Purpose:

To report a clinical case of surgical treatment of acute hemi-central retinal artery occlusion.

Methods:

A 52 years old female with hemi-central retinal artery occlusion due to calcific emboli (CE) on her right eye (RE) was operated on the 7th day after the event. The combined procedure that included phacoemulsification, intraocular lens implantation, pars plana vitrectomy and embolectomy followed fluid/air exchange was performed. Best corrected visual acuity (BCVA), fundus fluorescein angiography (FA), optical coherent tomography (OCT) and visual field (VF) examination were performed before and in 2 and 8 weeks after surgical treatment.

Results:

On the second day after the occlusion her initial BCVA on (RE) was 20/800. Fundus ophthalmosopy revealed calcific emboli that occluded lower branch of central artery in the area of optic disc and pale foveal zone. FA of the RE revealed postponed arterial phase in lower quadrants that corresponded to the occluded central retinal artery branch. OCT showed diffuse paracentra retinal oedema. Visual fields defects were observed in upper quadrants. During pars plana vitrectomy the vascular wall was cut with 25-gauge MVR blade and CE was removed with 23-gauge forceps. There was no bleeding noted right after embolectomy. Intraocular pressure was set to 60 mmHg for 5 min. In two weeks follow-up BCVA was 20/25. VF was still affected with significant improvement and with residual scotoma left. On FA arterial phase was restored, OCT showed reduction of macular oedema and pale zone of the fovea has disappeared.

Conclusions:

Surgical embolectomy following pars plana vitrectomy is the only etiologic treatment for acute hemi-central retinal artery occlusion caused by calcific emboli. The presence of the venous phase in the area of postponed arterial phase on FA is a good prognostic sign for postoperative visual acuity improvement. However, the visual field defects may persist.

Contact Details:

Email: lubko_l@yahoo.co.uk
Cell Phone: +380676708355