Treatment of Acute Central Retinal Artery Occlusion with Ocular Ischemic Syndrome

Jong Hwan Lee; Ho Seok Moon; Dong Heun Nam; Dae Yeong Lee

doi:10.3341/jkos.2014.55.8.1242

Journal List > J Korean Ophthalmol Soc > v.55(8) > 1009763

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Lee, Moon, Nam, and Lee: Treatment of Acute Central Retinal Artery Occlusion with Ocular Ischemic Syndrome

Case Report

J Korean Ophthalmol Soc 2014;55(8):1242-1247.

Published online: 31 August 2014

DOI: https://doi.org/10.3341/jkos.2014.55.8.1242

Treatment of Acute Central Retinal Artery Occlusion with Ocular Ischemic Syndrome

Jong Hwan Lee, MD, Ho Seok Moon, MD, Dong Heun Nam, MD, PhD, Dae Yeong Lee, MD

Department of Ophthalmology, Gachon University Gil Hospital, Incheon, Korea

Address reprint requests to Dae Yeong Lee, MD, Department of Ophthalmology, Gachon University Gil Hospital, #21 Namdong-daero 774beon-gil, Namdong-gu, Incheon, 405-760, Korea, Tel: 82-32-460-3364, Fax: 82-32-460-3358 E-mail: dylee@gilhospital.com

Received 14 March 2014 Revised 21 April 2014 Accepted 17 July 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We report a case of treatment of acute central retinal artery occlusion (CRAO) with ocular ischemic syndrome (OIS).

Case summary

A 72-year-old man presented with acute loss of vision in the right eye on that day. At initial examination, visual acuity tested positive for light sensitivity in the right eye. Fundus examination demonstrated a visible embolus at the central retinal artery overlying the optic disc head and a cherry-red spot in the fovea. Fluorescein angiography revealed that filling of the choroidal circulation was delayed, and the arteriovenous transit time was even further delayed. Carotid angiography showed marked stenosis within the right internal carotid artery. Laboratory tests included blood tests for hypercoagulability evaluation, for which the results were non-specific. To treat acute CRAO with OIS in the right eye, transluminal Nd:YAG laser embolectomy (TYE) was performed twice, and carotid angioplasty with stenting was conducted within the stenosed internal carotid artery. One month after the TYE procedure and carotid stenting, the patient's visual acuity improved to 0.06 and the arteriovenous transit time was within normal limits on fluorescein angiography.

Conclusions

The visual prognosis in eyes with CRAO plus an associated choroidal circulatory disturbance is extremely poor. However, we experienced and reported a case of CRAO with OIS treated successfully through a prompt TYE procedure and carotid angioplasty with stenting.

Keywords: Carotid angioplasty with stenting, Central retinal artery occlusion, Ocular ischemic syndrome, Transluminal Nd:YAG laser embolectomy (TYE)

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Figure 1.

(A) Fundus photograph of the right eye at the first visit. Large emboli were seen at the central retinal artery overlying the optic disc head. Superficial retinal whitening or opacification was noted in the posterior pole with evidence of a cherry-red spot in the fovea. (B, C, D) Fluorescein angiographs of the right eye at the first visit. A filling of the choroidal circulation was delayed and the arteriovenous transit time was even further delayed.

Figure 2.

(A) Fundus photograph of the right eye on the third days after first transluminal Nd:YAG laser embolectomy (TYE). Large emboli were not seen at the central retinal artery overlying the optic disc head any more. Vitreous hemorrhages were seen at optic disc area and inferior pole. (B, C, D) Fluorescein angiographs of the right eye on the third days after first TYE. A filling of the choroidal circulation was still delayed. But the arteriovenous transit time was within normal limit.

Figure 3.

Carotid Doppler sonogram and carotid angiograph of the right eye. A 90% obstruction of the right internal carotid artery was presented (red arrow).

Figure 4.

Fundus photograph and fluorescein angiographs of the right eye on the first month after transluminal Nd:YAG laser embolectomy (TYE) procedure and carotid stenting. (A) On fundus photograph, the central retinal artery and retinal arterioles appeared patent and no emboli were seen. (B, C, D) On fluorescein angiographs, the arteriovenous transit time was within normal limit on fluorescein angiography.

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