J Neurocrit Care.  2018 Jun;11(1):58-62. 10.18700/jnc.180040.

Successful Endovascular Thrombectomy in a Patient with Monocular Blindness Due to Thrombus of the Ophthalmic Artery Orifice

• Jang SH
• Sohn SI
• Yoo J
• Hong JH

• KMID: 2426216
• DOI: http://doi.org/10.18700/jnc.180040

Abstract

BACKGROUND
Retinal artery occlusion can lead to sudden visual loss without pain. The acute management of retinal artery occlusion remains unresolved.
CASE REPORT
A 65-year-old male was hospitalized to an emergency room for visual loss on the left side within 6 hours of onset. Combined occlusion at retinal artery and ciliary artery was confirmed by an ophthalmologist and we assessed ophthalmic artery occlusion. However, MRA revealed no significant steno-occlusion of internal carotid artery. Transfemoral cerebral angiography was carried out immediately and showed a movable thrombus at the orifice of the ophthalmic artery. We decided on endovascular thrombectomy to prevent permanent visual loss. Finally, his visual acuity was improved after successful thrombectomy.
CONCLUSIONS
Although MRA is intact, small thrombus right at the orifice of the ophthalmic artery can cause a sudden monocular visual loss due to occlusion of the retinal artery. In this setting, urgent endovascular thrombectomy can offer visual improvement.

Keyword

Monocular blindness; Ophthalmic artery; Thrombectomy

MeSH Terms

Aged
Blindness*
Carotid Artery, Internal
Cerebral Angiography
Ciliary Arteries
Emergency Service, Hospital
Humans
Male
Ophthalmic Artery*
Retinal Artery
Retinal Artery Occlusion
Thrombectomy*
Thrombosis*
Visual Acuity

Figure

• 

  Figure 1. Fundus photograph and fluorescein angiography of the left eye obtained before endovascular thrombectomy. Visual acuty in the left eye had a finger count of 30 cm prior to endovascular thrombectomy. (A) Fundus photograph shows embolus in the retinal artery (thick arrow). (B) At 36 seconds, fluorescein angiography reveals marked retinal perfusion delay and perfusion delay of the ciliary artery (thin arrow).

• 

  Figure 2. Initial brain magnetic resonance image (MRI) and magnetic resonance angiography (MRA) (A). Diffusion-weighted MRI shows acute infarction in the left frontal lobe, suggestive of embolic infarction. (B, C) MRA of the intracranial and neck arteries shows no stenosis or occlusion at intracranial or extracranial arteries.

• 

  Figure 3. Digital subtraction angiography. (A) Pre-thrombectomy. Several thrombi just to the orifice of the ophthalmic artery was confirmed by conventional cerebral angiography (arrow). (B) Post-thrombectomy. The thrombus was successfully removed with endovascular thrombectomy.

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