Retinal Arteriolar Occlusions Research Articles

A case of acute vision loss due to retinal arteriolar occlusion after forehead injection of triamcinolone acetonide

A case of acute vision loss due to retinal arteriolar occlusion after forehead injection of triamcinolone acetonide

A rare case of unilateral traumatic peripheral retinal arteriolar occlusions and neovascularization of optic disc

A young adult Asian Indian male presented to us with a 1-month history of trauma to the right eye (RE) with a tennis ball. He had intraocular pressure (IOP) of 32 mmHg while on three topical antiglaucoma drugs and oral acetazolamide, with uncontrolled inflammation in the anterior chamber (AC) and arteriolar occlusions in the periphery. His best corrected visual acuity was 20/20 in RE. Fluorescein angiography of the RE showed the presence of neovascularization of disc (NVD). Magnetic resonance angiography of the head and neck, and blood investigations ruled out the embolic origin of arteriolar occlusion and systemic causes for inflammation. Intra ocular pressure (IOP) and inflammation were controlled with appropriate treatment. NVD resolved with photocoagulation treatment (PRP) for capillary non-perfusion areas in 4 weeks. This case documents the occurrence of arteriolar occlusion, with neovascularization after arteriolar occlusion post blunt trauma, and successful adjunct use of topical cyclosporine in the management of AC inflammation and high IOP.

Retinal diffusion restrictions in acute branch retinal arteriolar occlusion

This study sought to investigate the occurrence of retinal diffusion restrictions (RDR) in branch retinal arteriolar occlusion (BRAO) using standard brain diffusion-weighted imaging (DWI). Two radiologists assessed DWI MRI scans of BRAO patients for RDR in a retrospective cohort study. Inter- and intrarater reliability were calculated using Kappa statistics. Detection rates of RDR were compared among MRI scans with varying field strength, sequence type and onset-to-DWI time intervals. 85 BRAO patients (63.1 ± 16.5 years) and 89 DWI scans were evaluated. Overall sensitivity of RDR in BRAO was 46.1% with visually correlating low ADC signal in 56.1% of cases. Localization of RDR matched distribution of fundoscopic retinal edema in 85% of patients. Inter- and intra-rater agreement for RDR in BRAO was κinter = 0.64 (95% CI 0.48–0.80) and κintra = 0.87 (95% CI 0.76–0.96), respectively. RDR detection rate tended to be higher for 3T, when compared to 1.5T MRI scans (53.7% vs. 34.3%%; p = 0.07). RDR were identified within 24 h up to 2 weeks after onset of visual impairment. RDR in BRAO can be observed by means of standard stroke DWI in a substantial proportion of cases, although sensitivity and interrater reliability were lower than previously reported for complete central retinal artery occlusion.

A Novel Quantitative Assessment Method of Disease Activity in Susac’s Syndrome Based on Ultra-Wide Field Imaging

ABSTRACT Purpose Susac’s syndrome (ScS) is a rare, potentially life-threatening auto-immune disease. Ophthalmic imaging can depict characteristic branch retinal arteriolar occlusions (BRAO) and arterial wall hyperfluorescences that form one of the three diagnostic pillars of this condition. We aim to demonstrate that ophthalmological ultrawide-field (UWF) imaging allows for a qualitative and quantitative assessment in ScS, with application in diagnostics, monitoring of treatment response, and titration of therapy. Methods In seven ScS patients (♀:♂ = 2:5), with a median age of 36 years, range 18 to 57 years, serial ultrawide-field fluoresceine angiography (UWF-FA) studies were performed, with adjunctive wide-field optical coherence tomography angiography analyses (WF-OCTA) in five patients. Mean follow-up was 12.5 months, range 1 to 46 months. Results In all seven patients, BRAO and arterial wall hyperfluorescences were present in UWF-FA and calculated as a quantitative score of disease activity in fluorescein angiography (DA-FA) during follow-up visits. Treatment response was accessible in follow-up imaging as partial reperfusion of retinal vessels, resolution of arterial wall hyperfluorescences and consequently, in reduction of DA-FA score. While qualitative analysis of WF-OCTA provided further information about retinal micro-perfusion, quantitative analysis did not demonstrate a vectored treatment response as it was accessible in FA. Conclusion DA-FA score, as a comprehensive disease activity parameter in ScS has potential to facilitate optimal communication between subspecialties and thereby treatment success.

Association of Acute Macular Neuroretinopathy or Paracentral Acute Middle Maculopathy with Sickle Cell Disease

To investigate the structural and microvascular changes in the retina and choriocapillaris in patients with sickle cell disease (SCD) demonstrating acute vision loss and acute macular neuroretinopathy (AMN) or paracentral acute middle maculopathy (PAMM) using multimodal imaging including OCT and OCT angiography (OCTA). Retrospective case series. Four hemoglobin SS (HbSS) or hemoglobin SC (HbSC) patients who demonstrated vision loss attributed to AMN (n= 2) or PAMM (n= 2). Clinical characteristics including best-corrected visual acuity and multimodal imaging features from fundus photography, fluorescein angiography, OCT, and OCTA were analyzed. Longitudinal changes in the structure and microvasculature of the retina and choriocapillaris were examined. In 2 patients with AMN, characteristic hyperreflective changes were observed in the outer nuclear layer with involvement of the ellipsoid and interdigitation zones. In 1 patient, the lesion was located in the foveal avascular zone, and only flow deficits in the choriocapillaris were noted. In the second patient, no flow loss was observed in the superficial capillary plexus (SCP) corresponding to the lesion, but flow loss was seen in the deep capillary plexus (DCP) and choriocapillaris. At the respective 1-year and 4-month follow-up examinations, the hyperreflectivities improved with no ensuing retinal atrophy. Deep capillary plexus and choriocapillaris flow also improved. Of the 2 patients with PAMM, 1 had PAMM in association with branch retinal arteriolar occlusions. In both patients, a hyperreflective band involving the inner plexiform, inner nuclear, and outer plexiform layers was seen in or adjacent to areas of prior macular thinning. These areas corresponded to flow deficits in both the SCP and DCP. At the respective 1-month and 1-year follow-up examinations, the hyperreflective band improved with ensuing atrophy of the middle retinal layers. OCT angiography demonstrated worsening of flow deficits in the corresponding SCP and DCP. To the best of our knowledge, this is the first report of AMN and the largest case series of AMN or PAMM in SCD to date. Paracentral acute middle maculopathy may precede macular thinning commonly observed in SCD. OCT angiography is a useful tool to demonstrate associated microvascular changes in AMN and PAMM in SCD.

Neurofibromatosis Type 1 Vasculopathy Presenting as Impending Central Retinal Artery Occlusion

Neurofibromatosis Type 1 Vasculopathy Presenting as Impending Central Retinal Artery Occlusion

Retinal and optic disc vasculitis in Susac's syndrome

Abstract Case report The case is presented of 42 year-old woman with no significant medical history, with severe headaches, nausea and vomiting, hearing loss, and alteration of mental status with disorientation and confusion. Ophthalmic examination showed optic disc hyperaemia in right eye, and focal areas of arteriolar occlusion in both eyes. Audiometry demonstrated bilateral neurosensory hypoacusis. Magnetic Resonance Imaging showed multiple small round hyperintense lesions located in the splenium, corpus callosum, basal ganglia, and white matter. Discussion Besides branch retinal arteriolar occlusion, the angiopathy in Susac's syndrome may affect the optic disc vessels.

Vasculitis retiniana y del disco óptico en el síndrome de Susac

Case ReportThe case is presented of 42 year-old woman with no significant medical history, with severe headaches, nausea and vomiting, hearing loss, and alteration of mental status with disorientation and confusion. Ophthalmic examination showed optic disc hyperaemia in right eye, and focal areas of arteriolar occlusion in both eyes. Audiometry demonstrated bilateral neurosensory hypoacusis. Magnetic Resonance Imaging showed multiple small round hyperintense lesions located in the splenium, corpus callosum, basal ganglia, and white matter. DiscussionBesides branch retinal arteriolar occlusion, the angiopathy in Susac's syndrome may affect the optic disc vessels.

Diverse Clinical Signs of Ocular Involvement in Cat Scratch Disease.

Objectives:To describe ocular manifestations, diagnosis, and treatment of cat scratch disease.Materials and Methods:Clinical records of patients with ocular cat scratch disease were reviewed.Results:Thirteen eyes of 10 patients (7 female, 3 male) with a mean age of 26.9±18.5 years were included. Nine patients had a history of cat contact and had systemic symptoms associated with cat scratch disease 2-90 days prior to the ocular symptoms. Ocular signs were: neuroretinitis in 4 eyes (associated with serous retinal detachment in the inferior quadrant in 1 eye), optic neuropathy in 2 eyes (1 papillitis and optic disc infiltration, 1 optic neuritis), retinal infiltrates in 6 eyes, retinochoroiditis in 1 eye, branch retinal arteriolar occlusion in 3 eyes, and endophthalmitis in 1 eye. Visual acuities at presentation were 1.0 in 7 eyes, 0.3 in 1 eye, ≤0.1 in 4 eyes, and light perception in 1 eye. Bartonella henselae immunoglobulin (Ig) M and/or IgG were positive in all patients. Systemic antibiotic therapy was administered in all patients. Systemic corticosteroid treatment (15-40 mg/day) was added to the therapy in 4 patients, following 5 days of intravenous pulse methylprednisolone in 2 patients. Treatment was ongoing for 1 patient and the mean treatment duration of the other 9 patients was 47±14.5 days. Visual acuities at final visit were 1.0 in 9 eyes, 0.8 in 1 eye, 0.4 in 1 eye, and no light perception in 1 eye.Conclusion:Cat scratch disease may present with different ocular signs and should be considered in the differential diagnosis in patients with such presentations.

Ocular manifestations in dengue fever

PurposeDengue fever, a viral disease epidemic in some parts of the world, caused by a virus, is characterized by fever, headache, muscle and joint pains. Ocular manifestations are uncommon, but of great significance. Main symptoms include blurring of vision, scotomata, metamorphopsia, and floaters. We describe the clinical spectrum of fundus manifestations and angiographic, optical coherence tomographic and electrophysiology features of dengue‐ associated maculopathy in few patient.MethodsWe reviewed clinical records and report 6 serial cases of ophthalmic complications resulting from dengue infection. Serology was positive in 100%. Investigations included Humphrey automated visual field analyzer, optical coherence tomography, fundus fluorescein and indocyanine green angiography, and electrophysiology.Results12 eyes of 6 patients, 5 women and 1 man, were studied. The mean age was 26.8 years.The mean log MAR presenting best corrected visual acuity was 0.53 (range of 1 to counting fingers). Multiple retinal yellowish deposits at fovea were an usual finding in 9 eyes. Of these, optical coherence tomography (OCT) showed focal disruption of the outer neurosensory retina in 8 eyes, and indocyanine green angiography corresponding hypofluorescent spots in 3 eyes. Intraretinal hemorrhage was seen in 1 eye, in association with an artery sheathing. In this case, OCT showed a thickening of the inner retina, the result of retinal arteriolar occlusion. Central or paracentral scotomas were observed in 83%. Multifocal electroretinography showed decreased foveal and parafoveal responses. Final visual acuity increased while relativ scotoma remained.ConclusionsOcular damage in Dengue fever are extremely varied and all examinations are needed to better characterize the lésion and thus assess the best visual prognosis of often young and active patients.

FUNDUS CHANGES IN BRANCH RETINAL ARTERIOLAR OCCLUSION.

To investigate systematically various fundus changes in branch retinal arteriolar occlusion (BRAO) and their natural history. The study comprised a cohort of 123 consecutive patients (135 eyes) with BRAO. Ophthalmic evaluation at initial and follow-up visits included recording visual acuity, visual fields, and detailed anterior segment and fundus examinations, and at initial visit fluorescein fundus angiography. Probability estimates of retinal infarct still present were 89% 1 week after BRAO onset, 69% after 2 weeks, 67% after 3 weeks, 34% after 1 month, and 13% after 3 months. Optic disk pallor in the involved region developed in 21% within 1 month from onset, in 42% by 2 months, and in 65% by 3 months. Retinal arteriolar attenuation developed in 19% within 1 month from onset, and in 28% by 6 months. Arteriolar sheathing developed in 19% within 1 month and 25% within 12 months. Arteriolar emboli were found in 58%; 65% of those were at initial visit, in BRAO seen within 1 week of onset. Most common cause of BRAO is embolism from the heart or carotid arteries; emboli usually get impacted at the arteriolar bifurcation. Migration and disappearance of retinal emboli is a common finding. Evolution of the retinal and optic disk changes is described.

A rare case of postoperative traumatic optic neuropathy in orbital floor fracture.

A rare case of postoperative traumatic optic neuropathy in orbital floor fracture.

Combined bilateral retinal arteriolar and retinal vein occlusion: An unusual presentation of systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a rare autoimmune disease associated with multi-organ damage mediated by tissue-binding autoantibodies and immune complexes. [1] Common ocular manifestations of SLE include nonspecific conjunctivitis, anterior uveitis, or iridocyclitis, which rarely threaten vision. In contrast, retinal vasculitis and optic neuritis are serious manifestations. [2] Branch retinal arteriolar occlusion (BRAO) and branch retinal vein occlusion (BRVO) in patients younger than 30 years of age is rarely caused by atheromatous diseases. Other diverse etiologies are more likely to be inflammatory and infectious conditions. Here, we have report a case of a 17-year-old woman with SLE and hypocomplementenemia, who presented with sudden loss of vision. A rare presentation of SLE is found as combined BRAO and BRVO in both the eyes (OU). Despite advances in the understanding of pathophysiology of SLE, its complications remains enigmatic and, in some instances, it may be multifactorial. Early accurate diagnosis and aggressive immunosuppression is recommended, which helps in the management and preservation of the vision.

SUSAC SYNDROME. CASE REPORT

The article discusses clinical manifestations of Susac syndrome: triad, including encephalopathy, secondary loss of vision due to retinal arteriolar branch occlusion, sensorineural hearing loss; typical MRI findings. Clinical observation of the case Susac syndrome is given.

Retinal arterial macroaneurysms

Retinal arterial macroaneurysms are acquired saccular or fusiform dilatations of the large arterioles of the retina, usually within the first three orders of bifurcation. They are associated with systemic vascular conditions such as hypertension and arteriosclerotic disease occurring most commonly in elderly women. The primary reported symptom is a sudden loss of vision due to haemorrhage or oedema affecting the macula. Most of macroaneurysms regress without treatment and without causing decreased visual acuity. Poor visual outcome may occur secondary to foveal exudates and subfoveal haemorrhage.

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.

Design and in vitro assessment of L-lactic acid-based copolymers as prodrug and carrier for intravitreal sustained L-lactate release to reverse retinal arteriolar occlusions

Ophthalmic conditions in which the retinal vasculature is obstructed generally lead to vision loss. Administration of the vasodilator L-lactate might offer a treatment strategy by restoring the blood flow, but unfortunately its effect after single intravitreal injection is short-lived. This study describes a concept in which the sustained release of L-lactic acid from a biodegradable copolymer system is investigated. The 50:50 (n/n) copolymer system, composed of L-lactic acid and L,D-2-hydroxyoctanoic acid, is a viscous injectable that will form an intravitreal drug depot. Hydrolysis of the copolymer will automatically lead to the release of L-lactic acid, which will convert to L-lactate at physiological pH, thereby providing a carrier and pro-drug in one. In vitro and ex vivo release studies demonstrate an L-lactic acid release over several weeks. Biocompatibility of the co-polymer and its degradation products is shown on a human retinal pigment epithelial cell line and on ex vivo retinal tissues. A low molecular weight copolymer (1200g/mol) with low polydispersity has promising properties with a constant release profile, good biocompatibility and injectability.

Retinal arteriolar occlusions due to cytomegalovirus retinitis in elderly patients without HIV

BackgroundFive of 7 (71%) elderly immunocompetent patients with cytomegalovirus retinitis had retinal arteriolar occlusions versus 2 of 8 (25%) elderly immunocompromised patients and 1 of 19 (5%) younger HIV-infected patients. Compared to HIV-infected patients, elderly patients were more likely to have occlusive events, neovascularization or hemorrhage, and underlying vasculopathy. The purpose of this study is to report the novel finding of extensive retinal arteriolar occlusions and neovascularization in immunocompetent patients with cytomegalovirus retinitis. This is a retrospective observational cohort study of cytomegalovirus retinitis (CMVR) in a university setting. Seven patients were elderly but not immunocompromised, 8 were elderly and iatrogenically immunocompromised, and 16 were HIV-infected. All patients underwent polymerase chain reaction testing of intraocular fluid. Primary outcome measure was visual acuity. Secondary outcome measures were vascular occlusions, ischemic complications, and response to treatment.ResultsMean age was 73, 70, and 41 years for immunocompetent, immunocompromised, and HIV-infected patients, respectively. Diabetes and vascular disease were common in the elderly. Vision loss to less than 5/200 occurred in 50% of the immunocompetent elderly patients, and 17% of CMV eyes in immunocompromised and HIV patients. Occlusion of the entire retinal vasculature occurred in 4/7 (57%) of immunocompetent patients despite lack of Zone I involvement, and rubeosis occurred in three, disc neovascularization in one, and vitreous hemorrhage in two patients. Vascular occlusive events were less common in immunocompromised patients and rare in the HIV-infected.ConclusionsCMVR in non-HIV-infected elderly patients is associated with retinal arteriolar occlusions. An intact host immune response may increase damage to retinal vessels. Prompt diagnosis may avert catastrophic vision loss.

Retinal Arteriolar Occlusions during a Sickle Cell Crisis

A 44-year-old black man with sickle cell disease presented to the eye clinic and reported that he had noticed acute, painless vision loss in his right eye when he awoke at 3 a.m. He reported drinking a “fair amount” of alcohol before going to sleep. On examination, the visual acuity in his left eye was 20/25 but in his right eye was limited to counting fingers directly in front of him. An examination of the anterior segment of both eyes was unremarkable. Intravenous fluorescein angiography was performed, and the angiogram showed multiple complete arteriolar occlusions in the retina of his . . .

Talc retinopathy presenting as multiple retinal arteriolar occlusions.

To describe a patient with bilateral retinal arteriolar occlusions secondary to talc in the associated vessels resulting from intravenous drug use and a patent foramen ovale. A 24-year-old woman presented with bilateral retinal arteriolar occlusions with visible foreign material in the associated vessels. A transesophageal echocardiogram showed a patent foramen ovale. A subsequent chest computed tomography angiogram showed a diffuse fine nodular pattern with focal nodules bilaterally and lung biopsy showed a foreign body giant cell reaction to polarizable material consistent with talc. This patient's patent foramen ovale allowed larger talc particles to enter her systemic circulation obstructing several retinal arterioles creating an atypical appearance of talc retinopathy. To our knowledge, this is only the second case report of talc causing arteriolar occlusions and displays the characteristic lung computed tomography angiogram and histopathologic findings associated with systemic talcosis.