Sudden unilateral visual field loss

ArticleinJournal of Emergencies Trauma and Shock 2(3):211-2 · September 2009with8 Reads
DOI: 10.4103/0974-2700.55352 · Source: PubMed
We report a classical case of branch retinal artery occlusion (BRAO) in the acute setting and review the literature relating to the diagnostic, therapeutic and prognostic facets of this condition. BRAO can cause sudden visual loss and is not an infrequent presentation to emergency medical services. BRAO may indicate predisposing and related conditions capable of significant morbidity and mortality. Although current therapeutic practices in the acute setting are of uncertain benefit, conservative measures may be attempted in the emergency room by a nonophthalmologist with the aim of dislodging the causative embolus. Regardless of the current means of acute management, anitplatelet therapy and cardiovascular risk management remain the mainstay of treatment for BRAO. The potential for life-threatening systemic associations necessities investigation and multidisciplinary input.
  • [Show abstract] [Hide abstract] ABSTRACT: To report the ocular manifestations of giant cell arteritis using the strict criterion of a positive temporal artery biopsy for diagnosis of giant cell arteritis. In a prospective study from 1973 to 1995, we investigated 170 patients whose diagnosis of giant cell arteritis was confirmed on temporal artery biopsy. At the initial visit, all patients were questioned regarding systemic and ocular signs and symptoms of giant cell arteritis and underwent ophthalmic, erythrocyte sedimentation rate (Westergren), and C-reactive protein evaluations. Any patient with a high index of suspicion of giant cell arteritis was immediately started on systemic corticosteroid therapy and had temporal artery biopsy performed as soon as possible. Eighty-five (50.0%) of the 170 patients with giant cell arteritis proven by temporal artery biopsy presented with ocular involvement. Ocular symptoms in patients with ocular involvement were visual loss of varying severity in 83 (97.7%), amaurosis fugax in 26 (30.6%), diplopia in five (5.9%), and eye pain in seven (8.2%); ocular ischemic lesions consisted of arteritic anterior ischemic optic neuropathy in 69 (81.2%), central retinal artery occlusion in 12 (14.1%), cilioretinal artery occlusion in 12 (of 55 patients with satisfactory fluorescein angiography [21.8%]), posterior ischemic optic neuropathy in six (7.1%), and ocular ischemia in one (1.2%). In almost every patient with giant cell arteritis, fluorescein fundus angiography disclosed occlusive disease of the posterior ciliary arteries. Because giant cell arteritis is a potentially blinding disease and its early diagnosis is the key to preventing blindness, it is important to recognize its various ocular manifestations.
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    Article · Oct 2000
  • [Show abstract] [Hide abstract] ABSTRACT: Occlusions of the retinal arterial and venous circulations are common causes of severe visual decline and can affect all age groups. Acute retinal arterial obstruction is often associated with critical cerebrovascular and cardiovascular disease that may require systemic treatment. Retinal venous obstruction may be the presentation of significant systemic hypertension, diabetes mellitus, and a greater risk for cardiovascular morbidity. Additional metabolic and hematologic abnormalities have been identified in patients with retinal occlusive disease. The authors review recent advances in the study of systemic conditions associated with retinal vascular occlusions and offer guidelines for appropriate medical evaluation of patients with retinal occlusive disease.
    Article · Jan 2001
  • [Show abstract] [Hide abstract] ABSTRACT: To assess whether early hyperbaric oxygenation (HBO) treatment has a beneficial effect on visual results after retinal artery occlusion (RAO). A comparative retrospective study in which medical records of all HBO-treated RAO patients in our department were reviewed and compared with matched RAO patients not treated by HBO (from a different medical center). Mean visual acuity (VA) at completion of treatment, the presence or absence of improvement in VA between admission and discharge, and the mean change in VA between admission and discharge were noted. All patients treated by HBO had treatment no later than 8 hours after the beginning of visual symptoms. Mean VA at discharge was 0.2981 (6/20) in the treated group and 0.1308 (6/46) in the control group (p < 0.03). In the treated group, 82.9% had an improvement in VA between admission and discharge, compared with 29.7% of the control group (p < 0.00001). Mean improvement in VA was 0.1957 in the treated group and 0.0457 in the control group (p < 0.01). Differences in outcome measures between treatment and control groups were found to reflect the difference between treated and untreated hypertensive patients. No difference was found between treated and untreated non-hypertensive patients. Early HBO therapy appears to have a beneficial effect on visual outcome in patients with RAO. Further large-scale prospective controlled studies are needed to confirm this.
    Article · Nov 2000
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    Article · Jul 2003
  • [Show abstract] [Hide abstract] ABSTRACT: Central retinal artery occlusion (CRAO) and branch retinal artery occlusion (BRAO) may be a result of platelet-fibrin emboli, cholesterol plaques, or calcific emboli that typically lodge at the bifurcation of retinal arterioles or at a location as the vessel narrows. Hollenhorst plaques (cholesterol emboli) can often be seen at the site of vessel obstruction. Obstruction of blood flow results in partial or complete retinal ischemia and sudden loss of vision. There is no effective therapy for CRAO and BRAO. The authors employed the Nd:YAG laser to photodisrupt emboli within the central retinal artery (CRA) and branch retinal arteries (BRA) to achieve rapid reperfusion of the retina. Translumenal Nd:YAG embolysis (TYL) or embolectomy (TYE) was performed on 19 patients with sight-threatening CRAO or BRAO. All patients had a visible embolus within the CRA or BRA. A fundus contact lens was used to focus the Nd:YAG laser on the embolus within the retinal arteriole. Laser applications were delivered directly to the embolus with increasing energy until the embolus was either fragmented within the lumen (embolysis) or was observed to pass into the vitreous through a small opening in the arteriole (embolectomy). TYL/E was achieved in all 19 patients. In 8 patients the emboli was fragmented (embolysis) and in 11 the embolus was transplaced into the vitreous (embolectomy). Reperfusion of the retina was observed in all patients as determined by fundus examination, fundus photography, and fluorescein angiography. Snellen visual acuity improved by an average of 4.7 lines (range, 1-11 lines) in 17/19 (89%) patients. Eleven of the patients (58%) gained greater than 4 lines. One patient had no improvement and another lost one line due to a persistent vitreous hemorrhage. Vitreous hemorrhage (VH) occurred in seven patients, and subhyaloid hemorrhage (SH) occurred in one patient. In five of the patients an early vitrectomy was performed to allow clinical assessment and documentation of the successful TYL/E. Photodisruption of an embolus within an occluded CRA or BRA can be achieved via TYL/E. Rapid reperfusion of the retina is associated with anatomic and visual acuity improvement. Translumenal Nd:YAG embolysis or embolectomy of a visible embolus in patients with CRAO or BRAO can be achieved resulting in restoration of retinal blood flow and improved visual function.
    Article · Mar 2008