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Recurrent Retinal and Choroidal Ischemia in a Case of Ocular Ischemic Syndrome

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Case Reports

Recurrent Retinal and Choroidal Ischemia in a Case of Ocular Ischemic Syndrome

Koushik Tripathy et al. Ther Adv Ophthalmol.

Abstract

A 62 year-old male patient presented with fluctuating vision in both eyes. On fundus fluorescein angiogram, there was an area of choroidal and retinal ischemia in the left eye. The carotid evaluation revealed complete stenosis of the right internal carotid artery and 90% stenosis of the left internal carotid artery for which he underwent left modified endarterectomy. The vision and angiographic features improved after the procedure. Eleven months after the procedure, he again presented with choroidal ischemia due to recurrent left internal carotid artery blockage which improved gradually after carotid stenting.

Keywords: atherosclerosis; choroidal filling; giant cell arteritis; short posterior ciliary artery; triangle of Amalric.

Conflict of interest statement

Conflict of interest statement: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
(a) The fundus picture of the left eye at the presentation, showed venous dilation, (b) The early arteriovenous (AV) phase of fundus fluorescein angiogram (FFA) image showed a slowly progressing front edge of the dye (*) in the superotemporal retinal artery (suspected cilioretinal artery) and delayed filling of the superotemporal retinal vein. The perfusion of whole choroid seems delayed and compromised, (c) Late AV phase, showed the area of choroidal ischemia, and sluggish flow in the superotemporal retinal artery (*), (d, e) Mid phase showed disk leak and the horizontal area of choroidal ischemia (in between arrowheads), (f) Late phase showed obvious disk leak and paravascular staining.
Figure 2.
Figure 2.
(a) The right fundus at presentation, (b) Early phase of FFA revealed irregular caliber of the retinal arterioles and microvascular abnormality around the fovea and temporal microaneurysms, (c) The late FFA image of the right eye showed mild perifoveal capillary leak, (d) The optical coherence tomography (OCT) scan of the right fovea showed normal foveal contour and absence of intraretinal/subretinal fluid, (e) The vertical optical OCT scan (going from inferior to superior) of the left fovea shows mild inner retinal thinning of the superior macula. FFA: fundus fluorescein angiogram.
Figure 3.
Figure 3.
(a) Four and half months after carotid endarterectomy, the choroidal and retinal ischemia has markedly improved, but there is still some paravascular capillary leakage (b) in the late phase and disk leak, (c) Eleven month after the procedure, left eye showed neovascularization of the disk. The arterial phase (d) showed impaired choroidal perfusion and arterial dye front in the superotemporal retinal artery. The arteriovenous phase (e) shows sluggish arterial circulation, and evident recurrent choroidal ischemia. Late phase (f) shows severe paravascular and capillary leak and disk leak. Peripheral retinal capillary nonperfusion areas were noted (g, h, i).
Figure 4.
Figure 4.
(a) Fundus photo of the left eye two and a half month after carotid stenting, (b, c, d) Corresponding FFA showed improved retinal and choroidal circulation, (e) Fundus photo after 2 and ½ years of carotid stenting of the left side, (f, g, h) FFA shows subtle residual choroidal ischemia and mild disk staining in the late phase (h). FFA: fundus fluorescein angiogram.

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