First Author: J.Beato PORTUGAL
Co Author(s): L. Figueira M.S. Falcão S. Penas A.M. Carneiro E. Brandão F. Falcão-Reis 0 0 0 0 0 0 0 0 0
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To present a study case of a unilateral optic disc edema accompanied by cilioretinal occlusion and white dots.
Department of Ophthalmology, Centro Hospitalar São João, Porto, Portugal.
We describe a case of cilioretinal occlusion in a 19-year-old caucasian female that presented with blurred vision in the right eye (OD) and periorbital pain sensation. The patient underwent detailed clinical examination with additional imaging using fluorescein angiography (FA), indocianine green angiography (ICGA), fundus autofluorescence (FAF), spectral-domain optical coherence tomography (SD-OCT). Functional evaluation was performed with computerized perimetry and electrophysiological tests.
A 19-year-old female presented with blurred OD vision and periorbital pain with 5 days of evolution. Past medical history included left eye (OS) decreased vision, rhinitis 2 months earlier and oral anticonceptives ingestion for the last 3 years. Best corrected visual acuities were: OD 10/10 and OS 8/10. There was OS relative afferent pupillary defect. OD fundoscopy revealed optic disc edema, pale retina edema in the cilioretinal artery supply area and multiple white dots in the retinal periphery. OS presented with pale optic disc. Neuroimaging showed left optic nerve atrophy. Evaluation for infectious, inflammatory, vasculitic and hipercoagulable etiologies was negative. OD SD-OCT showed optic disc and internal retinal layers, in the cilioretinal artery supply area, edema. OS demonstrated internal retinal layers atrophy in papilo-macular bundle. OD FA displayed patent cilioretinal artery and optic disc hiperfluorescence. OD ICGA showed hipofluorescent lesions in the early and late phases accompanied by peri-papilary hipofluorescence . FA and ICGA had no alterations in OS. OD perimetry showed ceco-central scotoma and OS presented a arcuate scotoma. The patient was treated with 5 day metilprednisolone pulse and anti-agregant therapy, followed by oral corticotherapy maintenance regime for 1 month. Final visual acuities were 10/10 OD and 8/10 OS.
To our knowledge, this is the first report in the literature of a cilioretinal artery occlusion associated with “white dot syndrome”. The patient in this study had an excellent final visual outcome due to little dependence of macular area on cilioretinal artery.