J Korean Ophthalmol Soc.  2014 Feb;55(2):304-308. 10.3341/jkos.2014.55.2.304.

A Case of Idiopathic Pediatric Acute Branch Retinal Artery Occlusion Involving the Macular Area

• Jang JH
• Moon JW
• Cho YW

• KMID: 2218428
• DOI: http://doi.org/10.3341/jkos.2014.55.2.304

Abstract

PURPOSE
We report a case of branch retinal artery occlusion (BRAO) interconnected with the perifoveal capillaries in a healthy young female.
CASE SUMMARY
A 16-year-old female presented with sudden loss of vision in her left eye. Upon initial examination, her left visual acuity was 0.02 and intraocular pressure was 31 mm Hg. Fundus examination revealed pallid retinal edema of the inferior posterior pole and retinal hemorrhage below optic disc. Ocular massage followed by anterior chamber paracentesis was performed for 30 minutes within 4 hours after the onset of vision loss. Fluorescein angiography (FAG) showed a very slow blood flow in the superotemporal and inferotemporal retinal arteries and a delay in retinal arteriovenous transit time. We performed hemodynamic tests such as blood pressure, echocardiography, and the hematologic test for thrombogenicity and all tests were normal. At three weeks after treatment, vision in the left eye was 0.7 and FAG revealed normal retinal arterial circulation and venous drainage time.
CONCLUSIONS
This is the first report regarding acute BRAO in a healthy Korean child without any detectable systemic disorder. Prompt treatment can prevent permanent visual loss in BRAO involving the macular area.

Keyword

Acute branch retinal artery occlusion; Idiopathic pediatric; Macular area

MeSH Terms

Adolescent
Anterior Chamber
Blood Pressure
Capillaries
Child
Drainage
Echocardiography
Female
Fluorescein Angiography
Hematologic Tests
Hemodynamics
Humans
Intraocular Pressure
Massage
Papilledema
Paracentesis
Retinal Artery
Retinal Artery Occlusion*
Retinal Hemorrhage
Retinaldehyde
Visual Acuity
Retinaldehyde

Figure

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  Figure 1. Color fundus photography of the right eye shows a normal retina (A), a pale retina along the inferotemporal vascular arcade, mild venous tortuosity, and flame shaped retinal hemorrhages are seen in the left eye (B).

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  Figure 2. Fluorescent angiography of the left eye after ocular massage. Superotemporal and inferotemporal branch retinal arteries filling is very delayed, whereas the choroidal vascular bed fills normally. Ateriovenous transit time (E-B) is delayed to about 32 seconds. Dye is reached to temporal peripheral area for 2 minutes. Red arrows show the sites of the downstream filling defects.

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  Figure 3. Color fundus photography and fluorescent angiography of the left eye 3 weeks after treatment. Arterial filling and arteriovenous transit time is normal. There is no retinal arterial occlusion.

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  Figure 4. Visual field examination of the left eye (A) at initial examination, (B) at 3 weeks after treatment. Visual field reveals slight superior central scotoma within 10 degrees.

Reference

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