Central retinal artery occlusion due to infective endocarditis

Abstract

We present a case of central retinal artery occlusion (CRAO) in a 59-year-old male suffering from infective endocarditis. The patient was receiving antibiotic treatment for the endocarditis for 5 days prior to the event and received conservative treatment for the CRAO without any improvement. A few days after the event, the patient underwent heart surgery with aortic and mitral valve replacement and eventually recovered without any other side-effects. CRAO is a rare but devastating embolic complication of infective endocarditis and can happen regardless of whether a patient is receiving systemic antibiotic treatment or not. These patients need close observation, because an immediate diagnosis and an urgent therapeutic procedure are mandatory, as the prognosis for vision is poor.

Central retinal artery occlusion fromStreptococcus gallolyticusendocarditis

“…5 6 It is estimated to be the aetiologic agent of IE in 11%-14% of cases. 5 To the best of our knowledge, this is the first reported case of CRAO due to S. gallolyticus IE and highlights the importance of multidisciplinary approach.…”

Bilateral Central Retinal Artery Occlusion in Infective Endocarditis

“…3 Ophthalmic manifestations include retinal hemorrhages, cotton-wool spots, Roth spots, CRAO, branch retinal artery occlusion, cilioretinal artery occlusion, and ophthalmic artery occlusion. [4][5][6][7] Most ocular embolic events have been reported to occur within the first 2 to 4 weeks of antimicrobial therapy. 8,9 CRAO is a rare but blinding ocular emergency, with an incidence of about 1 per 100 000 per year.…”

“…10 Embolism is the most common cause of CRAO, typically arising from the carotid artery, with the heart accounting for less than 10% of cases. 4,11 CRAO of embolic origin in patients suffering from IE is a very uncommon but potentially blinding complication. Other rare sources of emboli include fat or air secondary to trauma, talc emboli due to intravenous drug use, and synthetic emboli from iatrogenic procedures.…”

“…Although treatment of CRAO can be attempted by reducing the IOP via a combination of ocular massage, IOP-lowering medications, or anterior chamber paracentesis to increase retinal perfusion pressure, there are no proven treatments to reverse vision loss from CRAO. 4,21 Therefore, prompt recognition and treatment of IE are critical to prevent devastating embolic complications such as CRAO and to further reduce morbidity and mortality.…”

Peripheral ischaemic retinopathy and neovascularisation in a patient with subacute streptococcus mitis-induced bacterial endocarditis

“…In bacterial endocarditis, microembolisation of bacteria or debris from the damaged valve frequently occurs in the brain, spleen, kidney, and skin [ 6 ]. Seldomly, other organs may show evidence of embolic involvement, including the eye as evidenced by rare cases of central retinal artery occlusion [ 7 ], [ 8 ]. In our patient, continuous metastatic microembolisation of bacteria or debris from the damaged valve uniquely led to occlusion of the peripheral retinal vessels, resulting in extensive areas of ischemia triggering a proliferative ischaemic vasculopathy.…”