Department of Ophthalmology & Visual Sciences, Montefiore Medical Center/AECOM, New York, USA.
Department of Ophthalmology, Bronx Lebanon Hospital Center of Icahn School of Medicine at Mt Sinai, New York, USA.
Arq Bras Oftalmol. 2021 Jul 14;84(5):494-498. doi: 10.5935/0004-2749.20210073. eCollection 2021.
Patent foramen ovale might cause cryptogenic strokes, including retinal artery occlusion. Herein, we describe a previously healthy young man who presented with central retinal artery occlusion in the setting of patent foramen ovale and explore the need for transesophageal echocardiogram for its diagnosis. Cardiovascular workup and neuroimaging were unremarkable. Transthoracic echocardiogram bubble study revealed a right to left atrial shunt and subsequent transesophageal echocardiogram disclosed patent foramen ovale. This congenital cardiac anomaly was the likely conduit for a thrombo-embolic central retinal artery occlusion. We identified seven patients with patent foramen ovale associated with central retinal artery occlusion in the literature. Transthoracic echocardiogram was diagnostic in only one patient (14.3%), whereas transesophageal echocardiogram was required to reveal patent foramen ovale in the remaining six (85.7%). Our case and the previous reports support the link between central retinal artery occlusion and patent foramen ovale. Therefore, providers should consider the more sensitive transesophageal echocardiogram during the initial evaluation of young patients without immediately identifiable causes of retinal artery occlusion.
卵圆孔未闭可能导致隐源性中风，包括视网膜动脉阻塞。在此，我们描述了一位以前健康的年轻男性，他在卵圆孔未闭的情况下出现了视网膜中央动脉阻塞，并探讨了经食管超声心动图对其诊断的必要性。心血管检查和神经影像学均无明显异常。经胸超声心动图微泡研究显示右向左心房分流，随后经食管超声心动图显示卵圆孔未闭。这种先天性心脏异常可能是导致血栓栓塞性视网膜中央动脉阻塞的原因。我们在文献中发现了 7 例与视网膜中央动脉阻塞相关的卵圆孔未闭患者。经胸超声心动图仅在 1 例（14.3%）患者中具有诊断价值，而经食管超声心动图则需要在其余 6 例（85.7%）患者中显示卵圆孔未闭。我们的病例和之前的报告支持视网膜中央动脉阻塞与卵圆孔未闭之间的联系。因此，对于没有立即发现视网膜动脉阻塞原因的年轻患者，在初始评估中，医生应考虑更敏感的经食管超声心动图。
