Carotid-artery disease and retinal-artery occlusion.
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Arterial Occlusive Diseases↗
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Results for “Retinal Artery”
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Retinal arterial macroaneurysm: a case report.
BACKGROUND: Retinal arterial macroaneurysms are an acquired retinal vascular abnormality. These isolated dilatations of the major retinal arterial branches are found within the posterior pole and are associated with systemic hypertension, arteriosclerosis, retinal emboli and cardiovascular disease. RESULTS: Although many patients are asymptomatic, vision loss is the most commonly manifested symptom. Vision loss may occur as a result of hemorrhage (subretinal, intraretinal, preretinal or vitreous) or macular edema with associated lipoprotein exudation. Most lesions spontaneously involute without causing any visual consequence. If central vision is reduced or threatened, laser photocoagulation may be applied directly to the macroaneurysm itself or to affected retinal capillary beds. While retinal arterial macroaneurysms frequently manifest as isolated phenomena with few symptoms (loss of visual acuity if bleeding or exudation encroaches on the macula), their differential diagnosis includes retinal and systemic diseases that require thorough investigation. CONCLUSION: Optometrists should be familiar with the signs and symptoms of retinal arterial macroaneurysms, their differential diagnosis, workup, and management.
Aged↗
Retinal arterial occlusions in the young.
Retinal arterial occlusions occur secondary to a multitude of mechanisms. The evaluation and workup of a patient with a retinal arterial occlusion depends on many factors, including the age and the systemic health status of the patient. Retinal arterial occlusions in the young typically occur by somewhat different mechanisms than do arterial occlusions in older adults. This article reviews the recent literature related to the etiology and diagnostic evaluation of retinal arterial occlusions in young people as well as potential new managements.
Adult↗
Central retinal artery occlusion after radial optic neurotomy in a patient with central retinal vein occlusion.
PURPOSE: To describe a patient with a central retinal vein occlusion (CRVO) who developed central retinal artery occlusion after radial optic neurotomy. DESIGN: Interventional case report. METHODS: A 70-year-old woman with CRVO underwent a radial optic neurotomy on her right eye. Her preoperative visual acuity in the affected eye was 20/400. RESULTS: Radial optic neurotomy was performed after phacoemulsification and aspiration for a cataract with intraocular lens implantation. At the insertion of a CRVO knife, pulsating bleeding occurred from the cup of the optic disk; the bleeding was stopped within 2 minutes by elevating the intraocular pressure to 80 mm Hg. On the following day, the patient noticed that she had lost light perception. Fluorescein angiography showed a marked delay of arterial filling, indicating a central retinal artery occlusion. Retinal circulation returned to normal 2 months later; however, her vision was still no light perception. CONCLUSIONS: Ophthalmologists should be aware that severe complications such as central retinal artery occlusion can be associated with radial optic neurotomy, which is an unproven surgical procedure with a questionable pathophysiologic mechanism.
Aged↗
Central retinal artery occlusion.
Central retinal artery occlusion is characterized by sudden, painless visual loss due to blockage of retinal blood flow. It has been reported in all age groups including children but is most frequent in the sixth decade. Both thrombosis and embolism have been suggested as possible mechanisms. The emergency treatment includes intravenous acetazolamide, digital ocular massage, and inhalation of 5% carbon dioxide -- 95% oxygen for ten minutes. Following emergency treatment, immediate ophthalmologic referral and consultation is required. Comprehensive medical evaluation should be initiated to exclude systemic vascular disease.
Aged↗
[Hyperbaric oxygen therapy in retinal artery occlusion].
UNLABELLED: Retinal artery occlusion (RAO) is an ophthalmological emergency that causes a major decrease of visual parameters in most of the cases. Purpose of this pilot study was to evaluate the effect of adjunctive hyperbaric oxygen therapy (HBO) on visual acuity (VA). PATIENTS AND METHODS: Patients with acute central or branch artery occlusion (CRAO/BRAO) consecutively admitted to our hospital were offered adjunctive HBO. Standard therapy consisted of ocular massage for 3 minutes, paracentesis and intravenous acetazolamide. HBO (3 x 30 minutes at 240 kPa) was applied t.i.d. on the first day, b.i.d. on day 2 and 3 and o.d. for at least another 4 days. Patients who refused HBO or had contraindications served as controls. VA was measured according to the guidelines of ETDRS. The follow up was 3 months. RESULTS: HBO: 8 patients with CRAO showed a mean increase in VA of 1 line, 4 of 8 patients had an increase of 2 lines and more, in 3 of 8 patients VA was unchanged and one patient suffered a decrease of 6 lines. 10 patients with BRAO showed a mean increase in VA of 8 lines, 8 of 10 patients showed an mean increase of 2 and more lines, in 2 of 10 patients VA was unchanged. CONTROLS: 8 Patients with CRAO had a mean increase of 2 lines during follow up, 3 of 8 patients showed an increase of 2 lines and more, in 5 of 8 patients VA was unchanged. 6 patients with BRAO had a mean increase of VA of 4 lines, 3 of 6 patients had an increase of 2 lines and more, one patient lost 3 lines and in 2 patients VA was unchanged. The results are compared to the literature. CONCLUSIONS: HBO seems to be beneficial for VA in eyes with BRAO. Further investigations are necessary to prove this observation.
Acetazolamide↗
Interventions for acute non-arteritic central retinal artery occlusion.
BACKGROUND: Acute central retinal artery occlusion occurs as a sudden interruption of the blood supply to the retina and results in an almost complete loss of vision in the affected eye. There is no generally agreed treatment regimen although a number of therapeutic interventions have been proposed. OBJECTIVES: The objective of this review is to examine the effects of treatments used for acute non-arteritic central retinal artery occlusion. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register - CENTRAL/CCTR, which contains the Cochrane Eyes and Vision Group specialised register (Cochrane Library Issue 4, 2001), MEDLINE (1966 to August 2001) and EMBASE (1980 to September 2001). We searched the reference lists of relevant papers for trials. SELECTION CRITERIA: We included only randomised controlled trials in which one treatment aimed to re-establish blood supply to the retina in people with acute central retinal artery occlusion was compared to another treatment. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed the search results for trials to be included in the review. Discrepancies were resolved by discussion. MAIN RESULTS: We found no randomised controlled trials that met our inclusion criteria. REVIEWER'S CONCLUSIONS: There is currently not enough evidence to decide which, if any, interventions for acute non-arteritic central retinal artery occlusion would result in any beneficial or harmful effect. Well-designed randomised controlled trials are needed to establish the most effective treatment.
Humans↗
Carotid artery disease and central retinal artery occlusion.
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Adult↗
[Comparative studies on the histopathology of angiosclerosis in the opthalmic, central retinal arteries and in the retinal arterioles].
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Adolescent↗
[Persistent value of intra-arterial fibrinolysis 8 hours or more following central retinal artery occlusion or of its branches].
PURPOSE: To establish that intra-arterial fibrinolysis of the ophthalmic artery can still be efficient 8 hours or more after a central retinal artery occlusion. MATERIAL AND METHODS: Nine to twenty hours (average 12.5 H) after a loss of vision due to a central retinal artery occlusion or the occlusion of its branches, 7 patients were treated by intra-arterial fibrinolysis. The vision of the affected eye was limited to light perception for four patients, to hand movement at 1 meter for two patients, and to 4/10 P2 for one patient. Under radiological guidance, 300.000 IU of urokinase was injected through a microcatheter placed in the ophthalmic artery (6 patients), or in the facial artery (1 patient); in this case the angiogram showed an occlusion of the internal carotid artery and a retrograde filling of the ophthalmic artery through the facial artery. RESULTS: We did not observed any complication. The 3 patients who had a vision better than light perception recovered a vision of 10/10 P2. For the others: two patients recovered a vision of 9/10 P2 and 5/10 P2, two did not recover. CONCLUSION: Fibrinolysis of the ophthalmic artery must ideally be performed as soon as possible, but a recovery is still possible more than 8 hours after the onset of the loss of vision. The time limit is not yet defined but after 24 hours, the chance of improvement seems to be very low.
Adult↗
Pars plana vitrectomy for complications of retinal arterial macroaneurysms--a case series.
Retinal arterial macroaneurysms are distinct vascular lesions with a typically benign course. Laser treatment to these vascular lesions is controversial, and has been limited to cases of persistent macular edema. Devastating vision loss can occur, however, through vitreous or subretinal hemorrhage. We describe eight cases of retinal arterial macroaneurysms associated with subretinal or vitreous hemorrhage requiring pars plana vitrectomy. Final visual acuities ranged from 20/20 to 20/400 at most recent follow up. Until reliable indicators of rupture are identified, we suggest consideration of laser photocoagulation to clinically active, identifiable retinal arterial macroaneurysms within the macula.
Adult↗
Different autoregulation response to dynamic exercise in ophthalmic and central retinal arteries: a color Doppler study in healthy subjects.
PURPOSE: Prospective examination of the influence of changes in heart rate, arterial blood pressure and intraocular pressure induced by short dynamic exercise on orbital blood-flow velocities, and comparison of the autoregulation response in the ophthalmic artery and the central retinal artery. METHODS: Twelve young healthy volunteers were involved in the ophthalmic artery study and 12 others in the central retinal artery study. Blood-flow velocities were measured using color Doppler imaging before and after exercise. RESULTS: After exercise systolic blood pressure and heart rate were higher ( P<0.004) and intraocular pressure was lower ( P<0.006). However, in the central retinal artery the mean flow velocity, end-diastolic velocity and resistive indices remained stable, while in the ophthalmic artery these velocities actually decreased, and resistive indices increased significantly ( P<0.005). In the central retinal vein the velocities showed no significant change. CONCLUSION: Our results confirm the presence of an effective compensatory autoregulation for the retinal circulation, in connection with an increase in the ocular perfusion pressure induced by exercise. However, we found that in the ophthalmic artery some over-compensation occurs (significant decrease in some velocity parameters), whereas in the central retinal artery important flow parameters (mean velocity, end-diastolic velocity and resistive indices) appear to be successfully stabilized. Exercise history, heart rate, blood pressure and intraocular pressure all have to be monitored in orbital blood flow studies, as these variables are strongly affected by the changes in the autonomic nervous system and in turn significantly influence the measured flow velocity and resistivity values.
Adult↗
Branch retinal artery occlusion associated with rupture of retinal arteriolar macroaneurysm on the optic disc.
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Aneurysm, Ruptured↗
Bifemelane in the treatment of central retinal artery or vein obstruction.
Patients with retinal artery or vein obstruction received 150 mg of bifemelane hydrochloride daily for 1 to 11 months and other treatment (urokinase, steroid hormone, hyperbaric oxygen, or laser photocoagulation) or the latter without bifemelane. After treatment with bifemelane, improvements in visual acuity were seen in 12 of 17 eyes with central retinal artery obstruction, in three of four eyes with central retinal vein obstruction, and in five of nine eyes with branch retinal vein obstruction. Among the patients not receiving bifemelane, improvements were seen in two of six patients with central retinal artery disease, in 14 of 27 eyes with central retinal vein obstruction, and in 13 of 28 eyes with branch retinal vein obstruction. It is concluded that bifemelane can be used to improve visual acuity in many patients with central retinal artery obstruction.
Adolescent↗
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.
OBJECTIVES: To determine the effect of commonly used minimally invasive treatments for clinically complete nonarteritic central retinal artery occlusion (CRAO) and design a prospective randomized trial to evaluate selective intra-arterial lysis for this condition. METHODS: In this retrospective noncomparative case series, all medical records of patients with a diagnosis of CRAO treated at the Department of Ophthalmology, Ludwig-Maximilians-Universität, Munich, Germany, from 1994 through 1999 were reviewed for treatments administered and course of visual acuity. MAIN OUTCOME MEASURES: Best-corrected visual acuity (BCVA) at initial and last visit. RESULTS: We identified 102 patient medical records; 71 were suitable for further analysis. Forty-four (62%) of the 71 patients included were treated with oral acetylsalicylate; 44 (62%), with oral acetazolamide; 32 (45%), with ocular massage; 22 (31%), with isovolemic hemodilution; 19 (27%), with oral pentoxifylline; 8 (11%), with topical beta-blocker; 6 (8%), with paracentesis of the anterior chamber; 4 (6%), with subcutaneous heparin. A mean +/- SD number of treatments of 2.5 +/- 1.4 was administered per patient, and BCVA increased by a mean +/- SD number of Snellen lines of 0.7 +/- 2.8. The BCVA in 11 patients (15%) increased by 3 or more lines. Multivariate stepwise regression did not reveal any single or combination treatment as a significant factor for improvement in BCVA. Patient age and duration of visual impairment before initial examination were not significant predictors of final BCVA. CONCLUSIONS: Commonly used minimally invasive treatments of CRAO do not improve the natural course of the disease. A prospective trial by the European Assessment Group for Lysis in the Eye is under way to evaluate selective intra-arterial lysis, and in this trial some of these minimally invasive treatments are used in the control group.
Acetazolamide↗
The optic disk in anterior ischemic optic neuropathy associated with retinal artery occlusion.
Two patients who had retinal artery occlusion associated with impaired peripapillary choroidal circulation were followed up ophthalmoscopically, to evaluate the appearance of the optic disk. The first patient showed central retinal artery occlusion, and the second patient demonstrated branch retinal artery occlusion. A peripapillary choroidal filling defect was noted in both cases by fluorescein angiography, suggesting an association with anterior ischemic optic neuropathy. The first patient exhibited optic atrophy without demonstrating pale disk edema. The second patient showed pale disk edema, but a sectorial defect of disk swelling was noted in the quadrant that corresponded to the area affected by branch retinal artery occlusion.
Aged↗
[Occlusion of the retinal artery].
The occlusion of the retinal artery usually leads to sudden and, in most cases, continual visual impairment of the affected eye. This is an uncommon illness with a variable progression. To date it has not been possible to develop a generally recommended therapy using prospective, randomised studies, as is the case for circulatory impairment in other organs. Due to this uncertainty, the treatment of a retinal arterial occlusion is regarded as an ophthalmological emergency and a challenge for the attending practitioner. In this overview, the actual state of our knowledge on the pathogenesis of occlusion of a retinal artery as well as current and new therapies are presented.
Choroid↗
The vitreous in retinal arterial occlusions.
PURPOSE: To investigate whether retinal arterial occlusion induces posterior vitreous detachment (PVD). METHODS: Vitreous condition was studied retrospectively and examined on biomicroscopy in 52 eyes with retinal arterial occlusion; 50 fellow eyes served as controls. RESULTS: Of 52 eyes with retinal arterial occlusion 27 (52%) had PVD; 25 (50%) of the 50 control eyes had PVD. There was no significant difference between the two groups in prevalence of PVD. Of the 41 patients observed for more than 1 year, PVD developed in 2 (5%) patients from each group. CONCLUSION: Our findings strongly suggest that retinal arterial occlusion does not influence the development of PVD clinically.
Adult↗