First Author: R.Gonçalves PORTUGAL
Co Author(s): J. Serino J. Lemos C. Menezes P. Coelho B. Vieira P. Tenedório 0 0 0 0 0 0 0 0 0
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To report an unusual case of central retinal artery occlusion (CRAO) in the presence of a temporal cilioretinal artery and a large nasal cilioretinal vessel.
Department of Ophthalmology - Hospital Pedro Hispano, Matosinhos, Portugal.
Clinical case report and reviewed of the literature as to find out incidence and significance of cilioretinal arteries.
The inner retina is supplied primarily or exclusively by the central retinal branch of the ophthalmic artery. Occasionally the central retinal artery is assisted by one or more cilioretinal arteries. These arteries are derived directly from the circle of Zinn, which is formed by small branches from the short posterior ciliary arteries, which also supply the choroid. It is of clinical relevance that in case of CRAO a functioning cilioretinal artery can maintain the blood supply to the retinal region involved. A 60-year-old man with a history of hypertension was referred to our emergency department by sudden loss of vision in his left eye. His best corrected visual acuity (BCVA) was 20/20 OD, count fingers OS and there was a positive afferent pupillary defect on the left. Examination of the anterior segment was unremarkable and applanation tensions were 18 mmHg in both eyes. Fundoscopy and fluorescein angiography OS showed CRAO, with classical cherry-red spot in macular region, and a patent cilioretinal artery with medium extending supplying temporal peripapillary region and a nasal cilioretinal artery supplying a large area of retina nasal to the disc. One week after onset the BCVA improves to 20/100 OS and remained stable 2 months later.
The presence and area of supply by a patent cilioretinal artery can have a major impact on the visual outcome in CRAO. In the presented unusual case of CRAO with sparing by nasal and temporal arteries, although there is a marked decline in visual acuity without foveal region sparing, there is some improvement of visual acuity weeks later with peripheral visual field present. Those cilioretinal arteries are of a size to make the retinal region they supply play a role with regard to the remaining visual function.