Cilioretinal Artery Obstruction as a Complication of Retinitis Caused by Chikungunya Virus.

PURPOSE: The purpose of this case report is to describe the obstruction of cilioretinal artery in a patient with acute focal retinitis occurring due to Chikungunya virus (CHIKV) fever. CASE REPORT: A 45-year-old female presented with sudden and unilateral visual impairment from 2 days, which was preceded by a flu-like syndrome 2 weeks before. Multimodal imaging revealed focal retinitis in both eyes, which was complicated by cilioretinal artery obstruction in the left eye. Laboratory examinations confirmed the diagnosis of CHIKV fever and showed positive results (anti-CHIKV IgM and reverse transcriptase-polymerase chain reaction). The patient was treated with oral steroids. Following which, the patient showed a limited visual and anatomical recovery in the affected eye. CONCLUSIONS AND IMPORTANCE: CHIKV fever has been currently associated with atypical manifestations. This indexed report describes a unique perspective on CHIKV focal retinitis, complicated by cilioretinal artery obstruction, further leading to limited visual recovery.

Obstrucción de la arteria central de retina con persistencia de flujo de la arteria cilioretiniana en un paciente con obstrucción embólica de arteria carótida. Reporte de caso / Central retinal artery occlusion with cilioretinal artery flow persistence in a patient with carotid artery embolic occlusion. Case report

Objetivo: Describir el caso de un paciente con obstrucción de la arteria central de la retina (OACR) con persistencia de flujo ciliorretinal y su relación con la patología cardiovascular. Caso clínico: Paciente varón de 64 años, con antecedentes de hipertensión arterial sistémica, consultó por cuadro de visión tubular brusca en ojo derecho (OD) de 3 días de evolución. Se constató una agudeza visual (AV) de 20/25 en el ojo afectado. A la fundoscopía se destaca palidez retinal que respeta el área macular con la presencia de vasos optociliares, compatible con OACR con permeabilidad de la arteria ciliorretinal. Se realizó manejo multidisciplinario con cardiología y medicina interna para control y tratamiento de factores de riesgo. Materiales y métodos: Se realizó Angiografía bajo fluoresceína (AGF), campo visual (CV) y tomografía de coherencia óptica (TCO) macular, además se realiza estudio de fuente embólica con Ecodoppler carotídeo. Resultados: AGF revela un llenado precoz durante la fase coroidea y un retraso en la fase arterial. El CV del OD muestra conservación del área circunscrita entre los 10 grados centrales. La TCO macular muestra un engrosamiento dependiente del edema sin afectación central. Ecodoppler carotídeo revela obstrucción de 20 - 40 % en las arterias carótidas comunes, arterias carótidas internas y arterias vertebrales. Conclusión: La OACR se presenta en 1 en 10.000 casos en centros terciarios. La causa más frecuente es embólica de origen carotídeo. La arteria cilioretiniana permanece permeable en el 25% de las OACR y solo el 10% respeta de manera total el haz papilomacular, conservando agudeza visual central. Es considerada una emergencia oftalmológica debido a la pérdida de visión que produce y representa una alta mortalidad en los pacientes afectados, debiendo hacer un estudio completo y descarte de patología concomitantes que requieran tratamiento oportuno.

Purpose: To describe the case of a patient with obstruction of the central retinal artery (CRAO) with persistence of cilioretinal fl ow and its relationship with cardiovascular pathology. Clinical case: Male patient, 64 years old, with a history of systemic arterial hypertension, consultation for sudden tubular vision in the right eye (RE) of 3 days of evolution. The visual acuity (VA) was 20/25 in the eye aff ected. The fundoscopy highlights were retinal pallor that respects the macular area with the presence of optociliary vessels, this case was compatible with an CRAO with permeability of the ciliary artery. Multidisciplinary management is carried out with cardiology and internal medicine for the control and treatment of risk factors. Materials and methods: Fluorescein angiography (FA), visual field (VF) and macular optic cohort tomography (OCT) were performed, as well as an embolic source study with carotid Ecodoppler was done. Results: AGF reveals early fi lling during the choroidal phase and a delay in the arterial phase. Th e VD of the RE shows conservation of the circumscribed area between the 10 central grades. Macular TCO shows a thickening dependent on edema without central involvement. Carotid echodoppler reveals obstruction of 20-40% in the common carotid arteries, internal carotid arteries and vertebral arteries. Conclusion: The CRAO is presented in 1 in 10,000 cases in tertiary centers. The most frequent cause is embolic of carotid origin. Th e cilioretinal artery remains permeable in 25% of the CRAOS and only 10% fully respects the papillomacular bundle, conserving central visual acuity. It is considered an ophthalmological emergency due to the loss of vision that produces and represents a high mortality in the aff ected patients, having to make a complete study and discard concomitant pathologies that require timely treatment.

Impending central retinal vein occlusion associated with cilioretinal artery obstruction.

We report a case of a patient with an impending central retinal vein occlusion (CRVO) with cilioretinal artery obstruction, which may help to understand the nature of the retinal hemodynamic changes associated with CRVO which shows direct evidence of arterial vasospasm, suggesting an increased contractility of retinal arteries. The clinical course, with initial retinal whitening along a cilioretinal artery followed by signs of venous stasis, seems to confirm the pathogenesis hypothesis concerning a primary arterial affection due to arterial vasospasm.