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      Central Retinal Artery Occlusion after the Endovascular Treatment of Unruptured Ophthalmic Artery Aneurysm: A Case Report and a Literature Review

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          Abstract

          Endovascular coil embolization for ophthalmic artery (OphA) aneurysms has a risk of occlusion of the OphA, which can lead to loss of vision. The authors report a patient with unruptured OphA aneurysm which treated with endovascular coiling and were complicated by blindness due to OphA thromboembolic occlusion after the procedure. The OphA successfully recanalized using local intra-arterial fibrinolysis with complete regain of visual acuity. The risk of visual loss due to thromboembolic complications cannot be ignored during endovascular coiling of the OphA aneurysm despite of good retrograde flow during OphA occlusion test using a balloon catheter. Rapid intervention is required for recovering visual disturbance in such a situation.

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          Central retinal artery occlusion: visual outcome.

          Shawn M. Zimmerman, Sohan Hayreh (2005)
          To investigate systematically the natural history of visual outcome in central retinal artery occlusion (CRAO). Cohort study. At entry, 244 consecutive patients (260 eyes) with CRAO (seen consecutively from 1973 to 2000) had a detailed ocular and medical history and ocular evaluation. CRAO eyes were classified into four categories: non-arteritic (NA) CRAO (171 eyes), NA-CRAO with cilioretinal artery sparing (35), transient NA-CRAO (41), and arteritic CRAO (13). Within 7 days of onset of CRAO, initial visual acuity differed among the four CRAO types (P < .0001). In eyes with vision of counting fingers or worse, it improved in 82% of eyes with transient NA-CRAO, 67% of eyes with NA-CRAO with cilioretinal artery sparing, and 22% of eyes with NA-CRAO. Visual acuity improved primarily within the first 7 days (P < .0001). In the central 30-degree visual field, central scotoma was most common. Central visual field improved in 39% with transient NA-CRAO, 25% with NA-CRAO with cilioretinal artery sparing, and 21% with NA-CRAO. Peripheral visual field was normal in 62.9% of eyes with transient NA-CRAO and 22.1% in those with NA-CRAO. In 51.9% of eyes with NA-CRAO, the only remaining visual field was a peripheral island. Peripheral fields improved in NA-CRAO (39%) and in transient NA-CRAO (39%). Classification of CRAO is crucial for understanding differences in visual outcome. Marked improvement in visual acuity and visual field can occur without treatment and is determined by several factors. Visual field information is essential to evaluate visual disability in CRAO.
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            Central retinal artery occlusion: local intra-arterial fibrinolysis versus conservative treatment, a multicenter randomized trial.

            Martin Schumacher, Dieter Schmidt, Bernhard Jurklies … (2010)
            The reported outcomes of central retinal artery occlusion (CRAO) with or without treatment vary considerably. Although local intra-arterial fibrinolysis (LIF) using recombinant tissue plasminogen activator (rtPA) is a promising treatment, outcomes have not been compared in randomized trials. Prospective randomized multicenter clinical trial (the European Assessment Group for Lysis in the Eye Study) to compare treatment outcome after conservative standard treatment (CST) and LIF for acute nonarteritic CRAO. Between 2002 and 2007, 9 centers in Austria and Germany recruited 84 patients (40 received CST, 44 received LIF), and data for 82 patients were analyzed. Patients (age 18-75 years) with CRAO, symptoms for 20 hours or less, and best-corrected visual acuity (BCVA) or = 0.3 logMAR) was noted in 60.0% (CST) and 57.1% (LIF) of patients. Two patients in the CST group (4.3%) and 13 patients in the LIF group (37.1%) had adverse reactions. Because of apparently similar efficacy and the higher rate of adverse reactions in the LIF group, the study was stopped after the first interim analysis at the recommendation of the data and safety monitoring committee. In light of these 2 therapies' similar outcomes and the higher rate of adverse reactions associated with LIF, we cannot recommend LIF for the management of acute CRAO. The author(s) have no proprietary or commercial interest in any materials discussed in this article. Copyright 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
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              Aneurysms of the ophthalmic segment. A clinical and anatomical analysis.

              Emily A. Day (1990)
              The clinical, radiographic, and anatomical features in 80 patients with ophthalmic segment aneurysms were reviewed, and were categorized according to a presumed origin related to the ophthalmic (41 cases) or superior hypophyseal (39 cases) arteries. There was a marked female predominance (7:1) and high incidence of multiple aneurysms (45%) within this population. Clinical presentations included subarachnoid hemorrhage in 23 cases (29%) and visual deficits in 24 (30%); five patients exhibited both hemorrhage and visual loss. Twenty-eight aneurysms were incidentally identified. Ophthalmic artery aneurysms arose from the internal carotid artery (ICA) just distal to the ophthalmic artery, pointed superiorly or superomedially, and (when large) deflected the carotid artery posteriorly and inferiorly, closing the siphon. Abnormalities relating to vision were not identified until the aneurysm realized giant proportions. The optic nerve was typically displaced superomedially, which restricted contralateral extension until late in the clinical course; unilateral nasal field loss was seen in 12 patients. Nine patients had bilateral ophthalmic artery aneurysms which were often clipped via a unilateral craniotomy. Superior hypophyseal artery aneurysms arose just above the dural ring from the medial bend of the ICA, at the site of perforator origin to the superior aspect of the hypophysis, and had no direct association with the ophthalmic artery. The carotid artery was usually located lateral or superolateral relative to the aneurysm. These lesions could extend medially beneath the chiasm (suprasellar variant), producing a clinical and computerized tomography picture similar to a pituitary adenoma, or they could extend ventrally to burrow beneath the anterior clinoid process (paraclinoid variant). Preoperative categorization of these lesions according to their likely branch of origin provides excellent correlation with visual deficits and operative findings, and has allowed the author to clip 52 of 54 lesions, with very low operative or visual morbidity.
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                Author and article information

                Journal
                Journal ID (nlm-ta): NMC Case Rep J
                Journal ID (iso-abbrev): NMC Case Rep J
                Journal ID (publisher-id): NMCCRJ
                Title: NMC Case Report Journal
                Publisher: The Japan Neurosurgical Society
                ISSN (Electronic): 2188-4226
                Publication date Collection: July 2016
                Publication date (Electronic): 19 May 2016
                Volume: 3
                Issue: 3
                Pages: 71-74
                Affiliations
                [1 ]Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
                [2 ]Department of Neuroendovascular Therapy, Tohoku University Graduate School of Medicine, Sendai, Japan
                [3 ]Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan
                [4 ]Neuroendovascular section, Department of Neurology, Faculty of Medicine, Tanta University, Tanta, Egypt
                Author notes
                Corresponding author: Kenichi Sato, MD, PhD, Department of Neuroendovascular Therapy, Kohnan Hospital, 4-20-1 Nagamachi-minami, Taihaku-ku, Sendai, 982-8523, Japan. kenmina@ 123456nsg.med.tohoku.ac.jp
                Article
                Publisher ID: nmccrj-3-071
                DOI: 10.2176/nmccrj.cr.2015-0243
                PMC ID: 5386170
                PubMed ID: 28664002
                SO-VID: 539e0bf3-0bcf-4a27-ac65-8c75a54c4ebb
                Copyright © Copyright © 2016 The Japan Neurosurgical Society
                License:

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/

                History
                Date received : 21 September 2015
                Date accepted : 11 February 2016
                Categories
                Subject: Case Report

                Keywords: central retinal artery,complication,endovascular therapy,local intra-arterial fibrinolysis,ophthalmic artery aneurysm
                Data availability:
                Keywords: central retinal artery, complication, endovascular therapy, local intra-arterial fibrinolysis, ophthalmic artery aneurysm

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