Branch retinal artery occlusion during a migraine attack

A 60‐year‐old male with a history of migraine presented with evidence of branch retinal arterial occlusion that developed at the time of an attack of retinal migraine. The diagnosis of branch arterial occlusion secondary to migraine was made after exclusion of numerous possible medical conditions. The possible role of vasospasm in this condition is discussed.     

Branch retinal artery occlusion secondary to dengue fever

Dengue is known to affect the posterior segment of the eye, with a range of hemorrhagic and inflammatory sequelae. A 28-year-old lady convalescing from dengue fever complained of unilateral blurring of inferior visual field. She was evaluated clinically and with fluorescein angiography. Her best-corrected visual acuity was 20/20 bilaterally. Fundus examination revealed a branch retinal artery occlusion in the right eye. Fluorescein angiogram confirmed the clinical diagnosis; and also revealed a late staining and leakage from the affected arterial segment. The patient maintained status quo over a follow-up of six months. We report a major vascular occlusion complicating classic dengue fever even in the absence of severe systemic manifestations.     

视网膜动脉阻塞治疗的新希望

视网膜动脉阻塞是眼科的急症。早期恢复循环,有可能恢复视力。一些传统治疗方法的确切效果尚存在争议。近年来出现的导管技术联合局部溶栓药物动脉内注射、Nd:YAG激光击栓术、手术探通视网膜中央动脉等新的治疗手段给视网膜动脉阻塞的治疗带来了新的希望与挑战。这些方法的有效性有待于大样本的前瞻性临床试验来验证。     

Combined central retinal artery and vein occlusion in a child with systemic non-Hodgkin's lymphoma

Purpose: To report on a case of systemic non-Hodgkin's lymphoma and unilateral combined central retinal artery and vein occlusion. Method: We examined a 14-year-old boy who experienced a sudden unilateral visual loss five months after the initial diagnosis of systemic non-Hodgkin's lymphoma. Result: Visual loss was due to combined central retinal artery and vein occlusion in association with tumoral optic nerve involvement. Conclusion: Alhough very rare systemic non-Hodgkin's lymphoma may present with central retinal artery and vein occlusion prior to overt central nervous system involvement. This revised version was published online in July 2006 with corrections to the Cover Date.     

Hemi-central retinal artery occlusion in young adults

Amongst the clinical presentations of retinal artery occlusion, hemi-central retinal artery occlusion (Hemi-CRAO) is rarely described. This case series of four adults aged between 22 and 36 years attempts to describe the clinical profile, etiology and management of Hemi-CRAO. Case 1 had an artificial mitral valve implant. Polycythemia and malignant hypertension were noted in Case 2. The third patient had Leiden mutation while the fourth patient had Eisenmenger’s syndrome. Clinical examination and fundus fluorescein angiography revealed a bifurcated central retinal artery at emergence from the optic nerve head, in all cases. Color Doppler examination of the central retinal artery confirmed branching of the artery behind the lamina cribrosa. It is hypothesized that bifurcation of central retinal artery behind the lamina cribrosa may predispose these hemi-trunks to develop an acute occlusion if associated with underlying risk factors. The prognosis depends upon arterial recanalisation and etiology of the thromboembolic event.     

Pathogenetic mechanisms in combined cilioretinal artery and retinal vein occlusion: a reappraisal

We examined nine patients who presented cilioretinal artery occlusion (CLRAO) associated with retinal vein occlusion (RVO). CLRAO was probably secondary to the raised intraluminal resistance consequent to the RVO in patients showing initially a delayed filling of the cilioretinal artery in fluorescein angiography. Interestingly, these patients presented an ophthalmoscopically more severe form of RVO and had systemic predisposing factors for a RVO. In patients presenting a physiological perfusion of the cilioretinal artery in fluorescein angiography, RVO was a self limited disease and etiologic factors were not found. This may suggest that in these patients the CLRAO probably occurred simultaneously with the RVO after a decrease in perfusion pressure in both retinal and cilioretinal arterial systems. In this combined vaso-occlusive retinopathy the vulnerability of cilioretinal arteries can be explained either by the absence of autoregulation or by their lower perfusion pressure gradient in comparison with retinal arteries.     

视网膜动脉阻塞治疗现状

视网膜动脉阻塞常造成严重的不可逆性视力损伤。临床常采用保守型综合治疗,包括眼球按摩、前房穿刺、血管活性药物及降眼压治疗等。研究表明此类治疗难能有效改善患者视力,部分治疗可能对患者有害。激进型治疗包括动静脉溶栓、手术及YAG激光治疗,研究显示均具有一定治疗效果,以溶栓治疗为主,但存在各种并发症。中药治疗仍需进行临床试验评估。科学评估视网膜动脉阻塞患者病情,为患者适时选取最适治疗以达最佳治疗效果仍是未来的研究目标。     

Unilateral retinal vasculitis,branch retinal artery occlusion and subsequent retinal neovascularization in Crohn's disease

Purpose: To report on a case of Crohn's disease and unilateral retinal vasculitis, branch retinal artery occlusion and subsequent retinal neovascularization. Methods: We examined a 38-year-old woman with severe left visual loss and biopsy-proven Crohn's disease diagnosed four years prior to the ocular involvement. A Heidelberg scanning laser ophthalmoscope was used for fundus fluorescein angiography and indocyanine green angiography. Retinal neovascularization was detected during the follow-up. Results: Successful regression of retinal neovascularization was achieved after argon green laserpanretinal photocoagulation in addition to oral steroid and salazopyrine. Conclusion: Retinal vascular involvement is a rare ocular feature of Crohn's disease and may result in retinal neovascularization that may necessitate prompt laser photocoagulation.     

创伤性视网膜中央动脉阻塞1例报告

本文报告1例钝器眼伤后出现的视网膜中央动脉阻塞,这种病症比较稀少,文献报告中也不多见。视网膜中央动脉阻塞尽管少见但对视力影响非常大,在对急性创伤性视力减退进行鉴别诊断时应考虑到这种情况。     

Transcorneal electrical stimulation of retina to treat longstanding retinal artery occlusion

Purpose To report the outcome of transcorneal electrical stimulation (TES) of the visual system on long-standing retinal artery occlusion (RAO). Design Open labeled, case series. Patients and methods Two patients with central RAO (15 and 33 months respectively) and one with branch RAO (26 months) underwent TES therapy. Subjective and objective ophthalmological evaluations were performed before and after the TES. The ages of the patients were 38, 49, and 63 years. The TES (20 Hz biphasic pulses, 30 minutes, up to 1100 uA) was delivered by a bipolar contact lens electrode once a month for 3 months. Perimetric and/or electrophysiological examinations were performed as outcome measures. Results The visual acuity improved by more than 0.2 logMAR units in two cases, and the visual fields were improved in all three cases. The multifocal ERGs which had been reduced in the loci corresponding to the ischemic retinal area were improved after the treatment in two cases. Neither ocular nor systemic adverse effects were observed except for transient superficial keratitis. Conclusions TES of the retina can improve retinal function in eyes with long-standing RAOs. None of the authors have any financial or proprietary interest in any material or methods mentioned. This study was supported by Researches on Sensory and Communicative Disorders from the Ministry of Health, Labor, and Welfare, Japan.     

Bilateral arteritic central retinal artery occlusion in a Chinese patient

Purpose: To report the first case of bilateral central retinal artery occlusion caused by giant cell arteritis in a Chinese patient
Methods: We studied a Chinese patient who had a history of weight loss, calf claudication and sequential right and left central retinal artery occlusion.
Results: The erythrocyte sedimentation rate was greater than 150 mm/h. Temporal artery biopsy confirmed the diagnosis of giant cell arteritis. Systemic steroid prevented further visual loss in the second eye.
Conclusions: We believe that this is the first report in literature on the ophthalmological presentation of giant cell arteritis in a Chinese patient Giant cell arteritis as a cause of central retinal artery occlusion should always be on the list of differential diagnosis, as early diagnosis and treatment may help to salvage the first eye and prevent blindness from developing in the second eye.     

Combined central retinal vein and cilioretinal artery occlusion

We present a case of combined central retinal vein and cilioretinal artery occlusion which, due to the absence of the temporal branch retinal artery, was initially misdiagnosed as a combined central retinal vein occlusion and temporal branch retinal artery occlusion. Given that – in contrast to cases of combined central artery and central retinal vein occlusion – the prognosis for cilioretinal artery occlusion with central retinal vein occlusion is quite good, this case illustrates the importance of suspecting an unusual condition in the presence of a combined occlusion.     

吗来酸桂哌奇特治疗视网膜中央动脉阻塞的疗效观察

目的 探讨吗来酸桂哌奇特治疗视网膜中央动脉阻塞(CRVO)的疗效.方法 64例CRAO患者随机(随机数字表)分成2组.对照组:给予吸氧、降眼压及扩张血管等常规治疗;实验组除上述治疗外,加用吗来酸桂哌奇特240 mg静脉滴注,每日1次,14 d.记录治疗前及治疗3个月后患者的最佳矫正视力、视觉电生理oPS波、荧光素眼底血管造影(FFA)动脉充盈时间.结果 实验组和对照组的视觉电生理oPS波,FFA的动脉充盈时间,治疗后比治疗前均有改善且有统计学差异(P＜0.05).治疗有效病例数实验组、对照组分别为(28例,18例),临床有效率分别为(82.35％,56.25％),实验组比对照组高且有统计学差异(P＜0.05).结论 吗来酸桂哌奇特治疗视网膜CRAO安全且有较好的临床疗效.     

视网膜动脉阻塞传统疗法与新疗法的应用现状

视网膜动脉阻塞(retinal artery occlusion,RAO)是眼科中的一种急症、重症,视力预后较差,致盲率高。有研究表明视网膜组织在缺血缺氧后90min左右可发生不可逆的损害。因此发病后及早就诊、明确诊断、合理治疗及采用先进治疗技术是成功抢救视力的关键。近年来,随着国内外临床实践的研究,出现了许多新的治疗技术,在临床治疗中与传统方法结合发挥了巨大作用,在很大程度上挽救了患者的视力。现我们就临床中出现的视网膜动脉阻塞新治疗技术及与传统方法结合的应用作一综述。     

超选择眼动脉溶栓介入治疗视网膜中央动脉阻塞

目的评价超选择动脉介入溶栓治疗视网膜中央动脉阻塞的初步疗效。设计回顾性病例系列。研究对象21例(21眼)视网膜中央动脉阻塞患者。主要指标视力及手术并发症。方法经检眼镜检查及荧光素眼底血管造影检查证实为视网膜中央动脉阻塞患者21例,通过Seldinger技术经微导管超选择眼动脉推注尿激酶溶栓治疗。结果21例患者中10例经超选颈内动脉造影显示眼动脉主干狭窄和阻塞,11例眼动脉主干显影,全部患者均成功进行了溶栓治疗。溶栓治疗前、治疗后3天视网膜中央动脉显影时间分别为(38.18±10.86)秒、(12.65±3.30)秒(t=-11.89,P=0.000)。平均随访(3.23±1.26)个月。治疗后4例患者视力>0.25,9例视力不同程度改善,8例视力无变化。结论超选择眼动脉溶栓介入治疗视网膜动脉阻塞可改善患者视力,但需迅速完成内科、神经科及眼科诊断.尽快治疗。     

Central retinal artery occlusion. Retinal survival time

PURPOSE: To investigate the retinal survival time following central retinal artery occlusion (CRAO). METHODS: In 38 elderly, atherosclerotic and hypertensive rhesus monkeys, transient CRAO (varying from 97 to 240 min) was produced by temporarily clamping the CRA at its site of entry into the optic nerve. Stereoscopic color fundus photography, fluorescein fundus angiography, electroretinography (ERG), and visual evoked potential (VEP) recording were performed before and during CRA clamping, after unclamping, and serially thereafter. After unclamping of the CRA, the animals were followed for variable lengths of time (median duration 8.14 weeks). Finally, the eyes and optic nerves were examined histologically. The data on ERG changes were analyzed in the following four time frames: (1) baseline before CRA clamping, (2) during CRA clamping, (3) immediately after unclamping, and (4) at the end of follow-up. Duration of CRAO was divided into four groups: 97, 105-120, 150-165, and > or = 180 min. RESULTS: A 'negative ERG' appeared during CRA clamping. With removal of the CRA clamp, there was b-wave recovery, with differential rates of recovery of ERG-eyes with shorter CRAO recovered sooner than those with longer occlusion. On removal of clamp, recovery was seen in scotopic 24 dB b-wave, photopic 0 dB single flash b-wave and 30 Hz flicker, with the b/a ratio of the combined rod and cone response and selective rod response showing statistically significant differences amongst the shorter and longer periods of CRAO. A delayed normalization of the depressed b/a ratio immediately after CRA reperfusion may indicate high-grade ischemic damage. At the final follow-up test session, no clear-cut derangement of any ERG parameter was seen for any group, with subtotal b-wave amplitude recovery for all groups. Longer CRAO produced incomplete VEP recovery. On histology, in the macular retina, eyes with CRAO for 97 min showed practically no damage, but duration of CRAO was found to be significantly associated with the amount of damage in the ganglion cell layer (p = 0.009) and inner nuclear layer (p = 0.017). Outer nuclear and plexiform layers and photoreceptors showed no damage at all with CRAO. There was no significant association of the ERG measures and histologic changes with any of the residual retinal circulation variables. CONCLUSIONS: Our electrophysiologic, histopathologic and morphometric studies showed that the retina of old, atherosclerotic, hypertensive rhesus monkeys suffers no detectable damage with CRAO of 97 min but above that level, the longer the CRAO, the more extensive the irreversible damage. The study suggests that CRAO lasting for about 240 min results in massive irreversible retinal damage.     

白内障超声乳化吸出术后视网膜中央动脉阻塞风险因素分析

目的　探讨白内障超声乳化吸出术后发生视网膜中央动脉阻塞（ｃｅｎｔｒａｌｒｅｔｉｎａｌａｒｔｅｒｙｏｃｃｌｕｓｉｏｎ,ＣＲＡＯ）的风险因素及相关预后情况。方法　本研究为病例对照研究。收集２００９年１月至２０１５年１２月在郑州大学第二附属医院眼科行白内障超声乳化吸出术的连续病例８３６５例,纳入７２８３例（９１００眼）,统计ＣＲＡＯ例数７例（即ＣＲＡＯ组）,利用随机数列法,以１８比例在纳入病例中随机选取５６例（５６眼）作为对照组,若入选者为ＣＲＡＯ患者则剔除,继续选择。统计白内障核硬度、术前最佳矫正视力、眼压、麻醉方式、术中后囊膜破裂情况、全身疾病等,采用Ｆｉｓｈｅｒ确切概率法、ｔ检验、Ｌｏｇｉｓｔｉｃ回归等统计学方法分析ＣＲＡＯ的风险因素。结果　球后麻醉（风险比３．３０７,Ｐ＝０．０１２）、后囊膜破裂（风险比４．２８７,Ｐ＝０．０３４）是术后ＣＲＡＯ发生的危险因素,高血压、颈动脉斑块患者ＣＲＡＯ发生率与对照组相比差异均有统计学意义（均为Ｐ＜０．０１）,是危险因素。而术前最佳矫正视力（≤０．０１）、高度近视、青光眼病史、糖尿病病史等差异对于ＣＲＡＯ发生并无统计学意义（均为Ｐ＞０．０５）。结论　高血压、颈动脉斑块、球后麻醉及后囊膜破裂均为白内障超声乳化吸出术后ＣＲＡＯ发生的危险因素。