilateral central retinal artery occlusion in Churg-Strauss syndrome

Purpose To describe a rare bilateral central retinal artery occlusion in a patient with Churg-Strauss syndrome. Design Observational case report. Methods A 68-year-old Japanese man with Churg-Strauss syndrome developed sudden vision loss in both eyes. Medical history included bronchial asthma, elevated eosinophils, and aortic regurgitation. Result Central retinal artery occlusion was diagnosed by retinal whitening, a cherry-red spot, and delayed arteriovenous transit time on fluorescein angiography. Corticosteroids, cyclophosphamide, and anticoagulant therapy altered the hypereosinophilia and mononeuritis multiplex, but no visual recovery occurred during the following 2 years. Conclusion Bilateral central retinal artery occlusion can occur in Churg-Strauss syndrome. Patients with this diagnosis should be carefully followed.