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Case Reports
. 2013 Oct 21:2013:bcr2013201415.
doi: 10.1136/bcr-2013-201415.

Ischaemia-reperfusion injury in central retinal artery occlusion

Sandeep Saxena  1 , Nibha Mishra, Carsten H Meyer, Levent Akduman
Affiliations
Case Reports

Ischaemia-reperfusion injury in central retinal artery occlusion

Sandeep Saxena et al. BMJ Case Rep. .

Abstract

A 53-year-old man presented with sudden painless diminution of vision in his right eye for 3 days. His fundus examination showed diffuse whitening of the retina with a cherry red spot at the fovea with cilioretinal artery sparing. On fluorescein angiography delayed arteriovenous transit was observed. Three-dimensional spectral domain optical coherence tomography was used to assess retinal nerve fibre layer thickness and average macular central subfield thickness on days 3, 7, 30 and 90. Marked retinal oedema due to ischaemia was observed on day 3 of occurrence of central retinal artery occlusion. On day 7, significant decrease in retinal nerve fibre thickness and macular thickness was noted suggestive of acute reperfusion injury. Retinal nerve fibre layer thickness and macular thickness returned to near normal on day 30 due to restoration of blood supply with wash out of stress mediators. Retinal atrophy was observed on day 90.

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Figures

Figure 1
Figure 1
Coloured fundus photograph of the right eye showing diffuse whitening of the retina with a cherry red spot at the fovea with cilioretinal artery sparing.
Figure 2
Figure 2
(A) Fundus fluorescein angiography showing early perfusion of the cilioretinal artery. (B) Late phase showing delayed arteriovenous transit and late staining of the disc.
Figure 3
Figure 3
Retinal nerve fibre layer (RNFL) thickness profiles of both eyes noted on days 3 (A), 7 (B), 30 (C) and 90 (D) showing TSNIT values. Blue arrows show sample 60 values that is the RNFL thickness in the superior quadrant. RNFL profile precisely highlights initial rise due to retinal oedema on day 3 followed by marked decrease on day 7 suggestive of acute reperfusion injury. (C) Return to nearly normal values on day 30 signifying return of circulation and wash out of reperfusion stress mediators. Marked decrease in the value of average retinal nerve fibre thickness can be noted by day 90 due to setting in of atrophy.
Figure 4
Figure 4
Advanced macular visualisation shows increased hyper-reflectivity and thickness of inner retinal layer with low reflectivity of outer retinal layer. Hyper-reflectivity of inner layers decreased by day 30 with near normal appearance of retinal layers on day 90 (A—day 3, B—day 7, C—day 30 and D—day 90).
See this image and copyright information in PMC

References

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