Central Retinal Artery Occlusion - Acute - Cilioretinal Sparing
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77-year-old man was seen in the office on May 3, 2012. He had carotid ultrasound done in April, which was okay. As far as he knows he was doing fine until midnight of last night when he noticed sudden severe vision loss in the left eye. He went to the hospital. He had a CT scan done at the time and some blood work, all of which was fine. He is not having any headache, no fevers, and no weight loss. He does take a baby aspirin as well as fish oil. His vision in the right eye is good and the left eye is poor.
VISUAL ACUITY: OD 20/20, OS 2/200. IOP: OD 14, OS 10.
SLIT EXAMINATION: The posterior chamber intraocular lens is in good position in both eyes.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.5. There is posterior vitreous separation and 1+ macular drusen.
OS: Vertical C/D ratio is 0.2. There is a posterior vitreous separation. There is a red area of retina just adjacent to the optic nerve where there is a ciliary retinal artery. There is a cherry red spot centrally.
SPECTRALIS-SD-OCT SCAN: The OCT scan of the right eye shows a normal foveal contour. The left eye shows inner retinal edema.
FUNDUS PHOTOGRAPHY - AUTO FLUORESCENCE: The image in the right eye shows some patchy hyper auto fluorescence corresponding to the macular drusen. The left eye shows hypo auto fluorescence centrally and it does look like there may be reflective plaque right in the middle of the central retinal artery.
FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography of the left eye shows non filling of the central retinal artery all the way out to five minutes. There is some retrograde filling through the retinal veins as the ciliary retinal artery fills those retrograde. The right eye shows some staining of the macular drusen.
IMPRESSION:
1. CENTRAL RETINAL ARTERY OCCLUSION – LEFT EYE WITH CILIARY RETINAL SPARING
2. DRY AGE-RELATED MACULAR DEGENERATION – RIGHT EYE
DISCUSSION: I explained to the patient unfortunately he has had a central retinal artery occlusion and the artery is still occluded. I did an anterior chamber tap in hope of improving the circulation a little bit. I tapped the pressure down to zero. I asked him to take eye vitamins to protect the right eye. I asked him to return here for a check in two weeks or sooner should he notice a problem and see you back regularly.
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Central Retinal Artery Occlusion with Cilioretinal Sparing - Acute1097 views 77-year-old man was doing fine until midnight of last night when he noticed sudden severe vision loss in the left eye. VISUAL ACUITY: OD 20/20, OS 2/200.
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Central Retinal Artery Occlusion with Cilioretinal Sparing - Acute823 views 77-year-old man was doing fine until midnight of last night when he noticed sudden severe vision loss in the left eye. VISUAL ACUITY: OD 20/20, OS 2/200.
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Central Retinal Artery Occlusion with Cilioretinal Sparing - Acute - FA Very Slow Filling CRA915 views 77-year-old man was doing fine until midnight of last night when he noticed sudden severe vision loss in the left eye. VISUAL ACUITY: OD 20/20, OS 2/200.
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Central Retinal Artery Occlusion with Cilioretinal Sparing - Acute - FA Very Slow Filling CRA863 views 77-year-old man was doing fine until midnight of last night when he noticed sudden severe vision loss in the left eye. VISUAL ACUITY: OD 20/20, OS 2/200.
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Central Retinal Artery Occlusion with Cilioretinal Sparing - Acute - FA Very Slow Filling CRA813 views 77-year-old man was doing fine until midnight of last night when he noticed sudden severe vision loss in the left eye. VISUAL ACUITY: OD 20/20, OS 2/200.
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Central Retinal Artery Occlusion with Cilioretinal Sparing - Acute - FA Very Slow Filling CRA804 views 77-year-old man was doing fine until midnight of last night when he noticed sudden severe vision loss in the left eye. VISUAL ACUITY: OD 20/20, OS 2/200.
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Central Retinal Artery Occlusion with Cilioretinal Sparing - Acute - FA Very Slow Filling CRA742 views 77-year-old man was doing fine until midnight of last night when he noticed sudden severe vision loss in the left eye. VISUAL ACUITY: OD 20/20, OS 2/200.
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Central Retinal Artery Occlusion with Cilioretinal Sparing - Acute - FA Very Slow Filling CRA749 views 77-year-old man was doing fine until midnight of last night when he noticed sudden severe vision loss in the left eye. VISUAL ACUITY: OD 20/20, OS 2/200.
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Central Retinal Artery Occlusion with Cilioretinal Sparing - Acute610 views 77-year-old man was doing fine until midnight of last night when he noticed sudden severe vision loss in the left eye. VISUAL ACUITY: OD 20/20, OS 2/200.
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Central Retinal Artery Occlusion with Cilioretinal Sparing - Acute673 views 77-year-old man was doing fine until midnight of last night when he noticed sudden severe vision loss in the left eye. VISUAL ACUITY: OD 20/20, OS 2/200.
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Central Retinal Artery Occlusion with Cilioretinal Sparing - Acute - SD-OCT Line Scan Inner retinal edema1062 views 77-year-old man was doing fine until midnight of last night when he noticed sudden severe vision loss in the left eye. VISUAL ACUITY: OD 20/20, OS 2/200.
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Central Retinal Artery Occlusion with Cilioretinal Sparing - Acute - SD-OCT Line Scan Inner retinal edema1399 views 77-year-old man was doing fine until midnight of last night when he noticed sudden severe vision loss in the left eye. VISUAL ACUITY: OD 20/20, OS 2/200.
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Central Retinal Artery Occlusion with Cilioretinal Sparing - Acute - Line scan good eye895 views 77-year-old man was doing fine until midnight of last night when he noticed sudden severe vision loss in the left eye. VISUAL ACUITY: OD 20/20, OS 2/200.
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Central Retinal Artery Occlusion - MAP684 viewsProgression from acute to atrophy - decreasing retinal thickenss
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77-year-old man was seen in the office on May 3, 2012. He had carotid ultrasound done in April, which was okay. As far as he knows he was doing fine until midnight of last night when he noticed sudden severe vision loss in the left eye. He went to the hospital. He had a CT scan done at the time and some blood work, all of which was fine. He is not having any headache, no fevers, and no weight loss. He does take a baby aspirin as well as fish oil. His vision in the right eye is good and the left eye is poor.
VISUAL ACUITY: OD 20/20, OS 2/200. IOP: OD 14, OS 10.
SLIT EXAMINATION: The posterior chamber intraocular lens is in good position in both eyes.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.5. There is posterior vitreous separation and 1+ macular drusen.
OS: Vertical C/D ratio is 0.2. There is a posterior vitreous separation. There is a red area of retina just adjacent to the optic nerve where there is a ciliary retinal artery. There is a cherry red spot centrally.
SPECTRALIS-SD-OCT SCAN: The OCT scan of the right eye shows a normal foveal contour. The left eye shows inner retinal edema.
FUNDUS PHOTOGRAPHY - AUTO FLUORESCENCE: The image in the right eye shows some patchy hyper auto fluorescence corresponding to the macular drusen. The left eye shows hypo auto fluorescence centrally and it does look like there may be reflective plaque right in the middle of the central retinal artery.
FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography of the left eye shows non filling of the central retinal artery all the way out to five minutes. There is some retrograde filling through the retinal veins as the ciliary retinal artery fills those retrograde. The right eye shows some staining of the macular drusen.
IMPRESSION:
1. CENTRAL RETINAL ARTERY OCCLUSION – LEFT EYE WITH CILIARY RETINAL SPARING
2. DRY AGE-RELATED MACULAR DEGENERATION – RIGHT EYE
DISCUSSION: I explained to the patient unfortunately he has had a central retinal artery occlusion and the artery is still occluded. I did an anterior chamber tap in hope of improving the circulation a little bit. I tapped the pressure down to zero. I asked him to take eye vitamins to protect the right eye. I asked him to return here for a check in two weeks or sooner should he notice a problem and see you back regularly.
