Management of branch retinal artery occlusion: clinical case

Abstract

Background: Branch retinal artery occlusion (BRAO) occurs in 38% of acute retinal artery obstruction cases.[1] Most common cause of retinal artery occlusions are emboli from the carotid artery. BRAO leads to ischemia and reorganization of the retinal layers which can cause blindness.[2] We present a clinical case of a total corotid artery stenosis which led to BRAO. Case report: A 56-year-old man presented to the emergency room with “dimming” of the vision in the left eye. On examination, best corrected visual acuity- OD 1.0 and OS 0.6. Intraocular pressure were normal. Opthalmoscopy of the left eye revealed retinal emboli superior to the optic disc associated with retinal ischemia. Patient denied any other diseases. He was admitted to the hospital and treated with Pentoxifylline, Acetazolamide, peribulbar injection of Dexamethasone, Timolol and hyperbaric oxygen. Blood workup showed that patient had hypercholesterolemia and cardiologist diagnosed him with hypertension primaria stage 2. Patient was started on Aspirin and Perindoprilum treatment. Head and neck angiography showed significant left internal carotid artery occlusion of 100%, also a 75% stenosis of the left a.vertebralis (which is significant and needs treatment in order to prevent cortical blindness). Patient underwent endarterectomy of the left a. vertebralis. His left internal carotid artery was not dilated because there was a sufficient collateral circulation from a. communicans posterior to a. cerebri media. Patient was discharged two days after the surgery. Conclusions: there is no evidence based treatment for BRAO which might improve visual function so management of these patients must focus on determining etiology for acute retinal ischemia and treating it. The key point is to determine risk factors as soon as possible and manage them in order to prevent any future vascular disease. . [...].