Central Retinal Artery Occlusion Following Central Retinal Vein Occlusion- A Case Report

Abstract

A 73-year-old gentleman with diabetes mellitus was found to have impending central retinal vein occlusion (CRVO), on routine eye checkup. Despite initiation of anti-platelet agent, he developed ischaemic CRVO two months later, with severe macula oedema. His systemic investigations showed good diabetic control, no blood dyscrasia/ hypercoagulable state, normal lipid profile and inflammatory markers. Echocardiogram was normal. A month later, arteriolar attenuation was noted with rubeosis irides, and fluorescein angiogram study confirmed central retinal artery occlusion (CRAO). After ruling out the systemic risk factors, we postulate two possible anatomical related patho-mechanism of CRAO following CRVO: 1, CRVO converts the retinal circulation into a closed loop, results in complete hemodynamic block of the retinal circulation, and hence secondary CRAO; 2, swollen retinal nerve fibres at the optic nerve head secondary to CRVO cause compression to the retinal artery at the level of the lamina cribrosa, this compression is further aggravated by the increased in intraocular pressure (IOP), and hence secondary CRAO.

Unilateral sequential papillophlebitis and central retinal artery occlusion in a young healthy patient

“…Although combined CRVO (or papillophlebitis) and CRAO entity tend to develop devastating complications such as rubeosis iridis, macular ischemia, and neovascular glaucoma,[ 10 ] in the present case, even in the 3 rd month of vascular occlusion, neovascularization or macular ischemia was not seen and the visual prognosis was excellent, due to good perfusion of cilioretinal artery in the affected eye. In this regard, this patient is one of the rare cases which vision is preserved despite the combined CRVO and CRAO.…”

Combined Central Retinal Vein and Branch Retinal Artery Occlusion Post Intense Physical Activity

“…Retinal arteries and veins share a common adventitial sheath at crossing sites, and a distended vein or artery secondary to an occlusion may result in the compression of the normal vessel at these points. The second mechanism suggests that the occlusion initially takes place in the venous system [ 7 ]. Since the retinal circulation is a closed system, it is probable that a pressure increase and resistance to flow in the venous system could eventually backflow in the arterial circulation, decreasing the rate of arterial blood flow.…”