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Case Reports
. 2010 Sep-Oct;58(5):425-32.
doi: 10.4103/0301-4738.67069.

Hemi-central retinal artery occlusion in young adults

Pukhraj Rishi  1 , Ekta Rishi, Tarun Sharma, Sheshadri Mahajan
Affiliations
Case Reports

Hemi-central retinal artery occlusion in young adults

Pukhraj Rishi et al. Indian J Ophthalmol. 2010 Sep-Oct.

Abstract

Amongst the clinical presentations of retinal artery occlusion, hemi-central retinal artery occlusion (Hemi-CRAO) is rarely described. This case series of four adults aged between 22 and 36 years attempts to describe the clinical profile, etiology and management of Hemi-CRAO. Case 1 had an artificial mitral valve implant. Polycythemia and malignant hypertension were noted in Case 2. The third patient had Leiden mutation while the fourth patient had Eisenmenger's syndrome. Clinical examination and fundus fluorescein angiography revealed a bifurcated central retinal artery at emergence from the optic nerve head, in all cases. Color Doppler examination of the central retinal artery confirmed branching of the artery behind the lamina cribrosa. It is hypothesized that bifurcation of central retinal artery behind the lamina cribrosa may predispose these hemi-trunks to develop an acute occlusion if associated with underlying risk factors. The prognosis depends upon arterial recanalisation and etiology of the thromboembolic event.

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Figures

Figure 1
Figure 1
Case 1. Color fundus photograph of the right eye shows attenuation of the superior and supero-temporal retinal arterioles. Retinal pigment epithelial alterations are noted in the macula
Figure 2
Figure 2
Case 1. Color fundus photograph of the optic nerve head shows the superior (A) and inferior (B) hemi-trunks of central retinal artery emerging separately
Figure 3
Figure 3
Case 1. Early phase FFA shows superior hemi-trunk of central retinal artery with a reduced arteriolar caliber and filling-in earlier as compared to the inferior hemi-trunk
Figure 4
Figure 4
Case 1. A (30-2) Humphrey’s visual field analysis of the right eye shows an inferior altitudinal defect corresponding to the territory of vascular occlusion
Figure 5
Figure 5
Case 1. Right eye OCT revealed retinal thinning of the superior half of the macula as compared to inferior half. Also noteworthy is the preferential loss of inner retinal layers. Both these findings correspond to the level and territory of retinal vascular occlusion
Figure 6
Figure 6
Case 1. Multifocal ERG of right eye showed normal implicit times and reduced amplitudes. This corresponds to the underlying pathology of retinal vascular occlusion
Figure 7
Figure 7
Case 1. Color Doppler study of the right eye shows branching of the central retinal artery into hemi-trunks just behind the lamina cribrosa (long arrow)
Figure 8
Figure 8
Case 2. Left eye fundus photograph reveals well-demarcated retinal edema of the superior quadrant and an accentuated foveal reflex
Figure 9
Figure 9
Case 2. Color fundus photograph of the optic nerve head shows the superior (A) and inferior (B) hemi-trunks of central retinal artery emerging separately
Figure 10
Figure 10
Case 2: Left eye FFA shows early filling of superior hemi-trunk
Figure 11
Figure 11
Case 2: Left eye visual field analysis shows an extensive defect corresponding to the territory of vascular occlusion
Figure 12
Figure 12
Case 2: Negative-negative waveform for scotopic response and a loss of oscillatory potentials were recorded in the ERG for the left eye. This corresponds to inner retinal ischemia consequent to retinal vascular occlusion
Figure 13
Figure 13
Case 3: Color fundus photograph of the right eye shows gross retinal edema involving the superior half of the fundus, albeit sparing the fovea
Figure 14
Figure 14
Case 3. Color fundus photograph of the optic nerve head shows the superior (A) and inferior (B) hemi-trunks of central retinal artery
Figure 15
Figure 15
Case 3. Right eye FFA showed increased transit time along the superior retinal sector
Figure 16
Figure 16
Case 3. Right eye multifocal ERG shows grossly reduced responses
Figure 17
Figure 17
Case 3. Color Doppler of the right ophthalmic artery shows branching of the central retinal artery behind the lamina cribrosa
Figure 18
Figure 18
Case 4. Color fundus photograph of the left eye shows extensive retinal edema in the superior half, sparing the fovea
Figure 19
Figure 19
Case 4. FFA of the left eye shows early filling of the reperfused superior hemi-trunk
Figure 20
Figure 20
Case 4. Left eye ERG reveals a normal ‘a’ wave response and a reduced ‘b’ wave. This corresponds to inner retinal ischemia consequent to retinal vascular occlusion
Figure 21
Figure 21
Case 4. Left eye visual field analysis reveals an inferior altitudinal defect corresponding to the affected retina
Figure 22
Figure 22
Case 4. Color duplex imaging of orbit detected a temporal branch emerging from central retinal artery before lamina cribrosa
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