A case of central retinal artery occlusion after chiropractic manipulation of the neck

Here we report a case of central retinal artery occlusion after chiropractic manipulation on the neck. A 49-year old man presented at the hospital because of sudden visual loss in his right eye after chiropractic neck manipulation. He had received chiropractic manipulation of the neck by a chiropractor eight days prior. When he first visited us, his best corrected visual acuity in his right eye was hand motion. A full ophthalmic examination was performed. There was cherry-red spot in the macula in his right eye. We performed a fluorescein angiogram and cervical color Doppler. The arterio-venous transit time in the fluorescein angiogram was delayed, and we detected stenosis of the right internal carotid artery with diffuse atherosclerotic plaques in the right common carotid artery. We prescribed ginko biloba extract (Tanamin). Three years after his first visit, the best corrected visual acuity of his right eye was 20 / 200.     

小梁切除术联合视网膜光凝术治疗新生血管性青光眼

目的 探讨复合小梁切除术联合视网膜光凝术治疗新生血管性青光眼的疗效.方法 回顾性分析视网膜中央静脉阻塞继发新生血管性青光眼患者9例,行复合小梁切除术,术后1周予全视网膜光凝术.记录术前及术后3个月、12个月患者视力、眼压、虹膜及房角新生血管检查,眼底视网膜新生血管消退及无灌注区情况.结果 术后12个月患者视力提高8眼,1眼无明显提高.术后眼压：5例患者眼压控制在21mmHg以下;4例眼压控制欠佳,需要局部使用降眼压药物,其中2例使用一种局部降眼压药物后眼压控制在21mmHg以下,另外2例眼压不能控制.虹膜及房角新生血管消退.眼底3个月和12个月后行荧光血管造影显示新生血管消退,无水肿,毛细血管无灌注区消失.结论 复合小梁切除术联合全视网膜光凝术是一种治疗视网膜中央静脉阻塞继发的新生血管性青光眼的有效的方法.     

Bilateral retinal venous occlusion in pigmentary glaucoma

Background The association of central retinal vein occlusion with primary open angle glaucoma is well known. This communication reports the occurrence of branch retinal vein occlusion and central retinal vein occlusion in a case of pigmentary glaucoma.Methods A 32-year-old man presented with old branch retinal vein occlusion in one eye and resolving central retinal vein occlusion in the other eye. Examination revealed bilateral Krukenbergs spindle and hyperpigmented trabecular meshwork. Intraocular pressure was 30 mmHg OU. Topical antiglaucoma medication was prescribed.Results Intraocular pressure was controlled with topical antiglaucoma medication.Conclusion The present report suggests that intraocular pressure monitoring is important in eyes even with branch retinal vein occlusion. Pigment dispersion may be the underlying cause for bilateral retinal vein occlusion, especially in young patients.     

Comparison between Glaucomatous and Non-glaucomatous Eyes with Unilateral Retinal Vein Occlusion in the Fellow Eye

Purpose

To evaluate and compare the clinical and angiographic characteristics of retinal vein occlusion (RVO) in glaucomatous and non-glaucomatous eyes with unilateral RVO in the fellow eye.

Methods

Twenty-one glaucomatous eyes (GL group) and 25 age-matched non-glaucomatous eyes (non-GL group) with unilateral RVO in the fellow eye were included in this study. Fluorescein angiographic images were assessed in both groups by 3 retina specialists in order to determine the RVO occlusion site. The occlusion site was divided into 2 types: arteriovenous (AV)-crossing and non-AV-crossing (optic cup or optic nerve sited). The clinical characteristics and prevalence of AV-crossing and non-AV-crossing RVO were compared between the 2 groups.

Results

The mean baseline intraocular pressures of the RVO eye and the fellow eye did not differ between the 2 groups (RVO eye: 14.3 ± 2.5 mmHg [non-GL group], 15.5 ± 3.9 mmHg [GL group], p = 0.217; fellow eye: 14.4 ± 2.5 mmHg [non-GL group], 15.7 ± 3.7 mmHg [GL group], p = 0.148). The prevalence of systemic disease did not differ between the 2 groups (e.g., diabetes mellitus and hypertension, p = 0.802 and 0.873, respectively). AV-crossing RVO was significantly more frequent in the non-GL group (19 eyes; 76%) than in the GL group (4 eyes, 19%, p < 0.001).

Conclusions

Non-AV-crossing RVO, i.e., optic cup- or optic nerve-sited RVO, is more frequently associated with glaucomatous changes in the fellow eye. Therefore, this type of RVO should be monitored more carefully for indications of glaucoma in the fellow eye.     

Central retinal artery occlusion caused by expansion of intraocular gas at high altitude

PURPOSE: To report a case of central retinal artery occlusion caused by expansion of intraocular gas during mountain travel at high altitude.DESIGN: Interventional case report.METHODS: A 46-year-old man underwent vitrectomy with intraocular gas tamponade for rhegmatogenous retinal detachment, right eye. During his trip to Mountain Ali with an altitude of 6,210 feet, he felt a sensation of fullness and noted loss of vision in his right eye. When he came down to sea level, an intraocular pressure of 54 mm Hg was present in the right eye. He visited our clinics 2 weeks after the episode, and the right eye had best-corrected visual acuity of counting fingers, intraocular pressure of 14 mm Hg, attenuated retinal arteries, and a pale optic disk.RESULTS: Because of irreversible damage to the retina of the right eye, he did not receive any treatment.CONCLUSIONS: We should not neglect the possibility of hazard for patients with intraocular gas under low atmospheric pressure circumstances, such as mountain travel.     

A Case of Susac Syndrome

The purpose of this article is to report on the first known Korean case of Susac syndrome. An 18-year-old female came to our clinic reporting blurred vision of the left eye for 2 days. She also complained of decreased hearing with tinnitus of the right ear and mild headache. She was previously healthy and had no remarkable medical history. Best-corrected visual acuity was 20 / 50 in the left eye and 20 / 20 in the right eye. An axiomatic triad of ocular, cochlear, and neurologic involvement was observed in the patient. Fluorescein angiography showed branched retinal arterial occlusions in the left eye. A sudden right sensorineural hearing loss was observed on audimetry. Magnetic resonance images showed a hyperintense lesion in the white matter around the corpus callosum. The patient was treated with high doses of systemic corticosteroids, and no neuropsychological sequelae were observed. This is the first case report of Susac syndrome in Korea. In cases of retinal arterial occlusion with hearing loss or neuropsychological symptoms, Susac syndrome should be suspected.     

系统性红斑狼疮眼底病变的特征

目的探讨系统性红斑狼疮（SLE）患者的眼底病变的临床特点。方法回顾性系列病例研究。分析2002-2013年在北京协和医院眼科门诊就诊的36例（57眼）经免疫内科确诊为SLE患者的眼底病变情况。其中男4例,女32例;年龄14~71岁,平均（32.6±11.5）岁。常规用裂隙灯显微镜检查前节、散瞳查眼底、眼底照像及FFA。结果57眼中视网膜血管炎24眼;毛细血管前小动脉闭塞18眼;视网膜大血管阻塞17眼,其中视网膜动脉阻塞10眼,视网膜静脉不全阻塞5眼,视网膜动静脉阻塞2眼;视神经病变6眼,其中视神经乳头炎1眼,球后视神经炎4眼,缺血性视神经病变1眼;巨细胞病毒性视网膜炎3眼。结论SLE的眼底病变主要表现为视网膜血管炎、毛细血管前小动脉闭塞及视网膜大血管阻塞。     

Central retinal vein occlusion in pseudoexfoliation of the lens capsule

In surveying an extensive group of patients with unilateral pseudoexfoliation of the lens capsule certain interesting points emerged, particularly on the incidence of central retinal vein occlusion in this condition,and perhaps in glaucoma also. A total of 284 patients with unilateral pseudo-exfoliation of the lens capsule were examined clinically after an ophthalmic and general history were taken. Mean intraocular pressure (IOP) was 30.9 mmHg in the affected eye and 18.1 mmHg in the unaffected eye. Central retinal vein occlusion occurred in 10 affected eyes but no unaffected eyes and always in affected eyes with a rise in IOP. Average IOP in the affected eye with central retinal vein occlusion was 37.5 mmHg (range 26-54 mmHg);in the unaffected fellow eye it was 18.0 mmHg (range 11-28 mmHg). Although the process involved in producing pseudo-exfoliation of the lens capsule may contribute to the precipitation of central retinal vein occlusion, these findings suggest the rise in IOP is the more important cause. This may also be so in other forms of glaucoma.     

Oclusión arterial asociada con un asa vascular prepapilar. Cambios anatómicos en el seguimiento a largo plazo

We report the case of a 13-year-old patient who complains of an acute superior visual field scotoma in the last 48 hours. Best corrected visual acuity (BCVA) was 20/20 in both eyes. The right eye fundus examination revealed torsion of a prepapillary loop in the inferior branch of the retinal artery, associated with a arterial vascular attenuation and whitenning of the inferior retina that involved both nasal and temporal branches but spared the foveal region. During the follow-up the vascular loop dissapeared and only glial tissue was seen in front of the optic nerve head. BCVA remained 20/20 in both eyes.This report shows the evolution of the vascular loop after an occlusion. The absence of blood flow produces a collapse of the arterial walls, in time the vascular loop is replaced by glial tissue.     

Arteritis de Takayasu: obstrucción arterial retiniana isquémica como posible presentación inicial

Ocular manifestations are observed in 25% of patients with Takayasu's arteritis. Its signs and symptoms can be very variable. The case is presented of a 41-year-old woman with progressive vision loss in her right eye secondary to ischaemic retinal arterial occlusion. After a systematic study, a protein purified derivative (PPD) skin test compatible with tuberculosis was found to be the only alteration. After ruling out other causes, and based on the initial suspicion of tuberculous retinal vasculitis, treatment was started with antimicrobial agents and systemic corticosteroids, without any therapeutic response. Eighteen months later, the patient developed acute kidney failure, secondary to right renal artery stenosis. The CT-angiography revealed a thickening of the aortic arch and its branches, and Takayasús arteritis was finally diagnosed. Therefore, emphasis is made on the importance of the ophthalmologist in the diagnosis of Takayasús arteritis, in which its ophthalmological manifestations can be an early sign of the disease.     

Markedly increased unilateral intraocular pressure during hemodialysis in a patient with ipsilateral exfoliative glaucoma

PURPOSE: To report a man with markedly increased intraocular pressure in a unilateral exfoliated eye during hemodialysis. METHOD: Case report. RESULTS: A 75-year-old man with unilateral exfoliative glaucoma complained of blurred vision in his right eye during hemodialysis. The blurred vision always occurred during hemodialysis, and the intraocular pressure was increased during hemodialysis. The average increase in intraocular pressure during hemodialysis in the right eye was 22.5 mm Hg, and the intraocular pressure in the left eye remained in the normal range during hemodialysis. Argon laser trabeculoplasty was performed on the right eye, and a decrease in intraocular pressure was attained. CONCLUSION: Physicians must be alert to intraocular pressure increases in these eyes during hemodialysis.     

眼压和眼轴长与视网膜静脉阻塞的关系

目的探讨眼压和眼轴长与视网膜静脉阻塞（RVO）的关系。方法应用CanonTX-F型眼压计对56例RVO患者的眼压进行测量,并用A超对其眼轴进行测量,对照组为年龄、性别相匹配的98例白内障摘除患者。结果视网膜中央静脉阻塞（CRVO）阻塞眼眼压显著低于对测眼及正常对照眼（P〈0.01）;视网膜分支静脉阻塞（BRVO）阻塞眼眼压与对测眼及正常对照眼比较差异无显著性（P〉0.05）。CRVO阻塞眼眼轴长与对照眼比较差异有显著性（P〈0.01）;BRVO阻塞眼眼轴长与对照眼比较差异无显著性（P〉0.05）。结论眼轴长偏短是CR-VO的危险因素,CRVO可引起眼压降低;眼轴长偏短不是BRVO的危险因素,BRVO不能引起眼压降低。     

视网膜中央静脉阻塞继发青光眼的治疗

目的探讨氩激光超全视网膜光凝治疗视网膜中央静脉阻塞（CRVO）继发青光眼的疗效。方法2005年1月至2009年9月间住院和门诊就诊的CRVO继发青光眼21例（21只眼）患者,选择性进行超全视网膜光凝术,每只眼1300～1600点,分2—3次完成,随访疗效。观察眼压及新生血管消退情况。结果超全视网膜光凝21只眼,随访2个月至2年,眼压得到控制17只眼,2只眼发生了玻璃体积血,再行玻璃体切割手术联合全视网膜光凝术,1只眼行小梁切除手术,另1只眼行睫状体光凝术,术后患者眼压均得到控制。结论氩激光超全视网膜光凝术治疗CRVO继发青光眼安全、有效。     

Oclusión de la arteria central de la retina tras inyección facial de ácido hialurónico

A 57-year-old woman with no premorbidities presented with symptoms of sudden painless vision loss in the right eye (RE). Best-corrected visual acuity in the RE was counting fingers to 10 cm. A relative afferent pupillary defect was observed in the RE. Ocular fundus examination of RE was suggestive of central retinal artery occlusion. Systemic evaluation was normal. The most interesting fact in this case is that a hemorrhagic edema in the right glabellar region was the basis for the diagnostic suspicion. The patient recognized the loss of vision 24 hours after hyaluronic acid injection as a facial rejuvenation treatment.     

Ophthalmic complications with disseminated intravascular coagulation.

Massive lid oedema, ecchymosis, proptosis with a total restriction of extraocular movement, markedly raised intraocular pressure, and occlusion of the central retinal artery developed acutely in the right eye of a 26-year-old woman with a past history of disseminated intravascular coagulation. She had been admitted to hospital for symptoms of abdominal pain and bleeding from multiple sites a few hours earlier. Five days previously she had some proptosis of the other eye and had been treated with antibiotics for suspected orbital cellulitis at another hospital. The oedema and proptosis resolved on high-dose intravenous corticosteroid therapy. Despite attempts to relieve the orbital oedema and raised intraocular pressure with a lateral canthotomy and antiglaucoma medications, the patient lost all perception of light in the right eye and has subsequently developed an optic nerve atrophy.     

视网膜中央静脉阻塞并发渗出性视网膜脱离的临床特征

目的探讨视网膜中央静脉阻塞并发渗出性视网膜脱离患者的临床特征.方法回顾性分析视网膜中央静脉阻塞并发渗出性视网膜脱离患者的一般情况及视力、眼压、眼底、荧光素眼底血管造影、眼部超声波等检查资料.结果15例患者中,男性8例,女性7例;年龄18～42岁,平均25岁.5例合并新生血管性青光眼.患者就诊时的视力：光感至0.05.眼底检查显示全视网膜散在出血、视网膜静脉迂曲,黄斑区有明显的水肿和出血,在水肿和脱离区的边缘可见大片渗出.坐位时视网膜脱离为2～5个钟点范围.全部患者均未见视乳头血管吻合支的形成.荧光素眼底血管造影显示大片出血遮蔽荧光或可见后极部毛细血管无灌注区.超声波测量有5只眼平均眼轴长为22.98 mm.结论渗出性视网膜脱离是视网膜中央静脉阻塞的少见、严重并发症.多见于青年患者,易并发新生血管性青光眼,其眼底及荧光素眼底血管造影检查具有特征性.     

The effect of prolonged monocular occlusion on latent nystagmus in the treatment of amblyopia

We recorded eye movements in 5 patients with latent nystagmus (LN) before and after 2 days of occlusion of the better eye. The slow-phase speed of the nystagmus (SPS) was in general, before occlusion, lower when the better eye fixated but, after occlusion, lower when the worse eye fixated. However, the sum of SPS during right fixation and SPS during left fixation remained constant. Oscillopsia complaints gradually disappeared during the period of occlusion. These findings indicate that the difference between the SPS during fixation with the right eye and the SPS during fixation with the left eye in LN patients is caused by a compensatory drift that decreases LN during fixation with the better eye but increases LN during fixation with the worse eye. During occlusion, this compensatory drift changes its direction and magnitude slowly over days. Hence, occlusion of the better eye in children with amblyopia and LN should be prescribed only in days per week, not in hours per day.     

视网膜动脉阻塞的综合治疗

视网膜动脉阻塞(RAO)是眼科急症,患者视网膜由于缺血、缺氧而视细胞迅速死亡,如未能接受及时而有效的治疗,可能导致不同程度的视力损伤.RAO的传统治疗方法包括扩张血管和降低眼压治疗,前者包括药物治疗及气体吸入,后者包括前房穿刺术或青光眼降眼压药物治疗.除此之外,RAO现有的治疗方法还包括调节植物神经治疗、激光、手术等.溶栓治疗也是各类血管阻塞的治疗方法之一,有研究显示对RAO的患者在一定的时间窗内进行溶栓治疗可以提高视力预后,但同时溶栓治疗也存在诱发脑出血的风险,所以应谨慎选择.另外应注意视网膜中央动脉阻塞患者卒中风险增加的可能,研究显示视网膜中央动脉阻塞风险因素与脑卒中和心血管疾病动脉粥样硬化风险因素基本一致,因此应同时管理有可能引起其他血管疾病的风险因素,必要时应对其进行神经科评估及预防性治疗.     

Oclusión de la arteria central de la retina como complicación oftalmológica luego de un accidente ofídico

Snakebite causes 421,000 - 1,200,000 poisonings per year due to hematotoxicity, neurotoxicity and vasculotoxicity. Ophthalmological manifestations secondary to snake bites are rare. If the snake belongs to the Viperidae family, the most frequent ophthalmologic manifestations are macular infarction, chronic open-angle glaucoma, and retinal or vitreous hemorrhage. Central retinal artery occlusion is an extremely rare ocular complication. We report the case of a 30-year-old patient, who consulted due to poor vision in her left eye weeks after suffering a snake bite (Bothrops atrox) in her left lower limb. The diagnosis was a central retinal artery occlusion in the left eye with abnormal findings in the ophthalmological physical examination and in complementary retinal and neuro-ophthalmological tests.     

激光诱发视网膜静脉阻塞侧支循环的实验研究

目的 探讨在兔眼视网膜分支静脉阻塞（branch retinal vein occlusion,BRVO)模型基础上,利用激光诱发、建立视网膜和脉络膜静脉吻合的可行性及安全性。方法 通过光动力法建立21只兔（42只眼）BRVO模型,利用激光诱发并形成视网膜和脉络膜静脉吻合;对侧无BRVO眼作为对照,同样用激光击射,诱发吻合支形成。结果 在建立BRVO模型的21只眼中,4只眼形成了视网膜和脉络膜静脉吻合,形成时间为3－5周。对照眼中,1只眼形成了视网膜和脉络膜静脉吻合,形成时间为5周。在观察2－5个月期间,由激光击射引起的脉络膜、视网膜或玻璃本出血均在3周内吸收,未见其它严重并发症。结论 利用激光诱发并形成视网膜和脉络膜静脉吻合,在技术上可行,较为安全,但在提高成功率方面尚有待进一步研究 。