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2.
Medicine (Baltimore) ; 98(38): e17250, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567993

RESUMO

RATIONALE: Central retinal artery occlusion (CRAO) due to cardiac myxoma primarily occurs in elderly individuals. Early detection and surgical resection of myxoma are extremely important because CRAO causes complete blindness in most cases. However, due to the extremely low incidence of CRAO caused by cardiac myxoma in the pediatric age group, such condition is rarely reported. PATIENT CONCERNS: A 16-year-old female patient visited our hospital due to sudden onset of vision loss in the left eye, dysarthria, and right-sided hemiplegia. DIAGNOSES: She was diagnosed with CRAO via fundoscopy. Results showed a cherry-red spot, indicating CRAO. Brain magnetic resonance imaging (MRI) revealed multifocal diffusion-restricted foci, particularly in the left frontal lobe. Echocardiography revealed a left atrial mass measuring 4.21 cm × 2.25 cm. The mass was attached to the interseptum and moved along the inflow of the mitral valve. Cardiac computed tomography (CT) revealed an enhanced mass measuring 3 cm × 2.2 cm × 3 cm and with irregular margin on the anterior wall of the left atrium and the border of the fossa ovalis. INTERVENTIONS: The patient underwent surgical excision under general anesthesia. Intraoperative finding showed a huge, jelly-like, and extremely friable mass. Pathological examination confirmed myxoma. OUTCOMES: During a follow-up of 2 years after diagnosis, she did not present with other neurological deficits and no residual mass was observed on echocardiography. However, visual impairment of the left eye persisted. LESSONS: Most patients with CRAO may present with other mild symptoms that are often be neglected before CRAO development. We recommend that patients who present with frequent syncopal attack or symptoms of transient ischemic attack should undergo echocardiography.


Assuntos
Cegueira/etiologia , Átrios do Coração , Neoplasias Cardíacas/complicações , Mixoma/complicações , Adolescente , Ecocardiografia , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/patologia , Humanos , Mixoma/diagnóstico por imagem , Mixoma/patologia , Oclusão da Artéria Retiniana/complicações , Oclusão da Artéria Retiniana/diagnóstico , Oclusão da Artéria Retiniana/etiologia , Tomografia Computadorizada por Raios X
3.
Orv Hetil ; 160(29): 1146-1152, 2019 Jul.
Artigo em Húngaro | MEDLINE | ID: mdl-31303015

RESUMO

Retinal arterial occlusion causes acute, painless vision loss, and it requires immediate emergency care. There are two separate arterial systems (retinal and ciliary) in the retina, and in most cases only the central retinal artery and its branches supply blood to the inner retinal layers. Cilioretinal artery is an anatomical variant, which can also supply blood to the macula from the ciliary arterial system, and in the case of a retinal arterial occlusion, the cilioretinal artery could save central vision. We report a case of a 67-year-old woman who suffered a central retinal arterial occlusion while having a patent cilioretinal artery and she had a complete recovery of her central visual acuity. A series of fundus photography and optical coherence tomography images are presented that were taken during follow-up. The patient's complaints started one week before she presented in our department therefore acute therapy was not given. However, during the course of the follow-up her status gradually improved, and she finally regained 1,0 (20/20) visual acuity. In the presence of a cilioretinal artery following a central retinal arterial occlusion, there is a chance of visual acuity preservation. Orv Hetil. 2019; 160(29): 1146-1152.


Assuntos
Artérias Ciliares/diagnóstico por imagem , Angiofluoresceinografia/métodos , Oclusão da Artéria Retiniana/diagnóstico , Artéria Retiniana/diagnóstico por imagem , Oclusão da Veia Retiniana/etiologia , Tomografia de Coerência Óptica/métodos , Idoso , Artérias Ciliares/anormalidades , Feminino , Fundo de Olho , Humanos , Oftalmoscopia , Artéria Retiniana/anormalidades , Oclusão da Artéria Retiniana/etiologia , Oclusão da Veia Retiniana/diagnóstico , Oclusão da Veia Retiniana/patologia , Transtornos da Visão/diagnóstico , Transtornos da Visão/etiologia , Acuidade Visual
4.
BMC Ophthalmol ; 19(1): 147, 2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31291918

RESUMO

BACKGROUND: To characterize the vascular changes in eyes within the acute phase of retinal arterial occlusion (RAO) by optical coherence tomography angiography (OCT-A) imaging. METHODS: This was a retrospective, observational study. Nineteen patients with RAO (symptom onset within 7 days) and 19 age and sex-matched normal control individuals were included. A comprehensive ophthalmic examination and OCT-A examination were conducted for all the patients. RESULTS: The vessel density of the superficial capillary plexus (SCP), deep capillary plexus (DCP), and area with a width of 300 µm around the FAZ (FD-300) was significantly reduced in RAO patients compared with that in the fellow eyes and normal control eyes. The vessel density of the SCP of RAO fellow eyes was significantly lower than that of the normal control eyes (all P < 0.05). Though no difference was observed in the FAZ of RAO eyes compared with that of fellow eyes and normal control eyes, the acircularity index (AI) of the FAZ was significantly increased in RAO eyes (P < 0.05). Central macular thickness (CMT) was correlated with best-corrected visual acuity in central retinal arterial occlusion (CRAO) patients (r = 0.626, P = 0.024). In BRAO eyes, the vessel density of the RAO-affected hemifield was significantly reduced compared with that of the unaffected hemifield (P < 0.05). Radial peripapillary plexus (RPC) vessel density was reduced, accompanied by retinal nerve fiber layer (RNFL) thinning in 3 available CRAO patients. CONCLUSIONS: As a valuable noninvasive imaging tool, OCT-A provides deeper and more detailed vascular information that extends our understanding of the vasculature alterations in acute RAO.


Assuntos
Angiofluoresceinografia/métodos , Fóvea Central/patologia , Oclusão da Artéria Retiniana/diagnóstico , Vasos Retinianos/patologia , Tomografia de Coerência Óptica/métodos , Doença Aguda , Idoso , Feminino , Seguimentos , Fundo de Olho , Humanos , Masculino , Estudos Retrospectivos
5.
BMJ Case Rep ; 12(5)2019 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-31061190

RESUMO

Internal carotid artery dissection (ICAD) is caused by the disruption of the tunica intima, with the formation of an intramural haematoma that can cause stenosis or occlusion of the artery's lumen, leading to reduced blood flow and secondary thrombus formation. Up to two-thirds of patients with ICAD show ophthalmological symptoms or signs, which are, frequently, the first manifestations of this clinical condition, often preceding for weeks the neurological signs of cerebral infarction. Central retinal artery occlusion (CRAO) is a rare complication of ICAD, secondary either to haemodynamic compromise, with ocular hypoperfusion and reverse flow within the ophthalmic artery, or to thromboembolic events, in rarer cases. We report a case of CRAO secondary to a spontaneous ICAD, in an otherwise healthy middle-aged patient.


Assuntos
Dissecação da Artéria Carótida Interna/diagnóstico , Pressão Intraocular/fisiologia , Isquemia/diagnóstico , Oclusão da Artéria Retiniana/diagnóstico , Dissecação da Artéria Carótida Interna/fisiopatologia , Dissecação da Artéria Carótida Interna/terapia , Angiografia Cerebral , Embolização Terapêutica , Feminino , Cefaleia , Humanos , Isquemia/fisiopatologia , Isquemia/terapia , Pessoa de Meia-Idade , Oclusão da Artéria Retiniana/fisiopatologia , Oclusão da Artéria Retiniana/terapia , Trombectomia , Resultado do Tratamento
6.
Ophthalmic Surg Lasers Imaging Retina ; 50(5): e166-e170, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-31100171

RESUMO

The authors present the first case of central retinal artery occlusion (CRAO) resulting from moyamoya syndrome secondary to Southampton hemoglobinopathy. A 12-year-old Hispanic girl with a history of Southampton hemoglobinopathy with moyamoya syndrome presented with amaurosis fugax in her left eye that resolved within hours except for an inferior paracentral scotoma. She had left ophthalmic artery occlusion on magnetic resonance angiogram. Seven months later, spectral-domain optical coherence tomography showed diffuse inner retinal thinning. She was diagnosed with transient CRAO. The authors conclude that CRAO can result from moyamoya syndrome secondary to an underlying hemoglobinopathy. Multimodal imaging demonstrated residual inner retinal injury despite reperfusion. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e166-e170.].


Assuntos
Hemoglobinopatias/complicações , Doença de Moyamoya/complicações , Retina/diagnóstico por imagem , Oclusão da Artéria Retiniana/etiologia , Acuidade Visual , Criança , Progressão da Doença , Feminino , Angiofluoresceinografia , Fundo de Olho , Humanos , Angiografia por Ressonância Magnética , Doença de Moyamoya/diagnóstico , Oclusão da Artéria Retiniana/diagnóstico , Tomografia de Coerência Óptica
7.
Ophthalmic Surg Lasers Imaging Retina ; 50(5): S5-S8, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-31100175

RESUMO

BACKGROUND AND OBJECTIVE: To evaluate the efficacy of systemic prostaglandin E1 (PGE1) infusion within the first 24 hours of acute central retinal artery occlusion (CRAO). PATIENTS AND METHODS: Best corrected visual acuity (BCVA) was analyzed in a case series of six eyes from six patients (mean age: 69.33 years) with acute CRAO who were treated with twice-daily intravenous infusion of 40 µg PGE1. Therapy continued until the patient no longer experienced visual acuity improvements for 24 hours. RESULTS: Average time to presentation was 8.33 hours (range: 2 to 12 hours). The logMAR BCVA at presentation was 2.73. BCVA at the final visit 1 month after initial presentation was 1.48 (P = .025). All patients experienced vision improvement. No systemic adverse events were experienced. CONCLUSION: Intravenous PGE1 infusion resulted in significant visual improvement in patients presenting with acute CRAO and is well tolerated with few adverse effects. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:S5-S8.].


Assuntos
Alprostadil/administração & dosagem , Retina/patologia , Oclusão da Artéria Retiniana/tratamento farmacológico , Acuidade Visual , Idoso , Idoso de 80 Anos ou mais , Relação Dose-Resposta a Droga , Feminino , Angiofluoresceinografia , Seguimentos , Fundo de Olho , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Oclusão da Artéria Retiniana/diagnóstico , Estudos Retrospectivos , Resultado do Tratamento , Vasodilatadores/administração & dosagem
8.
Indian J Ophthalmol ; 67(5): 630-633, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31007223

RESUMO

Purpose: To report a series of central retinal artery occlusions (CRAO) following cataract surgery complicated by posterior capsular rupture (PCR). Methods: Data from 14 patients with acute CRAO following cataract surgery was collected for this study including subject demographics, initial and final best-corrected visual acuity, systemic investigations, optical coherence tomography (OCT) and fundus fluorescein angiography (FFA) findings. Results: Mean subject age was 59.9 ± 12.1 years. Male: Female ratio was 1:1. All patients were operated between October and November 2015 and presented with acute vision loss 1 to 4 days after surgery. All the patients underwent cataract surgery under peribulbar anesthesia and had PCR for which anterior vitrectomy (AV) was done. In all the cases Ethylene oxide (ETO) sterilized vitrectomy probe was used for AV. Clinical picture of CRAO was noted in all the cases during the immediate postoperative period. OCT showed inner retinal layer hyperreflectivity while FFA was normal in all the cases. The final visual acuity was poor in all the eyes. This paper discusses the possible mechanisms of CRAO in these cases. Conclusion: CRAO is a potential complication of peribulbar anesthesia for intraocular surgery in patients with vascular risk factors and hence any substance that can aggravate the vasospasm in such patients should be used cautiously. Vasospasm could be caused by ETO as residual ETO could be present in the vitrectomy machine tubing causing toxicity. It is recommended to be cautious while using ETO sterilized instruments for cataract surgery.


Assuntos
Extração de Catarata/efeitos adversos , Angiofluoresceinografia/métodos , Oclusão da Artéria Retiniana/etiologia , Vasos Retinianos/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Acuidade Visual , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Fundo de Olho , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Oclusão da Artéria Retiniana/diagnóstico , Oclusão da Artéria Retiniana/cirurgia , Estudos Retrospectivos , Vitrectomia/métodos
9.
J Stroke Cerebrovasc Dis ; 28(6): 1495-1499, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30935808

RESUMO

INTRODUCTION: Atrial fibrillation (AF) is a major cause of ischemic stroke and Transient Ischemic Attack (TIA) and investigation for paroxysmal AF is recommended following an embolic brain event. In contrast, retinal ischemic monocular blindness is traditionally considered most linked to carotid artery disease (CAS) and investigating for AF is less vigilant. We aimed to determine the prevalence of AF in patients with ischemic monocular blindness. METHODS: Consecutive records of all patients presenting to a daily TIA clinic with transient or permanent ischemic monocular blindness were reviewed, January 2014-October 2016. RESULTS: Of 400 patients, 224 (56.0%) were male, mean age 64.5 years (SD 15.1). A total of 263 (66%) presented with transient and 137 (34%) with permanent ischemic monocular blindness. ECG was performed in 364 patients (91%) but only 211 (52%) had further cardiac monitoring. The vast majority (97.3%) had carotid imaging. Thirty-six patients (9%) were found to have AF while 53 (14%) had ipsilateral CAS. Median ABCD2 score was 1 in AF and non-AF groups. Only 55% of known AF patients were anticoagulated at presentation, despite all having CHADVASC2 score greater than or equal to 1. Patients with AF had more hypertension (P = .004), previous TIA (P = .002), previous stroke (P = .044) and ischemic heart disease (P = .022) with no difference in age (P = .791), diabetes (P = .563), smoking (P = .460) nor hypercholesterolaemia (P = .083). CONCLUSIONS: A total of 9% of patients with ischemic monocular blindness had AF. This is an underestimate, as only 53% of patients had prolonged cardiac monitoring. Known AF was suboptimally managed with only 55% receiving anticoagulation despite being eligible.


Assuntos
Fibrilação Atrial/epidemiologia , Cegueira/epidemiologia , Isquemia Encefálica/epidemiologia , Ataque Isquêmico Transitório/epidemiologia , Oclusão da Artéria Retiniana/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Visão Monocular , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Amaurose Fugaz/epidemiologia , Amaurose Fugaz/fisiopatologia , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Cegueira/diagnóstico , Cegueira/fisiopatologia , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/fisiopatologia , Ecocardiografia , Eletrocardiografia , Feminino , Humanos , Ataque Isquêmico Transitório/diagnóstico , Ataque Isquêmico Transitório/fisiopatologia , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Recidiva , Oclusão da Artéria Retiniana/diagnóstico , Oclusão da Artéria Retiniana/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Adulto Jovem
10.
Mayo Clin Proc ; 94(2): 236-241, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30711121

RESUMO

OBJECTIVE: To determine the risk of ischemic stroke, transient ischemic attack (TIA), and amaurosis fugax around the time of central retinal artery occlusion (CRAO). PATIENTS AND METHODS: Patients at Mayo Clinic sites with a diagnosis code of CRAO from January 1, 2001, through September 9, 2016, were reviewed. New CRAOs were confirmed, and ischemic stroke, TIA, and amaurosis fugax events were tallied within 15 days before and after CRAO. RESULTS: Three hundred patients with CRAO were included in the study cohort. The median age at the time of CRAO was 72 years (range, 19-100 years), and 158 (53%) were male patients. Overall, 16 patients (5.3%) had symptomatic ischemic stroke around the time of CRAO, with 7 strokes (2.3%) occurring 15 days before CRAO, 4 (1.3%) occurring simultaneously with CRAO, and 5 (1.7%) occurring after CRAO. Transient ischemic attack and amaurosis fugax were seen in 5 (1.7%) and 26 (8.7%) patients, respectively. It was found that 7% (9/128) of patients with embolic CRAO had a stroke around the time of CRAO as compared with 1.3% (2/149) of patients with an unknown cause of CRAO. CONCLUSION: Symptomatic stroke, TIA, or amaurosis fugax is common around the time of CRAO. Therefore, CRAOs require urgent embolic work-ups.


Assuntos
Oclusão da Artéria Retiniana/complicações , Medição de Risco/métodos , Acidente Vascular Cerebral/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia por Tomografia Computadorizada , Feminino , Seguimentos , Humanos , Incidência , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Oclusão da Artéria Retiniana/diagnóstico , Oclusão da Artéria Retiniana/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Fatores de Tempo , Ultrassonografia , Estados Unidos/epidemiologia , Adulto Jovem
11.
Surv Ophthalmol ; 64(4): 477-485, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30703404

RESUMO

Susac syndrome is a rare condition presumed to be immune-mediated occlusion of small arterial vasculature principally of the brain, inner ear, and retina. Clinically, the syndrome manifests as a pathognomonic triad of encephalopathy, hearing loss, and branch retinal artery occlusion. Early recognition and diagnosis is important as delayed treatment may be profound and result in deafness, blindness, dementia, and other neurological deficits. The plethora of imaging technology, including magnetic resonance imaging, retinal fluorescein angiography, optical coherence tomography, and optical coherence tomography angiography, allows deeper and more discrete anatomical-physiological correlation of underlying pathology, early diagnosis, and imaging biomarkers for early detection of relapse during follow-up. We highlight the current clinical classification of Susac syndrome, available investigations, treatment, and care pathways.


Assuntos
Oclusão da Artéria Retiniana/etiologia , Síndrome de Susac/complicações , Transtornos da Visão/etiologia , Anti-Inflamatórios/uso terapêutico , Diagnóstico Diferencial , Técnicas de Diagnóstico Oftalmológico , Angiofluoresceinografia , Humanos , Fatores Imunológicos/uso terapêutico , Imunossupressores/uso terapêutico , Imagem por Ressonância Magnética , Oclusão da Artéria Retiniana/diagnóstico , Oclusão da Artéria Retiniana/tratamento farmacológico , Síndrome de Susac/tratamento farmacológico , Tomografia de Coerência Óptica , Transtornos da Visão/diagnóstico
14.
Am J Ophthalmol ; 200: 179-186, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30689989

RESUMO

PURPOSE: Central retinal artery occlusion (CRAO) confers a high risk of acute vascular ischemic events, including stroke and myocardial infarction (MI). Understanding the burden and risk factor profile of these ischemic events can serve as a valuable guide for ophthalmologists in the management and appropriate referral of these patients. DESIGN: Retrospective cross-sectional study. METHODS: The Nationwide Inpatient Sample (NIS) was queried to identify all inpatient admissions with a diagnosis of CRAO in the United States between the years 2003 and 2014. The primary outcome measure was the incidence of in-hospital acute vascular ischemic events. RESULTS: There were an estimated 17 117 CRAO inpatient admissions. The mean age was 68.4 ± 0.1 years and 53% of patients were female. The incidence of in-hospital stroke and acute MI were 12.9% and 3.7%. The incidence of stroke showed an increasing trend over the years, almost doubling in 2014 in comparison to 2003 (15.3% vs 7.7%). The combined risk of in-hospital stroke, transient ischemic attack, acute MI, or mortality was 19%. Female sex, hypertension, carotid artery stenosis, aortic valve disease, smoking, and alcohol dependence or abuse were positive predictors of in-hospital stroke. CONCLUSION: There is a significant burden of vascular risk factors, associated with an increased risk of in-hospital stroke, acute MI, and death in CRAO patients. The risk of CRAO-associated stroke is highest in women and in those with a history of hypertension, carotid artery stenosis, aortic valve disease, smoking, or alcohol abuse.


Assuntos
Isquemia Encefálica/epidemiologia , Infarto do Miocárdio/epidemiologia , Oclusão da Artéria Retiniana/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico , Estudos Transversais , Feminino , Hospitais/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Oclusão da Artéria Retiniana/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Estados Unidos/epidemiologia , Acuidade Visual
15.
Int J Rheum Dis ; 22(2): 325-330, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26403216

RESUMO

Several ophthalmic manifestations in patients with dermatomyositis have been described but involvement of the retina is rare. A 39-year-old man diagnosed with dermatomysitis had developed sudden painless visual loss in the left eye. He was non-diabetic and non-hypertensive. He was on treatment with systemic prednisolone (50 mg/day) and methotrexate (7.5 mg/day) for dermatomyositis. His visual acuity was finger counting at 2 feet in the left eye and 6/6 in the right eye. Left fundus showed slight blurring of the optic disc margins, large peripapillary flame-shaped haemorrhages and extensive area of opacification suggestive of central retinal artery occlusion (CRAO) with sparing of the area supplied by the cilioretinal artery. The exact pathomechanism of CRAO in dermatomyositis remains poorly elucidated. The infarctive events following endothelial damage and platelet thrombi occurring in arterioles and capillaries of retina, optic disc and choriocapillaries causing ischemia/infarction have been suggested as possible reasons. However, central artery occlusion from high intraocular pressure from marked (heliotrope) orbital edema appears more plausible in our case. The degree of retinal damage is variable when CRAO lasts between 105 and 240 min and irreversible profound visual loss may occur from its occlusion lasting for more than 240 min. A prompt ophthalmological opinion/management is recommended to limit its progression.


Assuntos
Dermatomiosite/complicações , Oclusão da Artéria Retiniana/etiologia , Transtornos da Visão/etiologia , Adulto , Dermatomiosite/diagnóstico , Dermatomiosite/tratamento farmacológico , Glucocorticoides/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Masculino , Metotrexato/uso terapêutico , Prednisolona/uso terapêutico , Recuperação de Função Fisiológica , Oclusão da Artéria Retiniana/diagnóstico , Oclusão da Artéria Retiniana/tratamento farmacológico , Resultado do Tratamento , Transtornos da Visão/diagnóstico , Transtornos da Visão/tratamento farmacológico , Transtornos da Visão/fisiopatologia , Visão Ocular , Acuidade Visual
16.
Curr Opin Neurol ; 32(1): 19-24, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30461463

RESUMO

PURPOSE OF REVIEW: To review recent advances in the management of acute ocular ischemic events, including: transient monocular vision loss, central and branch retinal artery occlusions, and nonarteritic anterior ischemic optic neuropathy. RECENT FINDINGS: Transient monocular vision loss and acute retinal arterial occlusions require immediate diagnosis and management, with recognition of these events as transient ischemic attack or stroke equivalents, respectively. Patients should undergo an immediate stroke workup in a stroke center, similar to patients with acute cerebral ischemia. The treatment of central retinal artery occlusions remains limited despite the growing use of thrombolytic treatments. The indication for these treatments remains under debate. No quality evidence exists to support any therapy, including corticosteroids, in the treatment of nonarteritic anterior ischemic optic neuropathy. The highest priority in management is to rule-out giant cell arteritis. SUMMARY: Effective therapies for the treatment of ischemic events of the retina and optic nerve remain elusive. Clinicians should focus on the prompt recognition of these events as ocular emergencies and immediately refer patients with vascular transient visual loss and acute central and branch retinal arterial occlusions to the nearest stroke center.


Assuntos
Cegueira/etiologia , Neuropatia Óptica Isquêmica/diagnóstico , Oclusão da Artéria Retiniana/diagnóstico , Humanos , Nervo Óptico , Neuropatia Óptica Isquêmica/complicações , Neuropatia Óptica Isquêmica/terapia , Retina , Oclusão da Artéria Retiniana/complicações , Oclusão da Artéria Retiniana/terapia
17.
Retin Cases Brief Rep ; 13(1): 75-78, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-28085758

RESUMO

PURPOSE: To report a patient with central retinal artery occlusion with double cilioretinal artery sparing. METHODS: Retrospective case report. RESULTS: A 45-year-old woman presented with sudden vision loss in her left eye for 10 days. Her best-corrected visual acuity was counting fingers at 2 meters in the left eye and 20/20 in the right eye. Funduscopy showed retinal opacity of posterior fundus, most marked in the macular region, and two small areas of the normal retina; one temporal to the optic disk and the other superior to the optic disk corresponding to the patent cilioretinal retinal arteries in the left eye; the right eye was normal. Fundus fluorescein angiography showed rapid filling of the two cilioretinal vessels and delayed filling of the central retinal artery at initial and last visits. Spectral domain optical coherence tomography findings disclosed diffuse thickening of the neurosensory retina in the perifoveolar area except two small areas at the first visit. After 6 months, spectral domain optical coherence tomography revealed diffuse thinning of the neurosensory retina except two small areas of the retina fed from two patent cilioretinal arteries. CONCLUSION: In this report, we documented double cilioretinal artery sparing in a patient with central retinal artery occlusion. It seems that a second cilioretinal artery can be present in some patients with central retinal artery occlusion.


Assuntos
Artérias Ciliares/anormalidades , Angiofluoresceinografia/métodos , Oclusão da Artéria Retiniana/diagnóstico , Artéria Retiniana/anormalidades , Tomografia de Coerência Óptica/métodos , Malformações Vasculares/complicações , Artérias Ciliares/diagnóstico por imagem , Feminino , Fundo de Olho , Humanos , Pessoa de Meia-Idade , Oftalmoscopia , Artéria Retiniana/diagnóstico por imagem , Oclusão da Artéria Retiniana/etiologia , Malformações Vasculares/diagnóstico
18.
Ophthalmic Plast Reconstr Surg ; 35(3): 227-231, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30198965

RESUMO

PURPOSE: This study aimed to evaluate the effects of retinal artery occlusions caused by cosmetic facial filler injections on the retrobulbar blood flow parameters. METHODS: This was a retrospective, noncomparative case series. Ten consecutive patients with fundus artery occlusions caused by facial filler injections were evaluated using color Doppler flow imaging (CDFI). The peak systolic velocity and end diastolic velocity of the ophthalmic artery, central retinal artery, and posterior ciliary arteries were determined. The clinical features, including the filler material, injection site, best-corrected visual acuity, fundus fluorescein angiography, and associated ocular and systemic manifestations were also collected. RESULTS: Injected materials included autologous fat (7 cases) and hyaluronic acid (3 cases). In 6 of the patients with ophthalmic artery occlusions, the CDFI showed no or drastic declines in the retrobulbar blood flow in the ophthalmic artery, central retinal artery, and posterior ciliary arteries. In 3 of the patients with central retinal artery occlusions, the CDFI showed no or a grossly decreased retrobulbar blood flow in the central retinal artery. In one patient with anterior ischemic optic neuropathy, the CDFI showed decreased end diastolic velocities and increased pulsatility and resistance indices in the central retinal artery, posterior ciliary arteries, and ophthalmic artery. During the follow-up period, the retrobulbar blood flow recovered to some degree. Overall, ophthalmic artery occlusion patients receiving autologous fat may have neurologic complications. CONCLUSIONS: The results suggest that the retrobulbar ocular blood flows measured with CDFI were distinctly different in the different types of ophthalmic artery occlusion. Color Doppler flow imaging could provide a practicable and convenient method for the diagnosis and follow up of retinal artery occlusions caused by cosmetic facial filler injections.


Assuntos
Ácido Hialurônico/efeitos adversos , Artéria Oftálmica/diagnóstico por imagem , Fluxo Sanguíneo Regional/fisiologia , Oclusão da Artéria Retiniana/diagnóstico , Artéria Retiniana/diagnóstico por imagem , Ritidoplastia/efeitos adversos , Ultrassonografia Doppler em Cores/métodos , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Ácido Hialurônico/administração & dosagem , Injeções , Pessoa de Meia-Idade , Artéria Oftálmica/fisiopatologia , Reprodutibilidade dos Testes , Artéria Retiniana/fisiopatologia , Oclusão da Artéria Retiniana/induzido quimicamente , Estudos Retrospectivos , Viscossuplementos/administração & dosagem , Viscossuplementos/efeitos adversos , Acuidade Visual , Adulto Jovem
20.
BMJ Case Rep ; 20182018 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-30420561

RESUMO

A 23-year-old woman with history of systemic lupus erythematous presented with dizziness and headache and was admitted for the stroke workup. During her stay, she had sudden painless loss of vision in her right eye consistent with central retinal artery occlusion (CRAO). Ocular massage and paracentesis were attempted without success to resume the flow. She was started on oral high-dose steroids (1 mg/kg) for lupus flare and therapeutic anticoagulation for antiphospholipid syndrome (positive for anticardiolipin and beta-2 microglobulin antibodies). On day 4, she started having painful bluish discoloration of her left index finger and right fifth toe, and on day 5 she had acute onset of left blurry vision with findings consistent with CRAO. She fulfilled the criteria of catastrophic antiphospholipid syndrome and was started on intravenous pulse steroids, plasmapheresis and higher international normalised ratio goal of 3-3.5 with improvement in her left eye vision from 20/200 to 20/20 on near card test by the end of treatment.


Assuntos
Síndrome Antifosfolipídica/etiologia , Lúpus Eritematoso Sistêmico/complicações , Oclusão da Artéria Retiniana/etiologia , Corticosteroides/uso terapêutico , Adulto , Anticoagulantes/uso terapêutico , Síndrome Antifosfolipídica/diagnóstico , Síndrome Antifosfolipídica/terapia , Diagnóstico Diferencial , Feminino , Humanos , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Plasmaferese , Oclusão da Artéria Retiniana/diagnóstico , Oclusão da Artéria Retiniana/terapia , Transtornos da Visão , Adulto Jovem
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