Cilioretinal Artery Occlusion Research Articles

Central retinal vein and cilioretinal artery occlusion in a case of systemic sclerosis treated with a JAK inhibitor figlotinib.

Central retinal vein and cilioretinal artery occlusion in a case of systemic sclerosis treated with a JAK inhibitor figlotinib.

Central retinal vein occlusion with secondary cilioretinal artery occlusion following oral minoxidil use: A case report and literature review

Minoxidil, a drug that is widely used for hair loss treatment, is considered a safe medication. While there are minor side-effects such as scalp irritation or systemic effects like tachycardia, it is rarely associated with severe ocular complications. We report a case where a 35-year-old man, taking oral Minoxidil for alopecia, developed Central Retinal Vein Occlusion (CRVO) with Cilioretinal Artery Occlusion (CLRAO), leading to sudden vision loss. After Minoxidil discontinuation, the patient’s vision significantly improved. This incident emphasises the importance of recognizing potential ocular side effects of Minoxidil among healthcare professionals and necessitates further research to understand its comprehensive impact on health.

Combined central retinal vein occlusion and cilioretinal artery occlusion in an MTHFR C677T homozygous 26-year-old patient with hyperhomocysteinemia: Case report

A 26-year-old female patient presented with sudden, painless visual disturbances in her right eye (RE). Fundus examination revealed signs of a central retinal vein occlusion (CRVO) (hemorrhages, mild venous tortuosity, mild disc swelling, and blurred disc margins), as well as a white ischemic area nasal to the optic nerve, suggesting a possible cilioretinal artery occlusion (CLRAO). A diagnosis of combined CRVO and nasal CLRAO with homozygosity for the C677T mutation in the methylenetetrahydrofolate reductase (MTHFR) gene and elevated levels of serum homocysteine was made. The patient was prescribed folic and acetylsalicylic acid and subsequent follow-up demonstrated gradual improvement.

Case report: acute isolated cilioretinal artery occlusion secondary to percutaneous coronary intervention

IntroductionThis case report aims to describe in detail the acute isolated cilioretinal artery occlusion (CLRAO) secondary to complicated therapeutic percutaneous coronary intervention (PCI).Case descriptionA 68-year-old Chinese man with coronary artery disease (CAD) complained of sudden, sharp chest pain. Coronary angiography revealed severe stenoses of the coronary arteries. The patient was then treated with PCI. One hour after the procedure, the patient presented with a sudden reduction in vision in the right eye. The patient was diagnosed with acute isolated CLRAO and treated with Salvia miltiorrhiza injections.ConclusionsThis is the report to provide a detailed description of acute isolated CLRAO secondary to therapeutic PCI treated with Salvia miltiorrhiza. The visual prognosis of the untreated patients is poor. Suitable management and prevention are essential for interventional cardiologists to prevent these complications.

Cilioretinal artery occlusion secondary to central retinal vein occlusion

Cilioretinal artery occlusion secondary to central retinal vein occlusion

Henle fiber layer hemorrhage associated with combined central retinal vein occlusion and cilioretinal artery occlusion: a case report

BackgroundThe purpose of this study is to describe a patient who experienced simultaneous central retinal vein and cilioretinal artery occlusions, as well as perifoveal hemorrhage in the Henle fiber.Case presentationA 67-year-old Iranian woman presented with a 3-day history of reduced vision in her left eye. Venous tortuosity and retinal hemorrhage were observed in the retina, together with whitened regions around the fovea, consistent with the diagnosis of central retinal vein occlusion in conjunction with cilioretinal artery occlusion. In structural and en face optical coherence tomography, star-shaped hemorrhages were observed around the fovea, which looked hyperreflective in the Henle fiber layer.ConclusionsWe present a case of central retinal vein occlusion exacerbated by cilioretinal occlusion and hemorrhage in the Henle fiber layer. The hemorrhage is most likely the result of increased intraluminal pressure in the deep capillary plexus.

A Case Series of Cat-Scratch Disease with Ocular Manifestations: Clinical Findings and Treatment Approach.

To present the clinical and demographic characteristics, imaging findings, diagnosis and treatment approach in cases of cat scratch disease (CSD) with ocular involvement. The records of 19 patients followed-up and treated between 2010 and 2020, including detailed ophthalmological examinations, imaging findings, and treatment approach, were evaluated retrospectively. Twenty-three eyes of 19 patients, 7 female (37%) and 12 male (63%), were included in the study. The mean age was 34.1±13.3 (range: 11-56) years, and the mean follow-up duration was 12.6±18.0 (range: 1-81) months. Unilateral involvement was observed in 15 cases (79%). Cat contact was reported in 14 cases (74%). In 6 cases (32%), flu-like symptoms were present before the ocular complaints. The mean visual acuity (VA) at presentation was 0.42±0.36 (range: 0.001-1.0). Anterior uveitis was observed in 3 eyes (13%). Posterior segment findings included neuroretinitis in 14 (61%), superficial retinal infiltrate(s) in 8 (35%), papillitis in 3 (13%), branch retinal artery occlusion in 2 (8%), and cilioretinal artery occlusion in 1 (4%) of the eyes. All cases were positive for Bartonella henselae immunglobulin (Ig)M and/or IgG. Systemic antibiotic therapy was administered to all patients. Intravenous pulse or oral corticosteroids were given, especially in cases with optic disc involvement. The mean final VA was 0.80±0.25 (range: 0.01-1.0). CSD may present with different ocular involvement patterns. Apart from the classical neuroretinitis and macular star appearance, patients may present with isolated optic disc edema, branch retinal artery occlusion, and retinal infiltrations. In such patients, cat contact history and Bartonella serology should be evaluated to differentiate CSD.

Giant cell arteritis: An interesting case presentation.

Giant cell arteritis (GCA), otherwise known as temporal arteritis, is a form of large vessel vasculitis. Patients may present with a variety of symptoms but the most common include headaches, jaw claudication, fatigue, night sweats and visual disturbance. Diagnosis is made using a combination of temporal artery ultrasound, clinical findings and blood tests and the diagnostic gold standard of a temporal artery biopsy and is sometimes needed for histopathological confirmation. Syphilis is a sexually transmitted disease caused by the spirochaete Treponema pallidum, which can infect the central nervous system and cause neurosyphilis, which can mimic GCA.

Combined central retinal vein occlusion and cilioretinal artery occlusion as the initial presentation of frosted branch angiitis: a case report and literature review

PurposeTo report a case of combined central retinal vein occlusion (CRVO) with cilioretinal artery occlusion (CLRAO) that heralded the development of frosted branch angiitis (FBA).Case reportA 25-year-old healthy male presented with sudden painless visual loss in his left eye with a visual acuity (VA) of 20/300. Fundus exam and fluorescein angiography showed signs of combined CRVO and CLRAO. Without treatment, his vision gradually improved until it reached 20/30 within four months. Five months after initial presentation, he returned with severe visual loss (20/400) in the same eye and a clinical picture of severe occlusive periphlebitis resembling a frosted branch angiitis pattern associated with severe macular edema. This was promptly and successfully treated with systemic steroids and immunosuppressive medications.ConclusionCRVO in young population can have an unusual course and one should carefully rule out underlying uveitic etiologies in each visit. Clinical suspicion and close follow‑up are required for early detection and timely management of FBA.

Paracentral Acute Middle Maculopathy in a Patient with Cilioretinal Artery Occlusion

Introduction: A 49-year-old woman presented at Inoda Eye Clinic with inferior visual field defect in the left eye. Ophthalmoscopic examination revealed well-demarcated retinal edema of the superior region at the posterior pole in the left eye. The area of retinal edema was consistent with the area of the cilioretinal artery, and therefore, cilioretinal artery occlusion was suspected. Optical coherence tomography showed hyperreflective bandlike lesions involving the middle layers of the retina at the level of the inner nuclear layer. Optical coherence tomography angiography showed decreased flow sign in outer retina layer and choriocapillaris layer rather than in superficial layer. Based on these findings, the patient was diagnosed with paracentral acute middle maculopathy due to cilioretinal artery occlusion. Optical coherence tomography angiography is a useful diagnostic examination instead of fluorescein angiography for evaluation of cilioretinal artery occlusion.

Combined Cilioretinal Artery and Branch Retinal Vein Occlusion Revealing a Carotid Artery Disease

We report the case of a healthy 55-year-old patient, who consulted at the ophthalmology emergency for a rapidly progressive unilateral visual impairment of the left right eye without neurological signs. Fundus examination of the right eye found retinal whitening following the territory of the cilioretinal artery corresponding to cilioretinal artery occlusion; dilated and tortuous retinal veins, and scattered retinal hemorrhages on the lower quadrants as well a puddle-like hemorrhages at the interpapillomacular area (Figure 1: Panel A). Fluoresceine angiography targeted a delayed perfusion of the inferior temporal branch vein (arrows) (Figure1: panel B). Macular OCT showed moderate macular thickening in the nasal macula and hyper reflectivity of the inner layers of the retina (Figure 2).

Hyperbaric oxygen treatment for paracentral acute middle maculopathy: a case study

A 47-year-old active-duty Navy diver with a complicated past medical history which resulted in his designation as not physically qualified (NPQ) for diving duty in 2016 presented on 07 May 2021 complaining of left-sided blurred vision. On exam by the attending undersea medical officer he was found to have a left upper inner and upper outer quadrant visual field defect along with a central scotoma. Urgent referral to ophthalmology ruled out retinal detachment but resulted in an initial diagnosis of a left branch retinal artery occlusion without embolus. Considering this a variant of central retinal artery occlusion, hyperbaric oxygen (HBO2) therapy was initiated approximately 12 hours after symptom onset, resulting in complete, though temporary, resolution of the visual field defect. He reported that after completion of his first HBO2 treatment, his visual field deficit began to return, but the deficit again resolved after initiating surface oxygen therapy between HBO2 treatments. After two days of continuous surface oxygen and daily HBO2 treatments, which kept his visual field defect minimized, his deficits changed to a persistent left lateral peripheral defect and a recurrent central nasal defect. At this time, his periodic ophthalmology evaluation revised his diagnosis to cilioretinal artery occlusion (CrAO). Further evaluation by ophthalmology revealed retinal changes consistent with a secondary diagnosis of paracentral acute middle maculopathy (PAMM), an ophthalmologic condition only recently defined in the literature (2013) [10] secondary to advances in retinal imaging technology. This case is presented to share the findings of this complicated case and to postulate a benefit from the use of HBO2 for cilioretinal artery occlusion with PAMM.

Resolution of cilioretinal artery occlusion with central retinal vein occlusion

Resolution of cilioretinal artery occlusion with central retinal vein occlusion

A rare case of a combined retinal artery and vein occlusion in a young patient

AbstractPurpose: To report a case of combined retinal artery and vein occlusion in a young patient.Methods: A case report.Results: A 37‐year‐old gentleman presented to the Emergency Department with a central scotoma in his right eye for 1 day. He was known to have right amblyopia but had no known past medical illness. He was a chronic smoker. Best corrected visual acuity was 6/45 in the right eye and 6/7.5 in the left eye. His intraocular pressure was 19 (right) and 18 (left) mmHg. Anterior segment examination was normal. His right eye fundus examination revealed retinal ischaemia and edema in the macula area supplied by cilioretinal artery. The inferotemporal vessels were also tortuous, with flame and dot haemorrhages. His left eye was normal. Optical coherence tomography showed inner retinal hyperreflectivity and edema. Fundus fluorescein angiography showed delayed filling of the cilioretinal artery and inferotemporal retinal vein corresponding to the clinical findings. He was diagnosed with a right eye combined cilioretinal artery and inferotemporal branch retinal vein occlusion. An anterior chamber tap was performed immediately to lower intraocular pressure and improve perfusion. The next day, he reported that his vision was clearer (visual acuity 6/20) and the scotoma was smaller in size. Given his young age, we performed a full systemic young‐stroke workup to evaluate his vascular risk factors and rule out thrombophilia. He was found to have newly diagnosed diabetes and hyperlipidemia. His coagulopathy screen was negative. A primary care referral was made for management of his chronic diseases and for smoking cessation support.Conclusions: Combined retinal and venous occlusions are rare and are often associated with significant systemic comorbidities. In a young, healthy patient, it is particularly important to perform detailed investigations to work up its cause, as this could be a harbinger of future ischaemic events.

The Role of the Inner Nuclear Layer for Perception of Persisting Tiling Inside a Monocular Scotoma.

We report two patients, one with and one without long-term persistent tiling inside an arcuate macular scotoma. In both cases, the scotoma was caused by a cilioretinal artery occlusion. Both patients were almost identical regarding the location and extent of the scotoma. In both cases, there was a comparable degree of atrophy on optical coherence tomography for the retinal nerve fibre, ganglion cell, and inner plexiform layers. The main difference was the preservation of the inner nuclear layer in the patient with persistent tiling. In this patient, optical coherence angiography demonstrates preserved perfusion of the superior vascular plexus, which was not the case in the patient with the negative scotoma who also had atrophy of the inner nuclear layer. Recreational use of cannabinoid enhanced the intensity of perceived tiling in the relative scotoma of the first patient. A review of the literature suggests that the persistent tiling described in our case is different to teichopsias of retinal or cerebral origin. These data suggest that persistent monocular tiling in a scotoma arises from retinal circuit activity that requires the preservation of the inner nuclear layer. Future research should investigate this functional-structural relationship in other diseases, including glaucoma.

CTNI-60. PRELIMINARY RESULTS OF BINIMETINIB AND ENCORAFENIB IN ADULTS WITH RECURRENT BRAF V600E-MUTATED HIGH-GRADE GLIOMA

Abstract BACKGROUND Although < 5% of high-grade gliomas (HGG) are BRAF-V600E mutated, these tumors are being identified more frequently as genetic testing increases in gliomas. Given the treatment-refractory nature HGG, RAF-targeted therapy is of special interest. The combination of encorafenib (BRAF inhibitor) with binimetinib (MEK inhibitor) was evaluated in adults with recurrent BRAFV600-mutated HGG. METHODS In this phase 2, open-label, Adult Brain Tumor Consortium trial(NCT03973918) encorafenib (450mg daily) and binimetinib (45mg twice daily) were administered continuously until disease progression, unacceptable toxicity, or death. Eligible patients had a histologically-confirmed HGG with BRAF-V600E mutation identified by PCR or next generation sequencing, and had progressed after radiation and any number of prior medical therapies. The primary endpoint was radiographic response rate by RANO criteria. Plasma was collected at baseline, on-study, and at progression for correlatives. RESULTS Five patients enrolled between January 2020 and November 2021. All patients had at least one prior recurrence (range 1-4) and received radiation one or more times. Median age was 27 years(range 22-77). Histopathologic diagnosis was glioblastoma(n = 2), anaplastic PXA(aPXA; n = 2), and anaplastic ganglioglioma(aGG; n = 1). Patients received treatment for 2-28months; currently 2/5 patients remain on treatment (8 and 30 months). Radiographic response rate was 60%(3/5): CR in two (glioblastoma, treated 10months; glioblastoma, 8months treatment ongoing), PR in one (aPXA, 28months treatment ongoing), SD in one (aGG, treated 3months), and PD in one (aPXA, treated 2months). Likely attributable adverse events (CTCAE grade ≥ 3) included cilioretinal artery occlusion (came off study) and asymptomatic elevated CPK. Analysis of paired plasma samples and correlation with response is ongoing. CONCLUSIONS Encorafenib and binimetinib demonstrate promising tumor responses in patients with recurrent BRAFV600E-mutated HGG with sustained responses in all GBM and 50% of aPXA in this small series, warranting careful consideration in this rare tumor subgroup. This Phase 2 study has closed due to enrollment issues

Clinical, biological, and ophthalmological characteristics differentiating arteritic from non-arteritic anterior ischaemic optic neuropathy.

To identify characteristics that can distinguish AAION from NAAION in emergency practice. This is a multicentre retrospective case-control study. Ninety-four patients with AAION were compared to ninety-four consecutive patients with NAAION. We compared the clinical, biological, and ophthalmological characteristics at baseline of patients with AAION and those with NAAION. Patients with AAION were older and more likely to have arterial hypertension. Cephalic symptoms and acute-phase reactants were more frequent in AAION. Profound vision loss and bilateral involvement were more frequent in AAION at baseline. Central retinal and cilioretinal artery occlusions was only observed in AAION, and delayed choroidal perfusion was more frequently observed in AAION than in NAAION. Using logistic regression, an age >70 years (OR = 3.4, IC95% = 0.8-16.1, p = 0.105), absence of splinter haemorrhage (OR = 4.9, IC95% = 1.4-20.5, p = 0.019), delayed choroidal perfusion (OR = 7.2, IC95% = 2.0-28.0, p = 0.003), CRP > 7 mg/L (OR = 43.6, IC95% = 11.6-229.1, p < 0.001) and platelets >400 × G/L (OR = 27.5, IC95% = 4.6-270.9, p = 0.001) were independently associated with a diagnosis of AAION. An easy-to-use score based on these variables accurately distinguished AAION from NAAION with a sensitivity of 93.3% and specificity of 92.4%. In patients presenting with AION, a set of ophthalmological and laboratory criteria can efficiently discriminate patients with AAION and NAAION and can identify which patients would benefit from high-dose glucocorticoids. External validation of our results is required.

Branch retinal artery occlusion caught in the act by an optical coherence tomography angiography image: case report

BackgroundRetinal artery occlusion is a vascular entity caused by the temporary blockage of retinal arterioles.Case presentationWe present the case of a 57-year-old woman a partial visual loss in the right eye due to a cilioretinal artery occlusion. Ophthalmoscopy revealed a focal area of retinal whitening superior to the optic nerve in the right eye, while the left eye was within the limit.Retinal imaging, in particular optical coherence tomography angiography (OCTA), showed a capillary drop out of the superficial capillary plexus and the corresponding b-scan showed a round hyporeflective grey dot (optical empty) corresponding to the dark grey spot on the enface view at the level of the retinal whitening area.ConclusionAlthough the images did not allow the differentiation between vasospasm or retinal emboli, the OCTA imaging might help to identify and to caught in the act the specific region causing the retinal impairment. Also, the possible formation of small microcavity should be considered in case with branch retinal artery occlusion. The use of this new imaging technology might help to evaluate the efficacy of the therapy in vivo.

Giant Cell Arteritis Presenting With Ocular Symptoms: Clinical Characteristics and Multimodal Imaging in a Chinese Case Series.

PurposeTo evaluate demographic and clinical characteristics of a Chinese population with giant cell arteritis using multimodal imaging focusing on ophthalmic examinations.DesignRetrospective observational case series.Materials and MethodsIn the neuro-ophthalmology division of the Eye, Ear, Nose, and Throat Hospital, Shanghai, we evaluated the demographic and clinical characteristics of patients diagnosed with giant cell arteritis between January 2016 and June 2021. Results of routine ophthalmic examinations including fundus examination, optical coherence tomography, color duplex ultrasonography of ocular and superficial temporal arteries, orbital magnetic resonance imaging, and superficial temporal artery biopsy were evaluated.ResultsA total of 15 patients (22 eyes; ten male and five female) were evaluated with a mean age of 77.0 ± 8.5 years. Among them, seven had bilateral involvement that occurred simultaneously or sequentially. Twelve patients presented with arteritic anterior ischemic optic neuropathy, two with arteritic anterior ischemic optic neuropathy combined with cilioretinal artery occlusion, and one with cotton-wool spots. In acute stages of optic neuropathy and retinopathy, optical coherence tomography revealed optic disc edema, thickening of the inner retinal nerve fiber layer and ganglion cell layer, and loss of layer structure. In late stages, optical coherence tomography revealed diffuse atrophy of the inner retina. The “halo” sign was observed in 12 patients in the superficial temporal artery ultrasound, and seven out of eight patients who underwent biopsy demonstrated classic giant cell arteritis pathological changes. Most patients having poor visual acuity but ability to perceive light; 10/22 eyes had permanent vision loss.ConclusionAlthough rare in Asians, giant cell arteritis may be underdiagnosed among elderly Chinese patients presenting with anterior ischemic optic neuropathy. Non-invasive superficial temporal artery ultrasound detecting inflammatory thickening of the intima as the “halo” sign combined with routine elevated erythrocyte sedimentation rate and C-reactive protein may be helpful in diagnosing patients with a high probability of having giant cell arteritis.

A Cilioretinal Artery Occlusion (CLRAO) Associated with Optic Disc Edema after Viral Vector SARS-CoV-2 Vaccination: Case Report

A cilioretinal artery occlusion (CLRAO) associated with optic disc edema was diagnosed in a patient seven days after the second dose of viral vector SARS-CoV-2 vaccination. The patient developed sudden blurred vision in the inferior hemifield of the right eye. His fundus examination showed retina edema at the superotemporal quadrant within vascular arcades of the right eye. Fundus fluorescein angiography (FFA), optical coherence tomography (OCT), and optical coherent tomography angiography (OCTA) were used to confirm the diagnosis. Keywords: COVID-19; SARS-Cov2; Cilioretinal artery occlusion; Disc edema; Vaccine