A 54-year-old male patient presented with a sudden painless decrease in vision in his right eye (RE) for 2 days. He had no history of trauma. He was hypertensive and was on irregular treatment.
On examination, his BCVA in the right eye (RE) was counting fingers close to the face. His BCVA in LE was 20/20. Anterior segment exam was normal. Fundus exam of RE revealed the presence of a white ischemic area in the posterior pole inferior to the fovea with boxcarring of vessels (red and white arrows). The optic disc was normal. Diagnosis of RE branch retinal artery occlusion was made.
OCT exam revealed the presence of hyperreflective inner layers. OCTA revealed the presence of ischemia in the inferior half of the retina.
The patient was given an ocular massage. Paracentesis was also done. OCTA was repeated after this manoeuvre. OCTA revealed the presence of perfusion in retinal vessels after ocular massage. In addition, it was seen in the color fundus photograph that blood flow has started in the area where there was no flow in the artery previously indicated with the red arrow. The visual acuity improved to 20/ 200 after ocular massage and paracentesis .After 2 weeks, on follow-up, BCVA improved to 20/80.
He was advised to undergo cardiological investigations. The patient underwent Carotid Doppler and was found to have a diffuse atherosclerotic thickening of bilateral carotid arteries with calcified plaque in the left carotid artery. He was started on statins and anti-platelet therapy and is under cardiac follow-up.
Branch retinal arterial occlusion occurs from the obstruction of a branch of the central retinal artery and results in focal ischaemia of the wedge-shaped area. The resultant hypoperfusion of retinal tissue may result in painless vision loss. Patients with hypertension should be routinely screened for various micro- and macrovascular complications, and prophylactic management should be done when required.
Credit: Dr. Kanwaljeet Harjot Madan, M.S. (Ophthal) P. G. I., (FAICO) Fellow Vitreous – Retina, Vitreo – Retinal Surgeon,
Thind Eye Hospital, Jalandhar City (Punjab). India
Instagram account: @drkhmadan