J Korean Ophthalmol Soc.  2017 Apr;58(4):478-481. 10.3341/jkos.2017.58.4.478.

A Case Report of Central Retinal Artery Occlusion Caused by Cardiac Myxoma

• Kim J
• Choi IH
• Choi KS

• KMID: 2376607
• DOI: http://doi.org/10.3341/jkos.2017.58.4.478

Abstract

PURPOSE
We report the case of a patient diagnosed with central retinal artery occlusion caused by cardiac myxoma who underwent surgery to remove the myxoma.
CASE SUMMARY
A 47-year-old woman came to our clinic presenting with a sudden decrease of visual acuity in the left eye. At the first visit, left eye visual acuity was hand motion, and intraocular pressure was 15.4 mmHg. A relative afferent pupillary defect was observed in the left eye. On fundus examination, a pale retina and cherry-red spot were observed at the posterior pole. On optical coherence tomography, macular edema was found. On fluorescein angiography and indocyanine green angiography, delayed blood circulation of the retina and choroid was found at early and late stages. Cerebral angiography was performed in the neurosurgery department and showed no occlusion of the ophthalmic artery. Cardiac ultrasonography and brain magnetic resonance imaging were performed. On cardiac ultrasonography, 4.46 × 2.09 cm cardiac myxoma was found. Resection of the cardiac myxoma was conducted in the thoracic and cardiovascular surgery department. Multiple cerebral infarcts were detected by brain imaging, and antithrombotic treatment was administered. After one month, blood circulation in the retina and choroid was observed in fluorescence angiography, but there was no improvement of visual acuity. At the 3-month follow-up visit, macular edema was decreased, but retinal atrophy and epiretinal membrane were observed on optical coherence tomography.
CONCLUSIONS
Central retinal artery occlusion is a disease related to one's general condition. We experienced this case of central retinal artery occlusion caused by cardiac myxoma.

Keyword

Cardiac myxoma; Central retinal artery occlusion; Retina

MeSH Terms

Angiography
Atrophy
Blood Circulation
Brain
Cerebral Angiography
Choroid
Epiretinal Membrane
Female
Fluorescein Angiography
Follow-Up Studies
Hand
Humans
Indocyanine Green
Intraocular Pressure
Macular Edema
Magnetic Resonance Imaging
Middle Aged
Myxoma*
Neuroimaging
Neurosurgery
Ophthalmic Artery
Pupil Disorders
Retina
Retinal Artery Occlusion*
Retinal Artery*
Retinaldehyde
Tomography, Optical Coherence
Ultrasonography
Visual Acuity
Indocyanine Green
Retinaldehyde

Figure

• 

  Figure 1. Patient case. (A) Fundus photography at first visit. Ischemic change of the posterior pole and cherry-red spot were observed. (B) Optical coherence tomography showing edematous retina. (C, D) Fluorescein angiography and Indocyanine green an-giography image at first visit. (C) At the early phase of Fluorescein/Indocyanine green angiography (FAG/ICG), we could find de-layed arm to retina time (24 seconds) and delayed choroidal circulation. (D) At the late phase of FAG/ICG (7:40), hypofluorescent lesions are observed in the superior, inferior, and temporal area of the optic disc including fovea.

• 

  Figure 2. Echocardiographic and brain magnetic resonance imaging findings. (A) Transthoracic echocardiographic finding. Mass with irregular margin in the left atrium (in subcostal view, arrow). (B) Brain magnetic resonance T2 imaging. Multiple micro-infarctions (more than 15) were found (arrows). LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle; MV = mitral valve.

• 

  Figure 3. Gross and pathologic slide pictures of resected myxoma. (A) Grossly, tumor mass showed heterogeneouslymyxoid appear-ance with focal hemorrhage. (B) Tumor cells consisted of hypocellular, fibromyxoid or loose myxoid stroma (Hematoxylin and eosin stain [HE] stain, ×40). (C) Tumor cells were spindled or stellated with occasional syncytia and had indistinct cell borders and hyperchromatic nuclei (HE stain, ×400). (D) Tumor cells showed positivity for CD34 (CD34, ×100).

• 

  Figure 4. Fluorescein angiography/Indocyanine green angiography (FAG/ICG) image (1 month later from the first visit). Optical co-herence tomography (3 months later from the first visit). (A) At the early phase of FAG/ICG, we could find recovered arm to retina time (18 seconds) and recovered choroidal circulation. (B) Optical coherence tomography shows retinal edema and epiretinal membrane.

Reference

References

1. Woo SC, Lip GY, Lip PL. . Associations of retinal artery occlusion and retinal vein occlusion to mortality, stroke, and myocardial in-farction: a systematic review. Eye (Lond). 2016; 30:1031–8.

2. Zheng JJ, Geng XG, Wang HC. . Clinical and histopathological analysis of 66 cases with cardiac myxoma. Asian Pac J Cancer Prev. 2013; 14:1743–6.

3. Varma DD, Cugati S, Lee AW, Chen CS. . A review of central retinal artery occlusion: clinical presentation and management. Eye (Lond). 2013; 27:688–97.

4. Lee SJ, Kim JH, Na CY, Oh SS. . Eleven years’ experience with Korean cardiac myxoma patients: focus on embolic complications. Cerebrovasc Dis. 2012; 33:471–9.

5. Schmidt D, Hetzel A, Geibel-Zehender A. . Retinal arterial occlusion due to embolism of suspected cardiac tumors - report on two patients and review of the topic. Eur J Med Res. 2005; 10:296–304.

6. Yuan SM, Humuruola G. . Stroke of a cardiac myxoma origin. Rev Bras Cir Cardiovasc. 2015; 30:225–34.

7. Bayir H, Morelli PJ, Smith TH, Biancaniello TA. . A left atrial myx-oma presenting as a cerebrovascular accident. Pediatr Neurol. 1999; 21:569–72.