First Author: P.Neves PORTUGAL
Co Author(s): R. Brito C. Bacalhau M. Santos D. Martins 0 0 0 0 0 0 0 0 0
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Retinal Artery Branch occlusions have a variety of previously described findings on OCT (optical coherence tomography) examinations and may aid in the differential diagnosis of early clinical presentations. Patients with significant comorbidities and difficult cooperation may be unable to undergo angiography examinations, but can still easily be examined using OCT. En face examination may also correlate with functional visual perimetry results.
Description of a case report of an early branch oclusion presenting to the emergency ophthalmology department - Setúbal Hospital Center, Portugal.
Case report: The authors describe the case of a 70-old man, with a personal history of an aortic aneurysm, bilateral cataract surgery and recently decompensated hepatic cirrhosis, that presented to the emergency department with a painless decrease in visual acuity over the last 3 days, mainly in the upper field of the left eye. VA was <0.2 when attempting foveal fixation, increasing to 0.8 when directing fixation slightly upward. Fundus examination showed only a subtle diffuse retinal whitening in the lower temporal vascular arcades at this time. Computorized perimetry revealed an altitudinal defect in the left visual field. OCT was performed on presentation and compared with the perimetry results. Re-examination after 4 days confirmed the diagnosis of a vascular occlusive disease, with a visible migrated Hollenhorst plaque on an inferior nasal artery branch bifurcation, occluding only one branch with a now clear cotton-wool exudate. OCT and OCT en face was again repeated at this time and compared with perimetric results.
OCT initially obtained an increase in reflectivity of the outer plexiform layer, with only minimal increased retinal thickness. After the migration of the plaque, the OCT now had a clear RNFL edema and en face imaging can easily distinguish between the occluded vessel, with decreased shadowing of deeper layers, and the still viable collateral. Comparison between the en face imaging of the affected areas also corresponded with perimetric results.
OCT offers a non-invasive and early aid in the differential diagnosis in arterial branch occlusions, with en face imaging anomalies corresponding with the functionally affected areas. It may be of special value in patients with significant comorbidities, unable to cooperate or otherwise unable to undergo angiography.