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At least 73 records · Page 4Linked to original sources
PubMed1997

Transthoracic echocardiography in young patients with acute retinal arterial obstruction. RECO Study Group. Retinal Emboli of Cardiac Origin Group.

OBJECTIVE: To report the transthoracic echocardiographic findings in young patients presenting with acute retinal arterial obstruction, given their clinical risk status for cardioembolic disease. DESIGN: Case series. SETTING: Four North American tertiary hospital centres. PATIENTS: Eleven patients less than 45 years of age presenting with acute retinal arterial obstruction who underwent transthoracic echocardiography. OUTCOME MEASURES: Anticoagulation therapy or cardiac surgery. RESULTS: Echocardiography showed abnormalities in five patients (45%). Five of the 11 patients were at high risk for cardioembolic disease on the basis of a history of risk factors or the presence of a cardiac murmur on presentation, or both. Three (60%) of the five had abnormal findings on echocardiography; all three required anticoagulation therapy or cardiac surgery. Of the six patients at low risk two (33%) had abnormal echocardiograms; neither required anticoagulation therapy or surgical intervention. CONCLUSIONS: All the patients who required anticoagulation therapy or cardiac surgery based on the findings on transthoracic echocardiography were deemed to be at high risk for cardioembolic disease. This emphasizes the importance of clinical risk stratification in the systemic evaluation of young patients presenting with acute retinal arterial obstruction.

Acute Disease↗
PubMed1993

Intra-arterial fibrinolytic therapy in central retinal artery occlusion.

We have treated 23 patients with central retinal artery occlusion by intra-arterial fibrinolysis, a method already in use for treatment of thromboembolic occlusion of the cerebral arteries. Fibrinolysis was carried out through a microcatheter placed in the origin of the ophthalmic artery. When ophthalmic artery cannot be catheterised, treatment can be carried out indirectly via the maxillary-ophthalmic anastomoses. In 18 cases urokinase was used in doses of 200,000-1,200,000 units; in 5 patients recombinant tissue plasminogen activator was used. Six patients showed marked improvement or total recovery, and six partial recovery, with improvement of visual acuity or a field defect. The worst results were obtained in six patients where the mean delay between the appearance of symptoms and initiation of treatment was more than 20 h. Intra-arterial thrombolysis led to a better outcome in acute occlusion of the central retinal artery than might have been expected with conservative treatment. A good prognosis is to be expected when treatment starts within the first 6-8 h, when some vision remains and when there is less retinal oedema.

Aged↗
PubMed1998

Retinal arterial tone is controlled by a retinal-derived relaxing factor.

The present study provides evidence that retinal tissue may profoundly influence the retinal arterial smooth muscle cell tone by releasing an unknown retinal relaxing factor. Isolated bovine retinal arteries with and without adhering retinal tissue were mounted in a wire myograph for isometric tension recordings. The maximal contraction induced by prostaglandin F2alpha was 0.95+/-0.7 mN (n=6) in the presence and 5.15+/-0.76 mN (n=6) in the absence of adhering retinal tissue. The contractions induced by U-46619, serotonin, and endothelin-1 were similarly blocked in the presence of retinal tissue. The K+ 120 mmol/L-induced contraction was not significantly affected (2.8+/-0.7 mN, n=6, in the presence and 3. 6+/-0.7 mN, n=6, in the absence of retinal tissue). Placing a piece of bovine retinal tissue in the proximity of a contracted (ie, with prostaglandin F2alpha) retinal artery induced a complete relaxation of the retinal vessel, suggesting the involvement of a diffusible chemical vasorelaxant. Also porcine, canine, and ovine retinal tissue completely relaxed the contracted (with prostaglandin F2alpha) bovine retinal artery. Other smooth muscle preparations, including rat mesenteric and renal arteries and rat main bronchi, also relaxed with the application of a piece of bovine retinal tissue. Incubation of bovine retinas in a Krebs-Ringer bicarbonate solution yielded a solution that relaxed isolated precontracted bovine retinal arteries, confirming the involvement of a diffusible chemical messenger. Hexane extraction, heating the solution to 70 degrees C, or treatment with trypsin did not alter the relaxing properties of the incubation solution. The characteristics of the retinal relaxing factor do not correspond with those of nitric oxide, prostanoids, adenosine, acetylcholine, or any other of the known vasoactive neurotransmitters released from the retina. Our results suggest that retinal arterial tone is controlled by a diffusible, hydrophilic, and heat-stable relaxing factor that does not correspond with a known vasoactive molecule formed within the retina.

Animals↗
PubMed1985

Abnormal retinal artery responses to stress in patients with type I diabetes.

The brachial artery pressure and retinal artery pressure responses to a one-minute cold pressor test were evaluated simultaneously in 14 patients with type I diabetes mellitus (six with and eight without diabetic retinopathy) and 10 age-matched control subjects. Five patients with type I diabetes had autonomic neuropathy. Mean baseline brachial artery pressure and retinal artery pressure were similar in patients with type I diabetes and control subjects. After cold pressor testing, the brachial artery pressure increased significantly (p less than 0.01) compared with baseline values in both groups. Retinal mean arterial pressures increased significantly (p less than 0.001) after cold pressor testing compared with the baseline values only in patients with type I diabetes. Positive correlation was found between the brachial and retinal mean arterial pressures after cold pressor testing (r = 0.48; p less than 0.05) in the diabetic patients but not in the control subjects (r = 0.10; p = NS). No correlation was found between the retinal artery pressure and age of onset of diabetes, duration of diabetes, the presence or absence of diabetic retinopathy, and glycemic control. Four patients with autonomic neuropathy and low retinal artery pressures, which remained unchanged after cold pressor testing, had no diabetic retinopathy. The fifth patient with autonomic neuropathy and exaggerated systolic brachial artery pressure (175 mm Hg) and retinal artery pressure (more than 80 mm Hg) responses had severe background diabetic retinopathy. In conclusion, abnormal retinal artery responses to stress are present in patients with type I diabetes. This may be modified by the presence or absence of both autonomic neuropathy and hypertension. The biologic significance of these findings is yet to be determined.

Adult↗
PubMedDate not supplied

Branch retinal artery occlusion combined with branch retinal vein occlusion in a patient with hepatitis C treated with interferon and ribavirin.

PURPOSE: To report a case of a combined branch retinal artery and vein occlusion in a patient with hepatitis C treated with interferon and ribavirin. METHODS: A 29-year-old man with a 1-week history of sudden visual field defect and decrease of central visual acuity was examined. RESULTS: Ophthalmoscopy and fluorescein angiography demonstrated an ischemic whitening of the inferior hemi-retina involving part of the macular region, numerous intraretinal hemorrhages, and a significant delay in arterial and vein filling of the dye. CONCLUSIONS: The findings of a retinopathy associated with interferon and ribavirin treatment of hepatitis C are important. The symptomatic permanent visual field defect and decrease of central visual acuity developing following a branch retinal artery and vein occlusion event emphasizes the need for careful and regular ocular monitoring of patients receiving interferon for hepatitis C.

Adult↗
PubMed2000

Spontaneous involution of a large retinal arterial macroaneurysm.

BACKGROUND: Acquired retinal macroaneurysms are round dilatations of retinal arterioles that occur in the posterior fundus. They tend to rupture before they grow large and cause a visual decrease. The average diameter of macroaneurysms in the previous reports is 281 micrometer. METHODS: A 63-year-old man complained of a sudden decrease of visual acuity in the left eye. Fundus examination of his left eye revealed a large protruded mass, 2 disc diameters in size, at the first bifurcation of the inferotemporal retinal artery. Preretinal vitreous bleeding and serous retinal detachment were observed around the lesion. Indocyanine green (ICG) angiography showed this mass to be continuous with the inferotemporal retinal artery and ICG dye leaked from the retinal artery into the lumen of the mass, with pulsation. RESULTS: Six months later, the large macroaneurysm underwent spontaneous involution. CONCLUSION: As shown in this patient, retinal macroaneurysms may grow extremely large. ICG angiography was useful to diagnose this large retinal arterial macroaneurysm.

Aneurysm↗
PubMedDate not supplied

[Role of vitrectomy in the treatment of retinal arterial macroaneurysms].

INTRODUCTION: Retinal arterial macroaneurysms are a rare cause of macular hemorrhage. Their treatment by photocoagulation is difficult and often ineffective. MATERIAL AND METHOD: Five aneurysmal cases complicated by a pre or retromacular hematoma or an intravitreal hemorrhage were treated surgically by vitrectomy with peeling of the vitreous cortex, hematoma drainage, dissection of the fibrinous aneurysmal body, perfluorocarbon fluid tamponade facilitating endophotocoagulation and temporary internal gas tamponade. RESULTS: Anatomical and functional results were satisfactory in this short series. One year after surgery, one case of secondary cataract was reported. DISCUSSION: Arterial abnormalities, located on the superior temporal retinal artery, are often discovered after assessment pre or submacular hemorrhage. Functional prognosis of aneurysmal rupture depends on the course of the retrofoveal hematoma. CONCLUSION: Early access to this surgery and good results in this series argue for rapid surgical treatment in sizeable submacular hemorrhage in order to avoid severe effects of subretinal fibrosis.

Aged↗
PubMed1998

Selective intra-arterial fibrinolysis of acute central retinal artery occlusion.

BACKGROUND AND PURPOSE: Occlusion of the central retinal artery (CRAO) causes a sudden decrease of monocular vision. Because early restoration of blood flow may improve outcome, we attempted to treat CRAO with selective intra-arterial fibrinolysis. METHODS: Intra-arterial fibrinolysis was performed within 6 hours after symptom onset in 17 patients with thromboembolic CRAO. Symptoms were painless, acute and severe decrease of vision. Urokinase (100 000 to 900 000 IU) was given through a microcatheter into the ophthalmic artery over 10 to 90 minutes. For comparison, the history and visual outcome of 15 control patients who did not receive fibrinolytics were evaluated. In both groups some of the patients underwent paracentesis and/or received carboanhydrase inhibitors. RESULTS: Patients who underwent fibrinolysis fared better than control patients (P=0.01). Three patients (17.6%) recovered completely after fibrinolysis and regained visual acuity of 20/20 (n=2) to 25/20 (n=1). Two additional patients (11.8%) showed a marked improvement to a visual acuity of 20/30. In 6 patients (35. 3%) vision improved slightly. They were able to count fingers, detect hand movements, or perceive light. In 6 patients (35.3%), fibrinolytic treatment was without effect. Among control patients, 1 patient (6.7%) showed partial, 4 patients (26.7%) minimal, and 10 (66.7%) no improvement of vision. CONCLUSIONS: A complete or marked improvement of visual acuity was achieved in one third of intra-arterial fibrinolysis patients but in none of the control patients. Intra-arterial fibrinolysis seems to have the potential to "lighten" the spontaneously poor outcome of CRAO.

Acute Disease↗
PubMed2006

[Internal carotid artery dissection on arterial fibromuscular dysplasia causing a central retinal artery occlusion: a case report].

INTRODUCTION: We report a case of a 66-year-old woman presenting a central retinal artery occlusion with no cardiovascular risk factor, with assessment using supra-aortic artery ultrasonography showing total internal carotid artery thrombosis. OBSERVATION: When vascular thrombosis risk factors are absent, more in-depth assessment such as a supra-aortic artery angioscan can provide the diagnosis of arterial dissection on arterial fibromuscular dysplasia. CONCLUSION: Central retinal artery occlusion is a rare but severe pathology. Therefore it is very important not to neglect the etiological assessment, because it can be the revealing element of a severe pathology.

Aged↗
PubMed2002

[Selective ophthalmic artery fibrinolysis in acute central retinal artery occlusion].

PURPOSE: To evaluate efficacy and reliability of local intra-arterial fibrinolysis (LIF) in Retinal Central Artery Occlusion (RCAO). MATERIAL AND METHOD: We have studied 12 patients with RCAO. Seven patients (group I) were treated with conventional therapy and 5 patients (group II) underwent treatment with urokinase via transcutaneous femoral catheter into the ophthalmic artery. Thereafter patients received heparin sulfate for 3 days. RESULTS: Mean follow up was 14 months and mean time from onset of symptoms to the beginning of therapy was 11 hours. One patient in group I showed improvement of visual acuity (from counting fingers to 0.1). In all patients in group II there was angiographic evidence of improved perfusion of retinal arteries and 4 patients (80%) showed improvement in visual acuity. The best results were obtained when LIF was performed before 10 hours after onset of symptoms. No complications were observed after the fibrinolysis treatment. CONCLUSION: LIF in ophtalmic arteries for the treatment of RCAO reduces dosage of fibrinolytic agents and becomes a safe and useful treatment during the first hours post RCAO.

Aged↗
PubMed1998

Microemboli are not a prerequisite in retinal artery occlusive diseases.

PURPOSE: Retinal artery occlusion (RAO) is caused by arterio-arterial or cardiovascular emboli in about 50% of all cases, but the role of non-embolic causes remains unclear. SUBJECTS AND METHODS: We studied 27 patients with amaurosis fugax (AFX), branch retinal artery occlusion (BRAO), central retinal artery occlusion (CRAO) and anterior ischaemic optic neuropathy (AION). Patients underwent an evaluation of cerebrovascular and cardiovascular risk factors, measurement of haemorheological parameters, and Doppler/duplex sonography including ultrasound detection of cerebral microembolic signals and echocardiography. RESULTS: Forty-one per cent of the patients had internal carotid atherosclerosis but only one patient had microembolic signals, probably due to a cardiac thrombus. Vascular risk factors, especially hypertension, were present in 82% of the patients correlating with abnormal haemorheological parameters such as increased thrombocyte reactivity. CONCLUSIONS: Our results indicate that altered haemorheological parameters, especially increased thrombocyte reactivity and vascular risk factors such as arterial hypertension, are non-embolic causes of vascular disease in a significant number of patients with RAO. This should guide diagnostic and therapeutic considerations concerning RAO in cases without proven embolic sources.

Adult↗
PubMed2001

RI in central retinal artery as assessed by CDI does not correspond to retinal vascular resistance.

The aim of the present study was to investigate the association between ultrasound Doppler measurements of resistive index (RI) in the central retinal artery and retinal vascular resistance (R) assessed with laser Doppler velocimetry, vessel size measurement, and calculation of ocular perfusion pressure (PP) in healthy subjects. An increase in vascular resistance was induced by inhalation of 100% O(2). During hyperoxia no significant changes in PP were observed. Mean flow velocity in main retinal veins was reduced by -27.5 +/- 2.0%. The average decrease in diameter was -11.5 +/- 1.0%. R, which was calculated as the ratio of PP to flow rate, increased by 97.6 +/- 7.7%. RI increased as well, but the effect was much smaller (6.6 +/- 2.2%). In addition, a negative correlation was found between baseline values of R and RI (r = -0.83). During hyperoxia R and RI were not associated. In conclusion, our data indicate that RI as assessed with color Doppler imaging in the central retinal artery is not an adequate measure of R.

Adult↗
PubMedDate not supplied

Argon laser photocoagulation for the treatment of idiopathic, bilateral, recurrent, diffuse retinal arterial aneurysms.

Spontaneous resolution of retinal arterial aneurysms may occur, but recurrences are uncommon. A case of idiopathic, bilateral, recurrent, diffuse retinal arterial aneurysms treated with direct laser photocoagulation is described. A 30-year-old woman with a history of physiologic menopause was found to have bilateral, diffuse, multiple retinal arterial aneurysms with massive subretinal exudates and intraretinal hemorrhages. Fluorescein angiography demonstrated multiple retinal arterial aneurysms with leakage. Direct argon laser photocoagulation successfully closed the aneurysms. During 6 years of follow-up, the aneurysms reoccurred twice, coinciding with a postpartum period. Recurrences were successfully treated with repeated laser photocoagulation with the aneurysms closed off. Hormonal imbalance may play a role in this condition. Recurrent retinal arterial aneurysms can be managed by direct laser photocoagulation.

Adult↗
PubMedDate not supplied

Branch retinal artery occlusion (BRAO) combined with branch retinal vein occlusion (BRVO) and optic disc neovascularization associated with HIV and CMV retinitis.

Two vaso-occlusive events, branch retinal artery occlusion (BRAO) and branch retinal vein occlusion (BRVO), were observed in the retina of an HIV-infected patient with cytomegalovirus (CMV) retinitis who developed neovascularization of the disc (NVD). Although BRVO and reversible NVD have been reported in association with CMV retinitis, we have seen no reports of concomitant BRAO. CMV damages endothelial cells and causes an occlusive vasculitis. In HIV-infected individuals, damaged endothelial cells and rheologic problems result in increased blood viscosity. HIV infection has also been associated systemically with elevated levels of cytokines, including tumor necrosis factor alpha (TNF-alpha). In vitro, TNF-alpha exerts effects that decrease fibrinolytic potential; this activity in the circulation of a patient with AIDS may lead to vascular occlusive events. In the patient reported here, the retinal changes were not reversed by induction therapy with ganciclovir and the NVD did not regress.

AIDS-Related Opportunistic Infections↗
PubMed1978

Treatment of acute central retinal artery occlusion.

Central retinal artery occlusion very often leads to irreversible visual loss and seldom responds to treatment. Retrograde cannulation of the supraorbital artery followed by irrigation with anticoagulants and vasodilators may be of value in the early management of this problem. A case in point is described.

Adult↗