Cilioretinal Artery Occlusion with Central Retinal Vein Occlusion

Messner, Leonard V.; Newman, Tricia L.; Bartlett, Matthew; Conto, John

doi:10.1097/00006324-199911000-00022

Cited by 4 publications

(2 citation statements)

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“…[ 25 ] It is also possible that the incidence of combined CRVO and CLRAO is grossly underestimated. [ 26 ] On the other hand, the 1st occurrence of CLRAO seems to confirm the hypothesis concerning primary arterial affection. [ 27 ] In evidence of arterial vasospasm, related to an increased contractility of the retinal arteries, initial retinal blanching along the cilioretinal artery followed by signs of venous stasis can be observed.…”

Section: Discussionmentioning

confidence: 54%

Cardiovascular risk factors in patients with combined central retinal vein occlusion and cilioretinal artery occlusion

Grzybowski

Elikowski²,

Gaca-Wysocka

2018

Medicine

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Rationale:To analyze cardiovascular risk factors and comorbidity of acute unilateral visual loss due to combined central retinal vein occlusion (CRVO) and cilioretinal artery occlusion (CLRAO).Patient concerns:Among patients with retinal vein or artery occlusion hospitalized at the Department of Ophthalmology between January 2011 and August 2017, subjects with combined CRVO/CLRAO were selected. All of them underwent ophthalmologic and cardiologic examination, including fluorescein angiography, optical coherence tomography, 12-lead electrocardiogram, transthoracic and transesophageal echocardiography, carotid Doppler sonography, cerebral magnetic resonance imaging, and a panel of laboratory tests.Diagnoses:Four subjects with coexisting CRVO and CLRAO were found among 146 patients with retinal vein or artery occlusion. There were no other types of concomitance of CRVO and retinal artery occlusion.Interventions:All patients were treated with low molecular heparin in a full dose for 2 weeks, then with 1 mg/kg once daily for the next 2 weeks, followed by acetylsalicylic acid 75 mg/kg/d. Other medication included long-term statins, angiotensin-converting-enzyme inhibitor in 3 patients and beta-blocker in one patient.Outcomes:All patients with CRVO/CLRAO presented multiple cardiovascular risk factors, including hypertension, obesity, hyperlipidemia, chronic nicotine addiction, and a positive family history of coronary artery disease or stroke. In all of them, echocardiography revealed left ventricular hypertrophy and atherosclerotic lesions in the descending aorta; in addition, 3 patients had insignificant atherosclerotic plaques in the carotid artery. Also, in 3 subjects, focal ischemic cerebral changes were diagnosed.Lessons:Patients with combined CRVO and CLRAO present numerous cardiovascular risk factors and abnormalities on imaging examinations, which should be routinely evaluated and treated.

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Section: Discussionmentioning

confidence: 54%

Cardiovascular risk factors in patients with combined central retinal vein occlusion and cilioretinal artery occlusion

Grzybowski

Elikowski²,

Gaca-Wysocka

2018

Medicine

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“…22 There are reports of CRVO with cilioretinal AO, which is believed to result from mechanical compression of the artery from increased venous pressure due to outflow obstruction. 23 In general, coagulation abnormalities are associated with increased homocysteine levels, Lp(a) levels, Factor V Leiden, protein S deficiency, protein C deficiency, and antithrombin III. [24][25][26][27][28] A complete hypercoagulability workup should be performed in all young patients with RAO, including eliciting a history of use of hormonal therapy and/or oral contraceptives.…”

Section: Discussionmentioning

confidence: 99%

Retinal Artery Occlusion in Young Patients: A 6-Year Review

Xia

Zarbin

Bhagat

2019

Journal of VitreoRetinal Diseases

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Purpose:This article describes the characteristics, management, and etiology of retinal artery occlusions (RAOs) in young patients.Methods:A retrospective chart review of patients <50 years of age with ophthalmic and RAOs was conducted. Data were collected on demographics, clinical presentation, laboratory and imaging evaluation, management, and outcome.Results:Seventeen eyes of 15 patients younger than 50 (mean age, 34±8 years; 71% male, 29% female) with RAOs were identified. AOs included: 8 (47%) central RAOs (CRAOs), 5 (29%) branch RAOs (BRAOs), 3 (18%) ophthalmic AOs (OAOs), and 1 (6%) combined CRAO and vein occlusion (CRAO/CRVO). Logarithm of the minimum angle of resolution visual acuity (VA) at presentation was 2.6±4 (Snellen range 20/15 to no light perception). Systemic diseases in patients with BRAO included Susac disease (n = 1), sickle cell disease (n = 2), patent foramen ovale (PFO) (n = 1), and HIV (n = 1). CRAO was diagnosed in 4 patients after invasive surgery (3 after neurosurgery and 1 after cardiac surgery). Other patients had hypertension (n = 3), hypercoagulability due to uterine cancer (n = 1), and PFO (n = 1). OAOs were noted in 1 patient with Saturday night retinopathy and in 1 with ruptured internal carotid aneurysm at the level of the ophthalmic artery. Two eyes with CRAO were treated with tissue plasminogen activator (1 intraophthalmic artery through catheterization and 1 intravenously) without any change in final VA. In these patients, VA remained poor (VA hand motions – counting fingers) at 6 months or greater follow-up visits.Conclusion:RAO in young patients is uncommon. In this series, one-fourth of occlusions were seen during the perioperative period. A significant number of patients had concurrent uncontrolled hypertension. Other associated systemic findings included PFO, hypercoagulability, sickle cell disease, Susac disease, and HIV.

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Central Retinal Vein Occlusion With Cilioretinal Infarction From Branch Flow Exclusion and Choroidal Arterial Steal

McLeod

2009

Retina

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In eyes with a cilioretinal supply, the probability that cilioretinal infarction will complicate retinal vein occlusion increases with increasing severity of venous obstruction and the more distally the cilioretinal artery arises from the posterior ciliary arterial tree. A distal branch point also facilitates observation of dye front reciprocation within the artery. Indicators of the degree of venous obstruction that may be necessary to instigate cilioretinal infarction include very prolonged dye transit times in the central retinal circulation, exaggerated venous cyanosis and tortuosity, perivenous cotton-wool sentinels, and macular perivenular whitening.

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Cilioretinal Artery Occlusion with Central Retinal Vein Occlusion

Cited by 4 publications

References 0 publications

Cardiovascular risk factors in patients with combined central retinal vein occlusion and cilioretinal artery occlusion

Cardiovascular risk factors in patients with combined central retinal vein occlusion and cilioretinal artery occlusion

Retinal Artery Occlusion in Young Patients: A 6-Year Review

Central Retinal Vein Occlusion With Cilioretinal Infarction From Branch Flow Exclusion and Choroidal Arterial Steal

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