Presentation
CASE PRESENTATION: A 22-year-old African gentleman presented with left nasal obstruction and epistaxis for 2 years and was diagnosed with nasopharyngeal carcinoma. [ncbi.nlm.nih.gov]
Additionally, each patient had evaluation for present or past history of ocular infections. [omicsonline.org]
Entire Body System
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Edema of the Hand
Macular edema Visual acuity hand motion only Dx ischemic retinal vein occlusion FA- Rt decreased perfusion in all quadrants OPG/ODM-Normal Carotid Ultrasound-Normal Rt significant decrease in flow in Rt eye. [omicsonline.org]
Cardiovascular
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Vascular Disease
Ryan Springer Science & Business Media, ٢٩/٠٣/٢٠١٠ - 779 من الصفحات Vascular diseases of the retina are a major cause of blindness among all age groups. [books.google.com]
Campo RV, Aaberg TM (1983) Digital subtraction angiography in the diagnosis of retinal vascular disease. Am J Ophthalmol 96: 632-640. [omicsonline.org]
Causes of OIS include arterial hypertension, atherosclerosis, diabetes, aortoarteritis and other vascular diseases. Clinical features depend on the extent, nature, and site of vascular involvement as well as the concurrent pathology. [ncbi.nlm.nih.gov]
Theme 7 Retinal Vascular Diseases Occlusion of the retinal arteries or veins produces retinal ischemia and visual loss. [neuro-ophthalmology.stanford.edu]
Henkind E Retinal vascular disease: introduction and phenomenology. Trans Am Acad Ophthalmol Otolaryngol 1977;83:367-372. 5. Rehany U, Kassif Y, Rumelt S. [healio.com]
Skin
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Cafe-Au-Lait Spots
Abstract Etiological investigation of a 15-year-old boy with left ophthalmic artery occlusion led us to a diagnosis of neurofibromatosis type I as there were numerous large cafe-au-lait spots, axillary freckling, and brain MRI changes consistent with [ncbi.nlm.nih.gov]
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Axillary Freckling
Abstract Etiological investigation of a 15-year-old boy with left ophthalmic artery occlusion led us to a diagnosis of neurofibromatosis type I as there were numerous large cafe-au-lait spots, axillary freckling, and brain MRI changes consistent with [ncbi.nlm.nih.gov]
Eyes
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Retinal Pallor
Areas of retinal pallor were better defined A diagnosis of left central retinal artery occlusion was made but the absence of a cherry red spot further suggests the absence of choroidal circulation indicating a possible occlusion of the ophthalmic artery [bmcophthalmol.biomedcentral.com]
pallor and macular infarction) of the right eye, suggesting occlusion of the ophthalmic artery. [healio.com]
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Unilateral Blindness
Unilateral blindness occurring during anaesthesia for neurosurgical operations. AMA Arch Ophthalmol 1954; 52: 819-30. 6. Halfon MJ, Bonardo P, Valiensi S, Zaffaroni MC, Fernandez Pardal MM, Ribero Ayerza D, et al. [neurologyindia.com]
Workup
[…] in younger patients 6 and an embolic workup in older patients. [aao.org]
Systemic workup should include an evaluation for those abnormalities associated with acute CRAO. From there your doctor will recommend a course of ocular therapy. [williamsoneyeinstitute.com]
In young patients a vasculitis and/or hypercoagulable workup should be performed. In older patients, an embolic workup should be performed. [eyewiki.aao.org]
[…] carotid disease, and other sources of emboli are classic causes of retinal ischemia (see Table 7.2). 7.1.3 Treatment of Acute Retinal Arterial Ischemia Acute treatment consists of the following: Patients seen acutely should be admitted for immediate workup [neuro-ophthalmology.stanford.edu]
Ophthalmic/retinal vascular occlusion (RVO) suggested an underlying systemic disease and recommended workup of a patient with RVO is suggested in [Table 3]. [ojoonline.org]
Treatment
Three weeks after treatment, the angiographic abnormalities had resolved, and the retinal and choroidal circulations were normal. Twenty-eight months after treatment, the visual acuity was 20/20 in each eye. [ncbi.nlm.nih.gov]
Prospective randomized multicenter clinical trial in Europe to compare treatment outcome after conservative standard treatment with LIF using recombinant tissue plasminogen activator for patients with CRAO within 20 h after the onset was stopped after [jstage.jst.go.jp]
Prognosis
Autologous fat injections were associated with a worse visual prognosis and a higher incidence of combined cerebral infarction. [ncbi.nlm.nih.gov]
Interestingly, autologous fat injection was associated with a worse visual prognosis and a higher incidence of combined cerebral infarction. [evrs.eu]
J Neurol Neurosurg Psychiatry 76: 196–199, 2005 20) Augsburger JJ, Magargal LE: Visual prognosis following treatment of acute central retinal artery obstruction. [jstage.jst.go.jp]
Further complications such as neovascular anterior segment changes can occur later, worsening the prognosis [ 5 ]. [omicsonline.org]
Prognosis Recovery of useful vision is related directly to the rapidity of treatment and presenting visual acuity. [emedicine.medscape.com]
Etiology
Abstract Etiological investigation of a 15-year-old boy with left ophthalmic artery occlusion led us to a diagnosis of neurofibromatosis type I as there were numerous large cafe-au-lait spots, axillary freckling, and brain MRI changes consistent with [ncbi.nlm.nih.gov]
(III, good quality, strong recommendation) Acute, symptomatic OAO or CRAO from embolic etiologies should prompt an immediate referral to the nearest stroke referral center for prompt assessment for consideration of an acute intervention. [aao.org]
Subsequent management is directed toward identification and treatment of any underlying disease, with etiologic considerations being similar to those for central retinal artery occlusion. [healio.com]
The etiology of the arterial occlusion (thrombosis, embolus, arteritis, vasospasm) has also been described as affecting outcome.(4,5) Careful classification of the factors involved in an individual case of CRAO is crucial to understanding the natural [uhms.org]
[…] with 4.3% in the CST group. 36 Future studies should carefully weigh the decision to give tPA based on the potential for restoration of sight vs that for life-threatening complications. 4 One final and much debated complication is the prevalence and etiology [retinalphysician.com]
Epidemiology
Devauchelle-Pensec V, Jousse S, Destombe C, Saraux A (2008) Epidemiology, imaging and treatment of giant cell arteritis. Joint Bone Spine 75:267–272 CrossRef PubMed Google Scholar 11. [link.springer.com]
Retinal arteriolar emboli: epidemiology and risk of stroke. Curr Opin Ophthalmol 2002; 13: 142–146. PubMed Crossref Google Scholar [34] Wong TY, Larsen EK, Klein R, et al. [degruyter.com]
FACS, 6 1 Emory Eye Center, Emory University, Atlanta, Georgia 2 Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota 3 Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals & Clinics, Iowa City, Iowa 4 Division of Epidemiology [aao.org]
The central retinal artery is affected in 57% of occlusions, the branch retinal artery is involved in 38% of occlusions, and cilioretinal artery obstructions occur in 5% of occlusions. [1] Epidemiology Frequency United States Recent estimates put the [emedicine.medscape.com]
Epidemiology The true incidence of CRAO in the population is unknown. Rumelt 1999 estimated an incidence of acute (less than 48 hours) CRAO of 0.85/100,000 population/year at their institution. [cochranelibrary.com]
Pathophysiology
ProCite RefWorks Reference Manager ARVO (1962-2015); The Authors (2016-present) Supplements Abstract Purpose To evaluate the angiographic features of cosmetic facial filler associated ophthalmic artery and its branches occlusion, thereby elucidate its pathophysiology [iovs.arvojournals.org]
New techniques for enhanced imaging of the choroid will certainly add to the understanding of the pathophysiology [ 23 ]. However, these techniques should be correlated with assessment of the ophthalmic artery. [omicsonline.org]
Pathophysiology Blood supply to the retina originates from the ophthalmic artery, the first intracranial branch of the internal carotid artery that supplies the eye via the central retinal and the ciliary arteries. [emedicine.medscape.com]
Pathophysiology The central retinal artery supplies the inner retina. Occlusion of the retinal arteries results in ischemia of the inner retina. When the inner retina is damaged, it first becomes very edematous. [eyewiki.aao.org]
Prevention
CONCLUSION: Pre-operative angio-architecture understanding and diligent selection of embolic material are helpful in preventing this adverse event. [ncbi.nlm.nih.gov]
This case highlights the importance of early diagnosis and prompt treatment of giant cell arteritis in order to prevent the blinding complications like ophthalmic artery occlusion, and in case of unilateral involvement, to save the other eye. [ijmr.org.in]
Conclusion Pre-operative angio-architecture understanding and diligent selection of embolic material are helpful in preventing this adverse event. [bmcophthalmol.biomedcentral.com]