Ocular Massage Research Articles

Central Retinal Artery Occlusion Associated with Atrial Septal Defect: A Case Report

Introduction: Central retinal artery occlusion (CRAO) is characterized by sudden obstruction of the arterial blood flow in the retinal circulation with consequent ischemic damage to the retina resulting in vision loss. An interesting case of unilateral CRAO associated with atrial septal defect (ASD) in a young female is reported here. Case: A young female presented to emergency department with history of sudden and painless loss of vision in her right eye for one day. Her visual acuity at the time of presentation was perception of light in right eye and 6/6 in left eye. On examination, anterior segments of both the eyes were normal. However, relative afferent pupillary defect was positive in her right eye. On fundus examination, right eye showed pale retina and cherry red spot whereas left eye was unremarkable. Findings were suggestive of right eye CRAO. Ocular massage was done and oral carbonic anhydrase inhibitor was given. Patient was referred to a cardiologist for further evaluation and establishment of the etiology. All tests were within reference limit except a large ASD (secundum type with left to right shunt) with a diameter of 28 mm was revealed on transthoracic echocardiogram. Conclusion: The association between ASD and CRAO is rare. Intracardiac shunts through defect may predispose the disease. Detailed cardiac evaluation is mandatory to rule out possible causes to prevent ocular or systemic embolic events and associated morbidity.

Oclusión de la arteria central de la retina iatrogénica tras angiografía de sustracción digital cerebral

Digital subtraction angiography (DSA) is a technique used in interventional radiology for the diagnosis of vascular cerebral conditions. Central retinal artery occlusion (CRAO) is a complication of endovascular procedures that involve atherosclerotic plaque removal with subsequent embolisation. The case is presented on a patient who noticed a sudden vision loss during a DSA. Funduscopy showed retinal pallor and a cherry red spot. The angiography showed a structure suggesting the presence of an embolus in the central retinal artery. The patient was diagnosed with a CRAO, and unsuccessfully treated with ocular massage, topical hypotensive drugs, oral acetazolamide, and anterior chamber paracentesis, with a final visual acuity of 0.05. Central retinal artery occlusion is a rare complication, but due to its poor prognosis, it must be considered when performing neuroradiological procedures such as DSA.

Encapsulated Bleb Excision with Collagen Matrix Implantation Following Failed Ahmed Glaucoma Valve Implantation.

PurposeTo investigate the clinical features and surgical outcomes of encapsulated bleb excision with collagen matrix implantation performed in patients with failed Ahmed glaucoma valve (AGV) implantation.MethodsEighteen eyes of 18 patients underwent encapsulated bleb excision and collagen matrix implantation. Patients were divided into two groups by reference to intraocular pressure (IOP) after preoperative ocular massage: group 1, patients who exhibited substantial IOP reductions; and group 2, patients who did not show substantial changes in IOP. Needling was conducted in group 2. The clinical features of the two groups were compared, including IOP changes after ocular massage and needling, AGV status, and surgical outcomes 6 months after surgery.ResultsThe mean preoperative IOP among the 18 patients was 30.6 ± 5.7 mmHg. After ocular massage, the IOPs decreased by 22 and 26 mmHg in the two patients in group 1 and the 16 patients in group 2 showed a mean IOP reduction of 1.6 ± 2.2 mmHg (p = 0.013). IOPs decreased after needling in group 2 (range, 6 to 30 mmHg; p < 0.001). Fibrovascular tissue ingrowth into the AGV was observed in the two patients in group 1 and the same ingrowth was observed in 10 of the 16 patients in group 2. Six months after surgery the mean IOP among the 18 patients decreased significantly (19.1 ± 3.2 mmHg, p < 0.001). There was no significant difference in the mean postoperative IOP at 6 months between group 1 (14.0 ± 2.8 mmHg) and group 2 (19.8 ± 2.6 mmHg, p = 0.052).ConclusionsEncapsulated bleb excision with collagen matrix implantation resulted in a significant IOP-lowering effect 6 months after surgery. Fibrovascular ingrowth into the AGV was common but did not seem to be a major cause of AGV implantation failure.

Does the addition of hyaluronidase improve the quality of peribulbar anesthesia in cataract surgery? – A randomized double blinded study

PurposeTo determine the necessity of hyaluronidase as an anesthetic adjuvant for peribulbar anesthesia during cataract surgery and to assess differences in anesthetic outcomes in the absence of hyaluronidase. MethodsIn this double blinded randomized study, 202 patients reporting for surgery for senile cataract in their first eye under regional ocular anesthesia without pre-existing extra ocular movement restriction were randomly divided into 2 groups: Group 1 – anesthesia without hyaluronidase, Group 2 – anesthesia with 50 IU/ml Hyaluronidase. Peribulbar block with 5 ml of anesthetic mixture of 2% lignocaine with 1:200000 adrenaline and 0.5% bupivacaine with or without hyaluronidase was performed with 3 ml deposited in the infero-medial quadrant and 2 ml in the supero-medial quadrant followed by ocular massage. Surgeons’ score for akinesia, patients’ score for analgesia, augmentation of block if any and extra ocular movements on first post-operative day were compared between the groups. ResultsThere was no statistically significant difference between the two groups in akinesia (p = 0.22, 0.68 and 0.98), analgesia (p = 0.44 and 0.09) or requirement of anesthetic augmentation (p = 0.3). Extraocular movement restriction was not noted in any patient. Onset of akinesia and analgesia was earlier in Group 2 (p = 0.004 and p = 0.005 respectively). ConclusionsHyaluronidase is not an essential adjuvant for peribulbar block for cataract surgeries. Appropriate deposition of a smaller volume of anesthetic agent and adequate ocular massage provide adequate and safe anesthesia.

Central Retinal Artery Occlusion and Partial Ophthalmoplegia Caused by Hyaluronic Acid Injection Filler Cosmetic

Central retinal artery occlusion is a rare ocular emergency condition that can lead to a total blindness. Hereby we report a 30-year-old woman with a sudden visual loss of the left eye after being injected by hyaluronic acid filler at the dorsum nasal area for cosmetic purpose. Visual acuity was light perception while anterior segment and intraocular pressure were within normal limit. Partial ophthalmoplegia include restriction to the nasal gaze were found. Funduscopic examination revealed total retinal edema with a cherry red spot at the fovea. Ocular massage was performed as initial management followed by humor aqueous paracentesis. All procedures were done within 90 minutes. The patients discharge with the visual improvement to hand motion and the Partial ophthalmophlegia has been improved after being evaluated less than a month.

Current treatment of central retinal artery occlusion: a national survey.

Central retinal artery occlusion (CRAO) is an ophthalmological emergency, the retinal analog of a stroke. To date there is no consensus or national guidelines on how this disorder should be managed. As academic neurologists and ophthalmologists treat CRAO frequently, we set out to understand how these clinicians approach patients with CRAO with a national survey. We identified university-associated teaching hospitals offering vascular neurology, neuro-ophthalmology and/or retina fellowships in the US and asked the directors of the programs to respond to questions in an open response format to profile the acute management of CRAO at their institution. We found remarkable heterogeneity in the approach to acute treatment of patients with CRAO among the 45 institutions that responded to the survey. Only 20% had a formal policy, guideline or white paper to standardize the approach to treatment. The primary treating physician was an ophthalmologist, neurologist, or neuro-ophthalmologist 44, 27, and 4% of the time, respectively; 24% were co-managed acutely by neurology and ophthalmology. Intravenous fibrinolysis was offered to selected patients in 53% of institutions, and was the preferred initial treatment in 36%. When the acute treatment team involved a vascular neurologist, fibrinolysis was more likely to be considered a first-line treatment (p<0.05). Anterior chamber paracentesis, ocular massage and hyperbaric oxygen therapy were offered 42, 66 and 7% of the time, respectively, while 9% of institutions offered no treatment. Anterior chamber paracentesis was more likely to be offered at programs where neurologists were not involved in treating CRAOs (p<0.001). At 35% of institutions, patients with acute CRAO were not routinely referred to a general emergency room for initial evaluation and treatment. Carotid imaging was routinely obtained by 89% of programs, magnetic resonance imaging of the brain by 69%, echocardiogram by 62%, laboratory screening for an inflammatory state by 27% and retinal angiography by 30%. The thoroughness of vascular risk factors' screening was greater in programs that routinely referred acute CRAO cases to the emergency department. This survey shows that there is significant variability in treatment practices for acute CRAO in the US. Because of the high cerebrovascular and cardiovascular risk reported in this population of patients, it is notable that the approach to risk factor screening is also highly variable and many programs do not routinely refer patients to an emergency department for urgent evaluation. Finally, there appears to be equipoise among treatment teams regarding the efficacy of systemic fibrinolysis, as 53% of programs report a willingness to treat at least some patients with this modality.

Is Intravenous Thrombolysis Safe and Effective in Central Retinal Artery Occlusion? A Critically Appraised Topic

Central retinal artery occlusion (CRAO) is a neurological and ophthalmologic emergency associated with poor visual recovery. There is a dilemma regarding the appropriate treatment, as formal guidelines are lacking. Despite being considered an ocular equivalent of cerebral infarction, the time window of intravenous (IV) thrombolysis administration for maximum efficacy and safety in CRAO remains uncertain. To critically assess the current evidence regarding the safety and effectiveness of IV thrombolysis in the treatment of patients with CRAO. The objective was addressed through the development of a critically appraised topic that included a clinical scenario, structured question, literature search strategy, critical appraisal, assessment of results, evidence summary, commentary, and bottom-line conclusions. Participants included consultant and resident neurologists, a medical librarian, and content experts in the fields of vascular neurology and ophthalmology. A recent patient-level meta-analysis was selected for critical appraisal. The study compared the visual recovery rates after IV thrombolysis in CRAO against the natural history of this illness and conservative therapies (ocular massage, anterior chamber paracentesis, and/or hemodilution). Time to thrombolytic therapy administration had a significant impact on visual recovery in CRAO (P<0.001). IV thrombolysis within the first 4.5 hours after symptom onset resulted in recovery of vision in 50.0% of the patients [95% confidence interval (CI), 32.4%-67.6%]. The rate of visual recovery was nearly 3 times higher than in the natural history cohort [odds ratio, 4.7 (95% CI, 2.3-9.6); P<0.001], with a 32.3% absolute risk reduction and a number needed to treat of 4.0 (95% CI, 2.6-6.6). There was no significant difference in the recovery rate after thrombolysis compared with the natural history cohort for those patients treated after 4.5 hours. No major hemorrhages occurred after alteplase administration in this meta-analysis. IV thrombolysis in CRAO seems to be safe and effective within the first 4.5 hours of symptom onset. A clinical decision based on this meta-analysis alone cannot be made due to several limitations. A randomized controlled clinical trial of early IV alteplase administration in CRAO is necessary to provide evidence-based therapeutic guidance.

Ophthalmic artery occlusion following neuro-embolization of the external carotid artery, a case report

BackgroundEmbozene® is a new neuroembolizing microsphere used to reduce intraoperative bleeding for head and neck tumours. We report a case of iatrogenic ophthalmic artery occlusion after Embozene® embolization of the external carotid artery (ECA).Case presentationA 22-year-old African gentleman presented with left nasal obstruction and epistaxis for 2 years and was diagnosed with nasopharyngeal carcinoma. He subsequently underwent embolization of the maxillary branch of the left ECA using Embozene® Microspheres - 250 μm in size before endoscopic tumour excision to reduce intra-operative bleeding. He complained of sudden painless profound visual loss in the left eye (LE) two hours after embolization. Visual acuity in LE was no light perception. Fundus examination showed pale retina with no cherry red spot. Arterial narrowing and segmentation were seen in all quadrants. A diagnosis of left ophthalmic artery occlusion was made. Despite immediate management including ocular massage and lowering of intraocular pressure, the visual loss remained. Retrospective review of digital subtraction angiogram showed an anastomosis between the left ophthalmic artery and anterior deep temporal artery as a potential route for microspheres migration.ConclusionPre-operative angio-architecture understanding and diligent selection of embolic material are helpful in preventing this adverse event. The use of newer agents for embolotherapy may cause migration of embolic material from the external to the internal carotid system leading to ophthalmic artery occlusion and blindness.

Acute Keratoconus-Like Corneal Hydrops Secondary to Ocular Massage Following Trabeculectomy

Purpose: To report a case of acute keratoconus-like corneal hydrops in a patient with long-term ocular massage following trabeculectomy. Methods: Case report and review of medical literature. Results: A rare complication of acute keratoconus-like corneal hydrops occurred in a patient following the use of ocular massage to maintain satisfactory aqueous humor filtration after trabeculectomy. The patient had a history of high myopia but denied previous ocular trauma, allergic disease and a family history of keratoconus. Slit-lamp examination demonstrated keratoconus-like corneal hydrops with formation of epithelial microcystic, and intrastromal cleft. He was diagnosed with acute corneal hydrops in the right eye and received intracameral gas (16% perfluoropropane) injection. On 5 months follow-up, the corneal edema was significantly improved. Conclusions: There may be a contributory relationship between the long-term post-trabeculectomy massage and the development of acute corneal hydrops. When prescribing therapeutic massage, patients should be followed up carefully to monitor for unexpected complications.

Review of external ocular compression: clinical applications of the ocular pressure estimator.

PurposeThe authors have previously validated an Ocular Pressure Estimator (OPE) that can estimate the intraocular pressure (IOP) during external ocular compression (EOC). The authors now apply the OPE in clinical states where EOC is clinically important. The original work is described for two periods of risk: during sleep and during the digital ocular massage (DOM) maneuver used by surgeons after trabeculectomy to keep the operation functional. Other periods of risk for external ocular compression are then reviewed.MethodsThe first protocol estimated the IOP in the dependent eye during simulated sleep. Subjects had their IOPs initially measured in an upright-seated position, immediately upon assuming a right eye dependent side sleeping position (with nothing contacting the eye), and then 5 minutes later while still in this position. While maintaining this position, the fluid filled bladder of the OPE was then placed between the subject’s closed eye and a pillow during simulated sleep. The IOP was continuously estimated in this position for 5 minutes. The subjects then had the IOP measured in both eyes in an upright-seated position. The second protocol determined if a larger vertical cup-to-disc ratio was more common on the side that patients reported they preferred to sleep on. The hypothesis was that chronic asymmetric, compression induced, elevations of IOP during sleep would be associated with otherwise unexplained asymmetry of the vertical cup-to-disc ratio. The third protocol assessed the IOP during DOM. The OPE was used to characterize the IOP produced during the DOM maneuver of five glaucoma surgeons. After this, 90 mmHg was chosen as a target pressure for DOM. The surgeons were then verbally coached during three additional compressions. After a 5-minute period, the surgeons were asked to reproduce this targeted IOP during subsequent compressions.ResultsThe mean IOP during the “sleep session” was 22±5 mmHg (SEM). The mean peak pressure was 40±11 mmHg (SEM) and the mean trough pressure was 15±2 mmHg (SEM). There was a 78% agreement between the eye that was reported to be dependent during sleep and the eye with the larger vertical cup-to-disc ratio, for eyes with at least a 0.10 cup-to-disc ratio difference, P=0.001, n=137. The OPE estimated an average induced IOP during typical DOM of 104±8 mmHg (SEM), with each compression having an average range of 17±3 mmHg (SEM). After coaching, and a 5-minute waiting period, the average induced IOP reduced to 95±3 mmHg (SEM) with a reduced average range of IOP to 11±1 mmHg.ConclusionThe OPE was successfully used to estimate the IOP while subjects experienced EOC during normal sleep postures. These EOC-induced elevations of IOP were considerable, and likely contribute to significant ocular pathology, not only for glaucoma, but for retinal vascular occlusive diseases, retinal vascular leakage, and the induction of the ocular-cardiac reflex in infants, as well. The correlation of a larger vertical cup-to-disc ratio in patients with a sleep posture preference suggests a causal relationship, since patients with other conditions known to be associated with cup-to disc ratio asymmetry were excluded from this study. The OPE is a useful device to teach DOM to surgeons and patients for home use.

Intravenous Fibrinolytic Therapy in Central Retinal Artery Occlusion: A Patient-Level Meta-analysis.

Central retinal artery occlusion (CRAO) is an ophthalmologic emergency that can result in blindness. At present, no proven therapy for CRAO exists. Treatment with fibrinolytic agents has shown promise but remains of unproven benefit. To assess the efficacy of systemic fibrinolytic therapy for patients with CRAO and to define a time window of efficacy. We systematically queried PubMed, Web of Science, and Scopus using the following index terms: "retinal artery occlusion" OR "retinal ischemia" AND "thrombolysis" OR "fibrinolysis" OR "tissue plasminogen activator" OR "streptokinase" OR "urokinase." Search was not limited by year of publication or language and was conducted in August 2014. In addition, we evaluated the references from relevant review articles. We assembled observational studies reporting on visual acuity outcomes after CRAO. Inclusion criteria were complete reporting of visual outcomes after CRAO (with or without fibrinolytic therapy) and a series of more than 5 patients for fibrinolysis treatment or more than 20 cases when untreated or treated with conservative modalities. Patient-level data were sought for studies reporting outcomes of treatment with fibrinolysis. Summary statistics were obtained for conservative treatment and natural history studies. The studies were weighted by the inverse of variance and merged in a random-effects model. Rate of visual recovery (defined as improvement of visual acuity from 20/200 or worse at presentation to 20/100 or better) was calculated for patients treated with fibrinolytic and conservative therapies and those who received no treatment. We obtained summary statistics from 7 studies that included 396 patients who received no treatment after CRAO and from 8 studies that included 419 patients treated with ocular massage, anterior chamber paracentesis, and/or hemodilution (conservative treatment). Patient-level data were obtained for 147 patients treated with systemic fibrinolysis. We found that fibrinolysis was beneficial at 4.5 hours or earlier after symptom onset compared with the natural history group (17 of 34 [50.0%] vs 70 of 396 [17.7%]; odds ratio, 4.7 [95% CI, 2.3-9.6]; P < .001). Absolute risk reduction was 32.3%, with a number needed to treat of 4.0 (95% CI, 2.6-6.6). We also found that conservative treatment significantly worsened visual acuity outcomes and recovery rates after CRAO compared with the natural history group (31 of 419 [7.4%; 95% CI, 3.7%-11.1%] vs 70 of 396 [17.7%; 95% CI, 13.9%-21.4%]; P < .001; number needed to harm, 10.0 [95% CI, 6.8-17.4]). Our analysis suggests that a clinical trial of early systemic fibrinolytic therapy for CRAO is warranted and that conservative treatments are futile and may be harmful.

Abstract W P67: Defining A Therapeutic Window For Successful Intravenous Fibrinolytic Therapy In Central Retinal Artery Occlusion: A Subject Level Meta-analysis

Central retinal artery occlusion (CRAO) is an ophthalmologic emergency which results in blindness in a high percentage of affected patients. A wide variety of treatment methods have been proposed to manage the resulting retinal ischemia; however, all but fibrinolysis have proven unsuccessful and fibrinolytic therapy, while promising, remains of unproven and controversial benefit. The purpose of the current analysis is to assemble the published literature on systemic fibrinolysis in CRAO at the subject level and compare the results against the natural history of this illness to determine a time-window of clinical effectiveness of fibrinolytic interventions for use in future clinical trials. Subject level data was obtained for 157 cases. We conclude that systemic fibrinolysis is likely to be beneficial in the first 4.5 hours after symptom onset (odds ratio 3.5 [95% confidence interval 1.8 to 6.9, p&lt;0.001], 31.4% relative risk reduction with a number need to treat of 3.9 [95% confidence interval 2.4 to 10.7). We argue that a clinical trial of fibrinolytic therapy for CRAO in this time window is likely to be successful. Interestingly, we also found that the conventional treatment with ocular massage, hemodilution and/or anterior chamber paracentesis significantly worsen visual acuity outcomes after central retinal artery occlusion.

Combined Central Retinal Vein and Cilioretinal Artery Occlusion in a Patient Who Underwent Allogeneic Renal Transplantation

A high incidence of venous thromboembolism has been reported in patients who have had renal transplantation especially within the early postoperative period. Herein, the management of a 31year-old renal graft recipient with the diagnosis of combined left central retinal vein occlusion (CRVO) and cilioretinal artery occlusion (CRAO) is presented. Although detailed work-up for inherited as well as acquired thrombophilic disorders was performed in our case, none of the definite prothrombotic and predisposing risk factors for venous thromboembolism was identified. The case under review or the index case had a remarkable visual recovery within 3 weeks after the referral, since anterior chamber paracentesis was immediately scheduled after performing ocular massage in order to achieve acute resolution of venous stasis.

Ahmed valve encapsulation as a main cause of its implantation failures

Objective. To study the relationship of post-operative ocular hypertension with the encapsulation of Ahmed valve’s plate. Methods. The standard Ahmed valve implantation was performed in 238 patients aged 18-86 with multiple glaucoma surgeries (39 %), secondary neovascular (36 %), pseudophakic (23 %), juvenile (8 %), uveal (5 %) and post-traumatic (2 %) glaucomas. A routine ophthalmic examination was performed in 1 week, 1, 3, 6, 9, 12 and 36 months after surgery. Results. Excision of the fibrous capsule as the only way to cope with post Ahmed valve ocular hypertension was performed on 16 patients 3-36 months after surgery. Macro- and microscopic analysis of the excised capsules was done. In all cases, preparations of 1.2-2.2 mm thickness were obtained. We found a bilaminar structure of the capsule, the inner surface consisting of densely-packed collagen fibers, whereas the outer layer is represented by a loose fi-brovascular layer. Suspension of encapsulation is possible at initial stages of scarring, by applying ocular massage, needling, revision of the surgical area, and injection of antimetabolites.

The effect of health education video on ocular massage after trabeculectomy.

The aim of this study was to investigate the effect of different ocular massage health education methods on ocular massage in glaucoma patients after trabeculectomy. Eighty-six patients with glaucoma after trabeculectomy (86 eyes) were randomly divided into two health education groups. One group was a watch video group (43 patients, 43 eyes), while the other was an orally taught health education group (43 patients, 43 eyes). Patients were followed up for 1 week, 1 month, and 3, 6, and 12 months after discharge. Records of the patient responses after health education, compliance of patients with follow-up, and intraocular pressure were determined. Measurements included intraocular pressure and differences between the watch video and orally taught health education groups. The differences between the watch video group and orally taught health education group were not statistically significant at 1 week and 1 month, while the differences were statistically significant at 3, 6, and 12 months. The results indicated that health education videos can enable glaucoma patients to have a better mastery of ocular massage after trabeculectomy. According to the needs of patients, health education video use produced good results and should be promoted.

Efficacy and Safety of Intra-Arterial Thrombolysis in Central Retinal Artery Occlusion

To investigate the efficacy and safety of intra-arterial thrombolysis (IAT) for acute central retinal artery occlusion (CRAO). Records from 101 CRAO patients treated with either IAT (n = 57) or standard treatment (ST; n = 44) were retrospectively reviewed. ST consisted of ocular massage and intraocular pressure-lowering agents. We used fundoscopic and angiographic findings to categorize CRAO as incomplete (diminished visual acuity [VA] with slight retinal edema, slight cherry-red spot), subtotal (severe VA reduction, cherry-red spot, distinct retinal edema), or total (massive edema, occluded perimacular arterioles, additional choroidal blood flow interruption). One-month and final best-corrected VA (BCVA) of the IAT group were compared with those of the ST group. Early (≤3-day) and final (1-month) reperfusion (improvement of retinal perfusion) rates were compared between groups. Subgroup analyses were performed according to CRAO stage. Overall, VA did not significantly differ between groups, but early reperfusion was greater in the IAT group (74.1% vs. 42.9%, P = 0.005). In incomplete CRAO, the IAT group exhibited greater visual improvement after 1 month (1.08 ± 0.21 vs. 0.23 ± 0.26 logarithmic values of the minimum angle of resolution [logMAR], P < 0.001) and at the final visit (1.08 ± 0.53 vs. 0.08 ± 0.57 logMAR, P < 0.001). However, in subtotal and total CRAO, no significant differences in visual outcomes were observed between groups. IAT resulted in clinically insignificant cerebral infarcts, detectable on brain imaging, in 8% of patients. Hemorrhagic transformation was not noted. The IAT treatment may provide early restoration of retinal perfusion and offer functional benefits in the management of incomplete CRAO.

N-Butyl cyanoacrylate-induced multiple retinal arteriolar occlusions

We report a case of multiple retinal arteriolar occlusions due to delayed embolisation of N-butylcyanoacrylate glue, initially injected in the external carotid artery for the management of Carotid body tumour. Ocular massage and anterior chamber paracentesis were unfruitful and patient suffered irreversible visual loss in the affected eye. Embolisation of N-butyl cyanoacrylate glue into the retinal vasculature after intratumoral injection should be kept in mind as a rare but possible complication by radiologists and ophthalmologists.

Complete visual recovery after incipient crao due to ocular hypoperfusion in a patient with moyamoya disease.

The purpose of this study was to report a case of an impending central retinal artery occlusion with hypoperfusion in a moyamoya patient. A young, surgically revascularized moyamoya patient experienced severe unilateral vision loss from 20/25 to hand motions because of impending central retinal artery occlusion. The patient was treated with a combination of intermittent ocular massage, intraocular pressure-lowering medications, and aspirin. A case of a moyamoya patient at Stanford University Medical Center. Visual acuity was restored to baseline by improving the ocular arterial-venous gradient after prompt administration of ocular massage, intraocular pressure-lowering drops, and aspirin. This dramatic result suggests that, if performed in a timely manner, augmentation of ocular perfusion can result in complete restoration of vision in some cases of incipient central retinal artery occlusion.

Impact of Ocular Compression on Ocular Surface Bacterial Contamination

Background: To study the impact of preoperative ocular compression on bacterial contamination of the lid margin and conjunctival sac. Methods: This study evaluated 106 eyes from 106 patients undergoing cataract surgery. Preoperatively, all of the patients received one drop of 0.5% levofloxacin eye drops 5 times per day for 4 days. The patients were divided into 2 groups after receiving retrobulbar anaesthesia. The study group (75 eyes) received 15 ± 2 minutes of ocular compression, and the control group (31 eyes) remained with their eyes closed for 15 ± 2 minutes without the application of ocular compression or digital massage. Following the device removal (study group only) and the opening of the eyes, bacterial cultures were taken from the lid margin and conjunctival sac. Results: The lid margin was positive for bacteria in 23 eyes (30.7%) in the study group vs. 3 eyes (9.7%) in the control group (P = 0.0223), and the conjunctival sac was positive for bacteria in 16 eyes (21.3%) in the study group vs. 5 eyes (16.1%) in the control group (P = 0.5409). Conclusion: Preoperative ocular compression is associated with the release of meibomian gland secretions and bacterial contamination of the eyelid edges.

ND:YAG laser embolectomy in a Patient with Branch Retinal Artery Occlusion

Management of central retinal artery occlusion and branch retinal artery occlusion is usually unsuccessful because of either late presentation or ineffective treatment options. Currently there is no effective therapy for central retinal artery occlusion and branch retinal artery occlusion. Transluminal NdYAG laser embolectomy can rapidly restore reperfusion. In this laser is focused on the embolus resulting in photodisruption of vessel wall. This leads to dislodgment of embolus through disrupted vessel wall and instant reperfusion of the occluded vessel at the cost of vitreous hemorrhage.We report a case of a 65 year old male patient having superotemporal branch retinal artery occlusion of left eye. After a trial of ocular massage and systemic acetazolamide which did not relieve the obstruction a single spot of 0.5mJ NdYAG laser was given over the embolus present over the bifurcation of superior trunk of central retinal artery resulting in instant removal of embolus and relief of obstruction. The major complication was vitreous hemorrhage.