Intraretinal gray lesions as a sign of reversible visual loss following prolonged ophthalmic artery hypoperfusion.
A 49-year-old woman developed severe unilateral visual loss following carotid artery ligation for a carotid-cavernous fistula. The pathophysiology was presumed to be an ophthalmic artery steal caused by the fistula. This was confirmed when visual acuity was restored by a subsequent ligation of the ophthalmic artery, despite 2 weeks of profound visual loss and ocular ischemia. Superficial cotton-wool spots and deep gray intraretinal lesions developed in the retina during the period of ocular ischemia. We postulate that the deep intraretinal lesions are clinical manifestations of a zone of retinal microvascular watershed ischemia, and that their presence may be an important diagnostic guide to the presence of reversible ocular ischemia.
Cherny
M
M
Department of Neuro-ophthalmology, St. Vincent's Hospital, Fitzroy, Australia.
O'Day
J
J
Currie
J
J
D001766:Blindness / Q000503:physiopathology*; D001775:Blood Circulation; D002340:Carotid Artery Diseases / Q000503:physiopathology / Q000601:surgery; D006259:Craniocerebral Trauma / Q000150:complications; D005260:Female; D005451:Fluorescein Angiography; D005654:Fundus Oculi; D006801:Humans; D007511:Ischemia / Q000473:pathology* / Q000503:physiopathology; D008875:Middle Aged; D009880:Ophthalmic Artery / Q000503:physiopathology*; D011183:Postoperative Complications; D012164:Retinal Diseases / Q000473:pathology* / Q000503:physiopathology; D014792:Visual Acuity