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Lauren Murphy, Gerard Carroll
A 25-year-old male patient presented to the emergency department with the chief complaint of sudden blindness and was found to have suffered bilateral central retinal artery occlusion (CRAO). This process is most commonly the result of a thrombus or embolus that occludes the retinal artery, and normally presents in a single eye in patients older than 65 who are predisposed to vascular disease. Diagnosis relies most heavily upon funduscopic exam. Potential treatments involve ocular massage, acetazolamide, anterior chamber paracentesis and systemic or local fibrinolysis...
March 6, 2018: American Journal of Emergency Medicine
Paul S Page, Nicolas K Khattar, Andrew C White, Alexander C Cambon, Guy N Brock, Shesh N Rai, Robert F James
Background and purpose: Acute central retinal artery occlusion (CRAO) is a serious ophthalmologic emergency that may result in monocular blindness. To date, studies evaluating intra-arterial thrombolysis (IAT) have not shown a definitive clinical benefit. We have conducted a systematic review with a meta-analysis to effectively evaluate this treatment option. Methods: A systematic literature search was focused on studies containing five or more patients undergoing IAT that included a control group treated with standard therapy...
2018: Frontiers in Neurology
Razek Georges Coussa, Andre Ali-Ridha, Natalia Vila, Rayan Alshareef, John Chen
Purpose: To describe a case of Crohn disease presenting as occlusive vasculitis resulting in a central retinal artery occlusion (CRAO) in one eye and transient ischemic optic neuropathy in the fellow eye. Observations: An 18-year-old patient recently diagnosed with biopsy-proven Crohn disease presented with CRAO OD after a previous episode of transient visual loss OS. Extensive workup was negative for other autoimmune or infectious etiologies. The patient was started on intravenous methylprednisolone for 72 h followed by maintenance dose of azathioprine and oral prednisone...
April 2017: American Journal of Ophthalmology Case Reports
Norihiko Ishizaki, Teruyo Kida, Masanori Fukumoto, Takaki Sato, Hidehiro Oku, Tsunehiko Ikeda
BACKGROUND: To describe a retrospective study of macular retinoschisis that developed long after the onset of retinal artery occlusion (RAO) using optical coherence tomography (OCT). METHODS: We describe changes in macular findings and visual acuity (VA) of 29 patients (21 males and 8 females, mean age: 66.1 ± 16.9 years) with RAO (18 branch RAOs [BRAOs] and 11 central RAOs [CRAOs] who visited Osaka Medical College Hospital over an 8-year period based on a medical chart review...
February 27, 2018: BMC Ophthalmology
Abdallah A Ellabban, Ajay D Patil, Mark T Costen, Atiq R Babar
Purpose: To describe a patient with acute central retinal artery occlusion (CRAO) during vitrectomy surgery and the possible role of vitrectomy in acute CRAO management. Observations: An 84-year-old man presented with broad vitreomacular traction and epiretinal membrane in the right eye. Preoperative assessment clearly showed normal retinal vasculature. On starting vitrectomy, complete CRAO with marked segmentation of all retinal vessels was noted. Vitrectomy was performed in the usual manner and once the posterior hyaloid detached from the disc, immediate complete revascularization of the retinal vessels was noted...
March 2018: American Journal of Ophthalmology Case Reports
Yi-Chun Chen, Hsiu-Mei Wu, Shin-Jen Chen, Han-Jui Lee, Jiing-Feng Lirng, Chung-Jung Lin, Feng-Chi Chang, Chao-Bao Luo, Wan-Yuo Guo
Cosmetic facial filler-related central retinal artery occlusion (CRAO) is a devastating complication of facial hyaluronic acid (HA) injection and can be managed by intra-arterial thrombolytic therapy (IATT). The authors report on a 20-year-old woman who developed unilateral CRAO due to facial HA injection and who, despite prompt IATT, lost vision. A review of the related literature found 14 other female patients who developed cosmetic facial filler-related CRAO and accepted IATT management. In no case was vision loss clinically improved...
January 29, 2018: Facial Plastic Surgery: FPS
Lucy Y Zhang, Jason Zhang, Richard K Kim, Jared L Matthews, Danielle S Rudich, David M Greer, Robert L Lesser, Hardik Amin
BACKGROUND: To evaluate the risk of concurrent acute ischemic stroke and monocular vision loss (MVL) of vascular etiology. DESIGN: Retrospective, cross-sectional study. SUBJECTS: Patients aged 18 or older diagnosed with MVL of suspected or confirmed vascular etiology who had no other neurologic deficits and who received brain MRI within 7 days of onset of visual symptoms were included. METHODS: A medical record review was performed from 2013 to 2016 at Yale New Haven Hospital...
January 22, 2018: Journal of Neuro-ophthalmology: the Official Journal of the North American Neuro-Ophthalmology Society
Kazuaki Kadonosono, Shin Yamane, Maiko Inoue, Tadashi Yamakawa, Eiichi Uchio
Central retinal artery occlusion (CRAO) is a severe disease, often causing blindness. We evaluated the efficacy and safety of a surgical procedure for the treatment of acute CRAO in which retinal arterial cannulation with tissue plasminogen activator (tPA) is performed. The surgical procedure consisted of vitrectomy followed by cannulation of the central retinal artery and injection of tPA (200 μg) using a 47-gauge microneedle. Thirteen CRAO patients were treated within 48 hours of the onset of symptoms...
January 22, 2018: Scientific Reports
Teddy S Youn, Patrick Lavin, Morgan Patrylo, Joseph Schindler, Howard Kirshner, David M Greer, Matthew Schrag
BACKGROUND: Central retinal artery occlusion (CRAO) is an ophthalmological emergency, the retinal analog of a stroke. To date there is no consensus or national guidelines on how this disorder should be managed. As academic neurologists and ophthalmologists treat CRAO frequently, we set out to understand how these clinicians approach patients with CRAO with a national survey. METHODS: We identified university-associated teaching hospitals offering vascular neurology, neuro-ophthalmology and/or retina fellowships in the US and asked the directors of the programs to respond to questions in an open response format to profile the acute management of CRAO at their institution...
February 2018: Journal of Neurology
Jorge Luiz Amorim Correa, Marcus André Acioly
BACKGROUND: Perioperative visual loss after spinal surgery is a devastating complication for the patient and the surgical team. Two known major causes are ischemic optic neuropathy and central retinal artery occlusion (CRAO). Traditional understanding of CRAO has been consistently related to occurrence of periocular trauma and signs of increased intraorbital pressure in addition to visual loss. However, such orbital signs are not a feature of any common perioperative visual loss syndrome...
February 2018: World Neurosurgery
Reema Bansal, Ramandeep Singh, Aastha Takkar, Vivek Lal
A 15-year-old healthy boy developed acute, rapidly progressing visual loss in left eye following herpes zoster dermatitis, with a combined central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO), along with optic perineuritis. Laboratory tests were negative. Despite an empirical, intensive antiviral treatment with systemic corticosteroids, and vision could not be restored in the affected eye. Herpes zoster dermatitis, in an immunocompetent individual, may be associated with a combined CRAO and CRVO along with optic perineuritis, leading to profound visual loss...
November 2017: Indian Journal of Ophthalmology
Philip J DeSouza, Claudia G Hooten, Christopher M Lack, Vishak J John, Timothy J Martin
BACKGROUND: Leukemic infiltration of the optic nerve is relatively rare. While previously described in acute leukemia, the infiltration in our case represents central nervous system (CNS) metastasis of Burkitt-type lymphoma that developed as a complication of solid-organ transplantation, resulting in a bilateral infiltrative optic neuropathy with sequential, bilateral central retinal artery occlusion (CRAO) and devastating vision loss. METHODS: The medical record, serial ophthalmic examination findings, clinical course, and imaging including magnetic resonance imaging (MRI), fundus photographs, and fluorescein angiography of a single patient were retrospectively reviewed...
September 2017: Ocular Oncology and Pathology
A Degoumois, S Miocque, E Denion
INTRODUCTION: The prevalence and etiology of neovascular glaucoma (NVG) as a complication of central retinal artery occlusion (CRAO) is a debated issue. According to some authors, NVG associated with CRAO always involves underlying chronic ocular ischemic syndrome (COIS) as a primum movens for CRAO. However, we describe 5 cases of NVG following CRAO with no underlying COIS, confirmed by carotid Doppler studies and ultrasound color Doppler imaging (USCDI) of the ophthalmic artery (OA)...
November 2017: Journal Français D'ophtalmologie
Nitish Mehta, Rosa Dolz Marco, Raquel Goldhardt, Yasha Modi
PURPOSE OF REVIEW: This review will seek to answer if advances in ophthalmic imaging and evolution of treatment modalities have shed further light on the epidemiology, pathophysiology, diagnosis, and acute management of acute CRAO. RECENT FINDINGS: Imaging characteristics of acute CRAO have been further characterized with the use of fluorescein angiography, optical coherence tomography (OCT), OCT-angiography, and indocyanine-green angiography. Layer segmentation of OCT imaging has found inner retinal layer hyper-reflectivity to be a common finding in acute CRAO...
June 2017: Current Ophthalmology Reports
M Akhlaghi, B Abtahi-Naeini, M Pourazizi
Presentation of a combination of branch retinal artery occlusion (BRAO)/central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO) in systemic lupus erythematosus (SLE) is extremely rare. Herein, we have presented the case of a 29-year-old female with SLE, who simultaneously developed bilateral CRVO and BRAO/CRAO in the absence of antiphospholipid syndrome (APS) as a catastrophic form of clinical flare. A combinatorial diagnosis of CRVO and BRAO/CRAO should be considered during clinical flare-up in a patient with SLE who presents with rapidly progressive visual loss...
January 1, 2017: Lupus
Vitaly Man, Idan Hecht, Michal Talitman, Assaf Hilely, Mohamad Midlij, Zvia Burgansky-Eliash, Asaf Achiron
AIMS: To review clinical experience, efficacy, and safety of transluminal Nd:YAG laser embolectomy/embolysis (TYE) for retinal artery occlusion. METHODS:  Electronic databases were searched for all published clinical studies and case-reports reporting on TYE in central (CRAO) or branch (BRAO) retinal artery occlusion. Individual patient data was evaluated in a weighted pooled analysis. RESULTS: Sixty-one cases were reported, 47 with BRAO and 14 with CRAO...
October 2017: Graefe's Archive for Clinical and Experimental Ophthalmology
Charlotte Fischer, Anne Bruggemann, Annette Hager, Josep Callizo Planas, Johann Roider, Hans Hoerauf
BACKGROUND: Ocular vascular occlusions following intraocular procedures are a rare complication. We report a case series of patients with retinal vascular occlusions or anterior ischemic optic neuropathy (AION) after anterior and posterior segment surgery and demonstrate possible risk factors. METHODS: Observational case series. RESULTS: In ten patients, vascular occlusions were observed within ten weeks after intraocular surgery: branch retinal arterial occlusion (BRAO) (n = 2), central retinal artery occlusion (CRAO) (n = 2), central retinal vein occlusion (CRVO) (n = 1), branch retinal vein occlusion (BRVO) (n = 1), anterior ischemic optic neuropathy (AION) (n = 3), and combined central artery and vein occlusion (n = 1)...
2017: Journal of Ophthalmology
S Schnichels, M Blak, J Hurst, T Dorfi, K U Bartz-Schmidt, F Ziemssen, M S Spitzer, M Schultheiss
Hypoxia plays an important role in several retinal diseases, especially in central retinal artery occlusion (CRAO). Although CRAO has been known for over a hundred years, no cure or sufficient treatment is available. Potential therapies are being evaluated in several in vivo models or primary cultures. However, in vivo models or primary cultures are very time-consuming, expensive, and furthermore several therapies or agents cannot be tested. Therefore, we aimed to develop a standardized organotypic ex vivo retinal hypoxia model...
July 15, 2017: Biology Open
Oana M Dumitrascu, Joanne F Shen, Madhavi Kurli, Maria I Aguilar, Lisa A Marks, Bart M Demaerschalk, Dean M Wingerchuk, Cumara B O'Carroll
BACKGROUND: Central retinal artery occlusion (CRAO) is a neurological and ophthalmologic emergency associated with poor visual recovery. There is a dilemma regarding the appropriate treatment, as formal guidelines are lacking. Despite being considered an ocular equivalent of cerebral infarction, the time window of intravenous (IV) thrombolysis administration for maximum efficacy and safety in CRAO remains uncertain. OBJECTIVE: To critically assess the current evidence regarding the safety and effectiveness of IV thrombolysis in the treatment of patients with CRAO...
July 2017: Neurologist
Satya Karna, Mukesh Jain, Md Shahid Alam, Bipasha Mukherjee, Rajiv Raman
Objectives: To report a rare occurrence combination of central retinal artery occlusion (CRAO) and Terson syndrome in a Barrow's type A carotid cavernous fistula (CCF) patient. Methods: Observational case report. Results: A twenty-year-old male patient with a history of road traffic accident presented with periorbital swelling and redness in the left eye. Examination revealed a CRAO with intraretinal and preretinal hemorrhages. On imaging, type A CCF and subarachnoid hemorrhage were detected. He underwent embolization of the fistula for cosmetic blemish...
2017: GMS Ophthalmology Cases
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