Zakaria Nur Aisyah, Cheng Teck Chee, Nasaruddin Rona A, Che Hamzah Jemaima
Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS.
Department of Ophthalmology, Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, Kuala Lumpur, MYS.
Cureus. 2023 Aug 10;15(8):e43303. doi: 10.7759/cureus.43303. eCollection 2023 Aug.
This case report aims to describe a case of unilateral central retinal artery occlusion (CRAO) with cilioretinal artery sparing, which was complicated by neovascular glaucoma (NVG). A 75-year-old Indian woman with underlying normal tension glaucoma presented with the sudden onset of painless generalized blurring of the right eye's vision for a week. Her right eye vision was hand motion with the presence of a right relative afferent pupillary defect. Fundus examination revealed retinal whitening over the macula sparing the papillomacular bundle with generalized retinal arteriolar attenuation, which was suggestive of right CRAO with cilioretinal artery sparing. Systemic examination revealed high blood pressure (175/75 mmHg) without ocular bruit or audible murmur on auscultation. Optical coherence tomography of the macula showed inner retinal thickening over the temporal macula. Ultrasound carotid Doppler and computed tomography angiography of the carotid showed more than 75% stenosis over the right distal internal carotid artery. Unfortunately, she developed rubeosis iridis over her right eye two weeks after her presentation, which required pan-retinal photocoagulation. She subsequently progressed to NVG, requiring maximum anti-glaucoma medications to stabilize intraocular pressure. In conclusion, CRAO is a sight-threatening medical emergency. Thorough investigations are required to determine the underlying cause so that early intervention can be done to reduce the risk of a similar attack in the fellow eye and the risk of a cerebrovascular event or cardiac ischemia, which could be life-threatening. The presence of a cilioretinal artery does not prevent ocular neovascularization in CRAO. Hence, patients should also be closely monitored after the initial diagnosis to prevent devastating complications such as NVG.
本病例报告旨在描述一例伴有睫状视网膜动脉保留的单侧视网膜中央动脉阻塞（CRAO），该病例并发了新生血管性青光眼（NVG）。一名75岁的印度女性，患有原发性正常眼压性青光眼，右眼突然出现无痛性全视野模糊，持续一周。她的右眼视力为手动，存在右侧相对性传入性瞳孔障碍。眼底检查显示黄斑区视网膜变白，乳头黄斑束未受累，伴有视网膜动脉普遍变细，提示右侧CRAO伴睫状视网膜动脉保留。全身检查发现高血压（175/75 mmHg），听诊未闻及眼部杂音或可闻及的杂音。黄斑区光学相干断层扫描显示颞侧黄斑区视网膜内层增厚。颈动脉超声多普勒检查和颈动脉计算机断层血管造影显示右侧颈内动脉远端狭窄超过75%。不幸的是，她就诊两周后右眼出现虹膜新生血管，需要进行全视网膜光凝治疗。随后她进展为NVG，需要使用最大剂量的抗青光眼药物来稳定眼压。总之，CRAO是一种威胁视力的医疗急症。需要进行全面检查以确定潜在病因，以便尽早进行干预，降低对侧眼发生类似发作的风险以及脑血管事件或心脏缺血的风险，这些可能危及生命。睫状视网膜动脉的存在并不能预防CRAO中的眼部新生血管形成。因此，在初步诊断后也应对患者进行密切监测，以预防诸如NVG等毁灭性并发症。
