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2.1
Retinal Artery Embolism
Embolic Spots in Retinal Arteries

Presentation

Case presentation A 23-year-old woman presented with sudden painless visual loss in the left eye of 100 min. She had been diagnosed with PTA at the age of 1 month. [bmcophthalmol.biomedcentral.com]

BCVA in the present case remained at 20/25, with a permanent visual field defect in the OD. [dovepress.com]

Presentation: A patient typically presents with acute, profound, painless, monocular vision loss with potentially a small amount of temporal sparing. [emdocs.net]

His blood pressure was 230/110 mm Hg at presentation. Glycosylated haemoglobin (HbA1c) was 8.8%. [austinpublishinggroup.com]

Eyes

  • Retinal Pallor

    Retinal pallor corresponds to the area supplied by the affected artery. Occasionally, an embolus (cholesterol, fibrinoplatelet, calcific) can be seen within the artery, and cotton wool spots may eventually occur around that area. [patient.info]

    Fundus showed reabsorption of retinal edema and resolution of retinal pallor in both eyes. [mjdrdypu.org]

    pallor, allowing it to stand out. 1-11 Following the acute injury, the retinal appearance resolves over the course of weeks. [reviewdiseasehandbook.com]

  • Blurred Vision

    The procedure was complicated by chest pain and the acute onset of blurred vision. Funduscopic examination revealed a white plaque in the left eye, occluding the inferior hemiretinal artery. This was interpreted as a fibrin embolus. [nejm.org]

    BRVO causes a painless decrease in vision, resulting in misty or distorted vision. If the veins cover a large area, new abnormal vessels may grow on the retinal surface, which can bleed into the eye and cause blurred vision. [sneretina.com]

    Blood clots, inflammation, infections, and the use of certain drugs are some of the known causes for Retinal Artery Occlusion The signs and symptoms of the condition include sudden blurred vision and blood clot in the eye. [dovemed.com]

  • Transient Blindness

    […] so conclusion: it is amaurosis ugax when the patint tells you that he has had transient episodes of blindness... it is retinal artery oclusion when the patient tells you that he or she is unilaterally blind (normally), and hasn´t recovered. both are 70% [prep4usmle.com]

Workup

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]

To evaluate etiology, workup may include: -Neurology evaluation for workup and modification of risk factors. -ESR/CRP and giant cell arteritis review of systems. [webeye.ophth.uiowa.edu]

Diagnostic workup in CRAO and BRAO focuses on identifying the underlying etiology, in order to institute appropriate secondary prevention measures to reduce the risk of future vascular events. [dovepress.com]

Treatment

In comparison, visual improvement after conservative treatment according to three different stages is shown in Table 9. Obviously, the results after treatment with LIF are better than with conservative treatment. [ajnr.org]

[…] was reported with treatment given after 48 hours of ischemia. 5 Nevertheless, shorter latency to treatment results in better outcomes. 38 It is therefore important to review all treatment options that aim to restore circulation to the ischemic retina [thejns.org]

"Treatment Options for Central Retinal Artery Occlusion". Current Treatment Options in Neurology. 15 (1): 63–77. doi : 10.1007/s11940-012-0202-9. PMC 3553407. [en.wikipedia.org]

Ophthalmology 2010;117:1367–1375. e1361.This randomised multicentre study compares the treatment outcomes of conventional treatment versus intra-arterial tPA in patients with CRAO. [ PubMed ] 57. Lindsberg PJ, Mattle HP. [ncbi.nlm.nih.gov]

Occasionally intravitreal injections of medications into the way may be used as treatment. New experimental treatments are now under investigation. [sneretina.com]

Prognosis

The prognosis is especially poor in the case of ischemic CRVO. References: [6] [7] [amboss.com]

Prognosis Recovery of useful vision is related directly to the rapidity of treatment and presenting visual acuity. [emedicine.medscape.com]

CRAO is a medical emergency which has a poor prognosis if not attended to promptly. Patients particularly at risk include those with giant cell arteritis, atherosclerosis and thromboembolic disease. [wesleyhyperbaric.com.au]

Prognosis The prognosis for central retinal visual acuity is poor with only about one-third of patients recovering useful vision. [medical-dictionary.thefreedictionary.com]

Etiology

With regard to etiology, 62 patients (41.1%) had LAA, the most common etiological factor. About 40% of our patients had a RAO of undetermined etiology. [journals.plos.org]

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]

Retinal artery occlusion and associated recurrent vascular risk with underlying etiologies. PLoS One 2017;12:e0177663. 6. Shin JW, Jeong JH, Jeong HY, Kim D, Moon J, Kim TJ, et al. [e-jnc.org]

Etiology: Although there are many etiologies for CRAO, carotid artery stenosis is thought to be the most common cause and is present in up to 70% of cases. 2 Cardioembolic disease is another prevalent etiology and is more likely in those under 40 and [emdocs.net]

Conclusions: Surgical embolectomy following pars plana vitrectomy is the only etiologic treatment for acute hemi-central retinal artery occlusion caused by calcific emboli. [evrs.eu]

Epidemiology

References: [1] [2] [3] [4] [5] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]

Two thirds of patients experience 20/400 vision while only one in six will experience 20/40 vision or better. [1] Epidemiology [ edit ] Risk factors for CRAO include the following: being between 60 and 65 years of age, being over the age of 40, male gender [en.wikipedia.org]

1,2 Categorized as branch (BRAO), central (CRAO), cilioretinal or ophthalmic, depending on the location of the blockage, they are not the result of a single disease but develop from several systemic abnormalities. 2,3 As such, there is no definitive epidemiology [reviewdiseasehandbook.com]

Retinal arteriolar emboli: epidemiology and risk of stroke. Current opinions in ophthalmology, 2002, 13(3):142–6. Klein R et al. Retinal emboli and cardiovascular disease: the Beaver Dam Eye Study. Archives of ophthalmology, 2003, 121(10):1446–51. [emro.who.int]

Diagnosis: Central Retinal Artery Occlusion (CRAO) EPIDEMIOLOGY Age > 40 years old. [webeye.ophth.uiowa.edu]

Pathophysiology

CRAO is the same pathophysiology in the retinal circulation. [hbot.com]

The pathophysiology of the disease is still not welldefined. In this case report, we are trying to illustrate a case of CRVO followed by CRAO with sequential fundus photo, and to describe the pathophysiology based on the anatomical basic. [omicsonline.org]

Date of Submission 12-Jan-2015 Date of Acceptance 25-Mar-2015 Date of Web Publication 25-May-2015 Dear Editor, The occurrence of postoperative visual loss (POVL) after spine surgery in prone position, although rare, has been described.[ 1 6 7 ] Various pathophysiologic [surgicalneurologyint.com]

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]

Prevention

Stroke Prevention in Atrial Fibrillation Study Group Investigators. Preliminary report of the stroke prevention in atrial fibrillation study. N Engl J Med 1990; 322: 863–868. Google Scholar 24. [link.springer.com]

Future prevention of cerebrovascular accidents or recurrent occlusive events in the eye is also initiated. [news-medical.net]

Prevention Since many cases of retinal vessel occlusion are related to high blood pressure, atherosclerosis or diabetes, it may be possible to prevent this eye problem by not smoking and controlling your blood pressure, cholesterol level and blood sugar [drugs.com]

Measures used to prevent other blood vessel (vascular) diseases, such as coronary artery disease, may decrease the risk for retinal artery occlusion. [medlineplus.gov]

The best way to prevent retinal vascular occlusion is to identify and treat the risk factors. [healthline.com]

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