Pourazizi Mohsen, Dehghani Alireza, Karbasi Sepehr, Rahmanipour Elham
Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran.
Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Case Rep Ophthalmol. 2024 Oct 18;15(1):730-735. doi: 10.1159/000541498. eCollection 2024 Jan-Dec.
Central retinal artery occlusion (CRAO) is a serious ophthalmic disease predominantly affecting older individuals with cardiovascular risk factors. While most cases are attributed to thrombus formation from atheromatous plaques or cardioembolic events, trauma-related CRAO, though rare, presents unique diagnostic and therapeutic challenges.
A 47-year-old woman with multiple controlled comorbidities presented to the emergency department with right eye pain and erythema following a traumatic injury involving a knitting needle. Initial examinations revealed hand motion visual acuity in the right eye, a partial thickness scleral laceration, and conjunctival laceration, which were surgically repaired. Postoperatively, she developed blurred vision, hyphema, and signs of CRAO, prompting anterior chamber paracentesis. OCT imaging revealed marked hyperreflectivity and thickening of the inner retinal layers, indicating significant ischemic damage. Despite normal inflammatory markers, the patient's visual acuity gradually improved from 2/10 to 5/10 with intervention and eventually reached 10/10 with myopic correction after the hyphema resolved.
The case emphasizes the necessity of early recognition and intervention in managing traumatic CRAO to mitigate irreversible retinal damage. It underscores the need for enhanced diagnostic and therapeutic strategies as understanding the condition's pathophysiology advances.
视网膜中央动脉阻塞(CRAO)是一种严重的眼科疾病,主要影响有心血管危险因素的老年人。虽然大多数病例归因于动脉粥样硬化斑块形成血栓或心脏栓塞事件,但创伤相关性CRAO虽然罕见,但却带来了独特的诊断和治疗挑战。
一名47岁患有多种可控合并症的女性因针织针造成的外伤后出现右眼疼痛和红斑而就诊于急诊科。初步检查发现右眼手动视力、部分厚度巩膜裂伤和结膜裂伤,均进行了手术修复。术后,她出现视力模糊、前房积血和CRAO体征,促使进行前房穿刺。光学相干断层扫描(OCT)成像显示视网膜内层明显高反射和增厚,表明存在严重的缺血性损伤。尽管炎症指标正常,但经干预后患者视力从2/10逐渐提高到5/10,前房积血消退后经近视矫正最终达到10/10。
该病例强调了早期识别和干预外伤性CRAO以减轻不可逆视网膜损伤的必要性。随着对该疾病病理生理学认识的提高,它强调了加强诊断和治疗策略的必要性。