First Author: A.Arsan TURKEY
Co Author(s): E. Goktas H. Kanar N. Bulut G. Akcay
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The purpose of this presentation is to share a case report of a 62 year old female patient with unrecognized unilateral impending central retinal vein occlusion (CRVO).
Sağlık Bilimleri University Dr Lütfi Kırdar Kartal Educational and Research Hospital
A 62 year old female patient, presented with a 1 month history of vision loss in her left eye. One month ago she came with acute vision lose in her left eye to the emergency department of another hospital. Visual acuity were hand movements in left eye and there was no ophthalmologic pathological finding were detected on ophthalmology consultation. Patient had been evaluated multidisciplinary. Cranial and orbital magnetic resonance imaging and computed tomography were performed. Several laboratory tests had been done although sedimantation rate was normal a temporal artery biopsy had also been performed. Optical coherence tomography (OCT) and fluorescein angiography (FA) examinations were interpreted as normal. As visual evoke potential showed a delay time and patient had somewhat headache neurology clinic decided to explore and lumbar puncture had been performed but no pathological findings were found. As preliminary diagnosis were thought to be an optic neuropathy treatment was initiated with methylprednisolone 1gr/day for 3 days and 100 mg/day acetylsalicylic acid at the external medical centre.
Patient was then referred to the SBU Dr Lütfi Kırdar Kartal Educational and Training Hospital Ophthalmology Clinic to evaluate and manage her symptoms. Patients previous history and work-up were evaluated . Her visual acuity was 1,0 (+2.50X+0.75X axis90) in right eye and o.1 (+2.75+0.75axis90) in left eye. Intraocular pressure was 22mmHg OD and 20 mmHg OS. Although minimally swallow anterior segment was normal. Fundus examination revealed numerous retinal haemorrhages in four quadrants, engorgement and dilatation of the retinal veins and few cotton wool spots especially around disc although the disc swelling were not prominent. Examining of the previous colour photograph and FA showed, on the left eye slightly tortuous and dilated venous vessels especially comparing the healty eye and mildly distrubuted barely visible tiny few haemmorhages. Another finding was that tiny turbinating, corrugating torsiyonel vessels reminding collateral on the optic disc. OCT and FA was repeated. FA revealed delay in arteriovenous transit time, hypofluorescence as blocking defect and collateral vessels prominent. OCT showed irregularity of the layers and macula edema. Anti-glaucoma agent bilateraly and intravitreal aflibercept was applied to left eye. After 4 week control BCVA was 0.7
Impending CRVO is not a well defined condition that some authors rather prefer to describe the term partial or stasis CRVO. Patients may be either asymptomatic or may complain of mild, often transient episodes of blurring of vision characteristically worse on waking and improves during the day or may have more prominent visual loss as in this case. Their fundi demonstrate mild venous dilation and tortuosity, and a few widely scattered flame-shaped retinal haemorrhages may accompany the condition. In impending CRVO, FA will reveal a mild increase in retinal circulation time. It is considered that this condition may resolve or progress to complete obstruction. It is important to recognize the condition as to prevent progression to complete occlusion and performing unnecessary clinical radiological etc work-up.Treatment mainly consist of correcting any predisposing systemic conditions, avoiding dehydration, and lowering intraocular pressure to improve perfusion. Antiplatelet agents may be of benefit, and in some circumstances such as monocularity in an otherwise healthy patient it may be appropriate to consider other options such as anticoagulants or fibrinolytics .