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Case Reports
. 2017 Apr;65(4):323-325.
doi: 10.4103/ijo.IJO_698_16.

Rescue vitrectomy with blocked artery massage and bloodletting for branch retinal artery occlusion

Chun-Ju Lin  1 , Cheng-Wen Su  2 , Huan-Sheng Chen  3 , Wen-Lu Chen  4 , Jane-Ming Lin  4 , Yi-Yu Tsai  1
Affiliations
Case Reports

Rescue vitrectomy with blocked artery massage and bloodletting for branch retinal artery occlusion

Chun-Ju Lin et al. Indian J Ophthalmol. 2017 Apr.

Abstract

A 61-year-old male suffered from sudden blurred vision and superior visual field defect oculus dexter. His vision was counting fingers at 20 cm. Fundoscopy demonstrated inferior pale retina and a large embolus located at the proximal inferior retinal artery. Branch retinal artery occlusion (BRAO) was diagnosed. Initial paracentesis, topical brimonidine tartrate, oral pentoxifylline, and hyperbaric oxygen therapy were performed but showed limited improvement. Hence, he received 25-gauge vitrectomy, artificial posterior vitreous detachment, blocked retinal artery massage, and bloodletting 5 days after onset. After the surgery, his vision improved to 20/25. Fundoscopy showed reperfused retina, and optical coherence tomography revealed resolved retinal edema. RAO is an ophthalmological emergency; however, no standard guideline is available. Vitrectomy with blocked retinal artery massage and bloodletting showed favorable results in this case of BRAO with a large embolus. More prospective clinical trials are needed for setting up the standard treatment.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
(a) Fundoscopy showed pale whitish retina in the inferior quadrant with fovea involved. A large embolus (arrow) was found at the optic disc within the proximal inferior temporal artery. (b) The intraoperative photo of 25-gauge pars plana vitrectomy and blocked retinal artery massage with a 25-gauge soft-tip backflush needle. (c) Fundoscopy showed reperfused retina with a smaller embolus (arrow) postoperative 1 month
Figure 2
Figure 2
(a) The spectral-domain optical coherence tomography showed hyperreflectivity of the inner retina with obvious optical shadowing effect preoperatively (arrow). (b) Decreased hyperreflectivity, optical shadowing, intact ellipsoid zone, and external limiting membrane postoperatively (arrow). (c) Visual field examination revealed the corresponding defect at the right upper quadrant
See this image and copyright information in PMC

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