Lima-Gómez V, Rojas-Dosal JA

Language: Spanish
References: 18
Page: 207-212
PDF size: 139.04 Kb.

ABSTRACT

Clinical case: We present a case study of a patient with sudden visual loss, who had 20/200 visual acuity and macular edema at initial evaluation. Angiographies showed no interruption of vascular flow and in the visual field a central island of vision in the inferior hemifield was identified, surrounded by absolute scotoma.
Discussion: Clinical aspect at the initial evaluation required a differential diagnosis between retinal and neural disease. The clinical approach used to integrate the restrospective diagnosis of central retinal artery occlusion is presented, and an explanation is proposed for the visual recovery after 4 months of visual loss (20/20 visual acuity).
Conclusions: Central retinal artery occlusion is a clinical diagnosis, but anatomical variants may modify the prognosis. Although the diagnosis of central retinal artery occlusion may be clinically evident, an angiography is required to evaluate the type of treatment to be instituted and to determine prognosis.

REFERENCES

1. 1. Ryan SJ. Retina. St Louis: Mosby; 2001.

2. 2. Pavan-Langston D. Manual of Ocular Diagnosis and Therapy. Philadelphia: Lippincott Williams and Wilkins; 2002.

3. 3. American Academy of Ophthalmology. Basic and Clinical Science Course. Section 12, Retina and Vitreous. San Francisco: American Academy of Ophthalmology; 2004.

4. 4. Beatty S, Au Eong KG. Acute occlusion of the retinal arteries: current concepts and recent advances in diagnosis and management. J Accid Emerg Med 2000;17:324:329.

5. 5. Wijman CAC, Gomez JA, Winter MR, Koleini B, Matjucha ICA, Pochay VE, et al. Symptomatic and asymptomatic retinal embolism have different mechanisms. Stroke 2004;35:e100-e102.

6. 6. Schmidt DP, Schulte Möntig J, Schumacher M. Prognosis of central retinal artery occlusion: local intraarterial fibrinolysis versus conservative treatment. Am J Neuroradiol 2002;23:1301-1307.

7. 7. Arnold M, Koerner U, Remonda L, Nedeltchev K, Mattle HP, Schroth G, et al. Comparison of intra-arterial thrombolysis with conventional treatment in patients with central retinal artery occlusion. J Neurol Neurosurg Psychiatry 2005;76:196-199.

8. 8. Augsburger JJ, Magargal LE. Visual prognosis following treatment of acute central retinal artery obstruction. Br J Ophthalmol 1980;64:913-917.

9. 9. Mueller AJ, Neubauer AS, Schaller U, Kampik A. Evaluation of minimally invasive therapies and rationale for a prospective randomized trial to evaluate selective intra-arterial lysis for clinically complete central retinal artery occlusion. Arch Ophthalmol 2003;121:1377-1381.

10. 10. Prado-Serrano A, De Obaldía-Faruggia I. Neovascularización de la papila secundaria a la oclusión de la arteria central de la retina en un sujeto con enfermedad carotídea. Presentación de un caso. Rev Mex Oftalmol 2004;78:33-36.

11. 11. Glaser JS. Neuro-ophthalmology. Philadelphia: Lippincott Williams and Wilkins; 1999.

12. 12. American Academy of Ophthalmology. Basic and Clinical Science Course. Section 5, Neuro-ophthalmology. San Francisco: American Academy of Ophthalmology; 1997.

13. 13. Sharma S, Brown M, Brown GC. Retinal artery occlusions. Ophthalmol Clin North Am 1998;11:591-600.

14. 14. Junk ZK, Rosenbaum PS, Engel HM, Rosenbaum DM. Visual recovery after central retinal artery occlusion (CRAO) – A new pathophysiologic approach to the clinical entity of partial CRAO. Invest Ophthalmol Vis Sci 2003;44:E-Abstract 4055.

15. 15. Hayreh SS, Zimmermann M. Central retinal artery occlusion: visual outcome. Am J Ophthalmol 2005;140:376-391.

16. 16. Opremcak EM, Benner JD. Translumenal Nd:Yag laser embolysis for branch retinal artery occlusion. Retina 2002;22:213-216.

17. 17. Reynard M, Hanscom TA. Neodymium: yttrium.aluminum-garnett laser arteriotomy with embolectomy for central retinal artery occlusion. Am J Ophthalmol 2004;137:196-198.

18. 18. Feist RM, Emond TK. Translumenal ND: YAG laser embolysis for central retinal artery occlusion. Retina 2005;25:797-799.