Korean J Ophthalmol.  2009 Dec;23(4):315-317. 10.3341/kjo.2009.23.4.315.

Treatment of Branch Retinal Artery Occlusion With Transluminal Nd:YAG Laser Embolysis

• Lim JY
• Lee JY
• Chung HW
• Yoon YH
• Kim JG

• KMID: 754772
• DOI: http://doi.org/10.3341/kjo.2009.23.4.315

Abstract

The purpose of this paper was to report a successful treatment of transluminal Nd:YAG laser embolysis (NYE) for branch retinal artery occlusion (BRAO) with visible emboli. Two patients with acute, severe vision loss secondary to a branch retinal artery occlusion with visible emboli in one eye underwent NYE. A complete ocular examination was performed which included biomicroscopy of the posterior pole of the retina, intraocular pressure measurement, fundus color photographs, and fluorescein angiography (FA). After the NYE, the two patients showed dramatic improvements in best-corrected visual acuity, as well as, immediate and dramatic restorations in flow past the obstructed arteriole in FA. NYE is a treatment modality to be considered in patients with BRAO who present acutely with severe vision loss and a visible embolus.

Keyword

Branch retinal artery occlusion; Emboli; Nd:YAG laser

MeSH Terms

Aged
Aged, 80 and over
Female
Fluorescein Angiography
Follow-Up Studies
Fundus Oculi
Humans
Laser Coagulation/*methods
Lasers, Solid-State/*therapeutic use
Microscopy, Acoustic
Retinal Artery Occlusion/diagnosis/*surgery
Thrombectomy/*methods
Visual Acuity

Figure

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  Fig. 1 Color fundus photographs and fluorescein angiography (FA) showing branch retinal artery obstruction in case 1. (A) Color fundus photograph demonstrating an intraluminal embolus (arrow) and whitening of the retina along the inferior and temporal vascular arcades. inserted: the asterisk panel '*' shows a magnification of the embolus. (B) FA of the same patient showing obstructed blood flow at the site of the embolus and a downstream filling defect. (C) Color fundus photograph of the same patient taken five days after Nd:YAG laser embolysis (NYE). Note the small amount of vitreous hemorrhage around the disc. (D) Fluorescein angiography (FA) of the same patient five days after NYE showing perfusion at the site of the embolus and restoration of the downstream blood flow. (E) Color fundus photograph taken three months after NYE. There was no remaining vitreous hemorrhage. (F) FA at three months after NYE showing a patent retinal artery with good blood flow and no neovascularization.

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  Fig. 2 Color fundus photographs and fluorescein angiography showing branch retinal artery obstruction (BRAO) in Case 2. (A) Color fundus photograph six mon prior to BRAO. The asterisk panel '*' shows a magnification of the disc and indicates no transluminal embolus. (B) Color fundus photograph showing a superior temporal branch retinal artery occlusion. Note the transluminal embolus (arrow) and opacification of the retina along the superior and temporal vascular arcades. The double asterisk panel '**' shows a magnification of the transluminal embolus. (C) Fluorescein angiography (FA) showing the filling defect in the arteriole corresponding to the intraluminal embolus. (D) Color fundus photograph taken three days after Nd:YAG laser embolysis (NYE). Note the small amount of vitreous hemorrhage around the disc. (E) FA three days after NYE showing restoration of retinal blood flow. (F) Color fundus photograph taken two mon after NYE. Note the spontaneous clearing of the small vitreous hemorrhage. (G) FA two mon after NYE showing a return of retinal blood flow.

Reference

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