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RETINAL ARTERY OCCLUSION AFTER INTRAVASCULAR PROCEDURES: Case Series and Literature Review

Cho, Soo Chang, MD, MS*,†; Jung, Cheolkyu, MD; Lee, Joo Yong, MD, PhD§; Kim, Sang Jin, MD, PhD; Park, Kyu Hyung, MD, PhD*; Woo, Se Joon, MD, PhD*

doi: 10.1097/IAE.0000000000002008
Original Study: PDF Only

Purpose: To evaluate clinical characteristics and possible mechanisms of retinal artery occlusion (RAO) after intravascular procedures.

Methods: This study is retrospective case series and literature review. Twenty-seven patients with intravascular procedure–associated RAO (10 new patients and 17 from previous reports) were divided into Groups 1 and 2 according to assumed etiology—dislodged and new emboli, respectively. Clinical features and etiology of RAO were analyzed.

Results: Branch and central RAO were observed in 17 (63%) and 10 (37%) patients, respectively, and 61.1% of patients exhibited final BCVA ≥20/40. Intravascular procedures were performed at the carotid artery (48.1%), heart (25.9%), carotid artery or heart (3.7%), brain (11.1%), scalp/glabella (7.4%), and thyroid (3.7%). Ratio of patients with immediate and delayed (≥24 hours after procedure) onset of RAO was 17 (63.0%):10 (37.0%). In Group 1 (n = 16), RAO was associated with dislodged plaques in the carotid artery (9; 56.3%), heart (6; 37.5%), or carotid artery/heart (1; 6.3%), and one patient each experienced acute brain infarction and contralateral branch retinal artery occlusion. In group 2 (n = 11), RAO was associated with new thrombi (6; 54.5%) or emboli (5; 45.5%), and one patient experienced ocular pain, ophthalmoplegia, and blepharoptosis.

Conclusion: Intravascular procedures might result in RAO because of embolic plaques dislodged from the carotid artery or heart, or new thrombi or embolic materials migrating through collateral channels. Branch retinal artery occlusion was more frequent than central retinal artery occlusion after intravascular procedures, which resulted in relatively good visual outcomes. Patients should be informed about immediate or delayed presentation of RAO after intravascular procedures.

This study investigated clinical characteristics and possible mechanisms of retinal artery occlusion after intravascular procedures. Intravascular procedures might result in retinal artery occlusion because of embolic plaques dislodged from the carotid artery or heart, or new thrombi or embolic materials migrating through collateral channels. Branch retinal artery occlusion was more frequent than central retinal artery occlusion after intravascular procedures, which resulted in relatively good visual outcomes.

*Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea;

Department of Bioinformatics and Statistics, Korea National Open University, Seoul, Republic of Korea;

Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea;

§Department of Ophthalmology, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea; and

Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Reprint requests: Se Joon Woo, MD, PhD, Department of Ophthalmology, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea; e-mail: sejoon1@snu.ac.kr

Supported by the National Research Foundation of Korea Grant 2016R1D1A1B03934724, funded by the Korean government (Ministry of Science, ICT and Future Planning; MSIP). The funding organization had no role in the design or conduct of this study.

None of the authors has any conflicting interests to disclose.

© 2018 by Ophthalmic Communications Society, Inc.