Branch retinal artery embolization due to calcific aortic valve stenosis.
OBJECTIVE
Branch retinal artery occlusion caused by calcific embolization secondary to calcific aortic valvulopathy.


METHODS
A 45-year-old woman came to our attention complaining a sudden painless loss of her peripheral superior visual field. Best visual acuity was 20/20. Fundus examination revealed the presence of a retinal arterial embolic occlusion of the inferior branch. Fundus retinography, visual field, and fluorescein angiography were performed and medical therapy was started. The echocardiography examination revealed a tricuspid and calcified aortic valve with moderate stenosis and regurgitation. Due to the heart pathology, the patient moved to the cardiosurgery department, where an aortic valve replacement was performed.


RESULTS
Four months after cardiac surgery, visual acuity of both eyes was stable (20/20). Fundus examination showed a complete reabsorption of the retinal edema and the resolution of retinal pallor. Fluorescein angiography confirmed the delay of the arterial filling. No retinal ischemia was observed. The visual field examination confirmed the deep scotoma previously registered.


CONCLUSIONS
Retinal arterial embolization is a rare but potentially devastating complication of calcific aortic stenosis. Initial retinal presentation of calcific aortic stenosis is a rare condition. Keeping in mind that these emboli may be recurrent and potentially bilateral, a sudden onset of visual field defects, especially in young asymptomatic patients, needs immediate diagnosis and consideration of an urgent surgical correction.
Mannino
Giuseppe
G
Department of Ophthalmology, University of Rome Sapienza, 2nd Faculty of Medicine, Rome - Italy.
Romano
Mary
M
Calanchini
Matilde
M
Mannino
Cristina
C
Cascone
Nikhil Carlo
NC
D001024:Aortic Valve Stenosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D002114:Calcinosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D004452:Echocardiography; D015150:Echocardiography, Doppler; D004617:Embolism / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D008875:Middle Aged; D015356:Retinal Artery Occlusion / Q000175:diagnosis / Q000209:etiology*; D014786:Vision Disorders / Q000209:etiology; D058609:Visual Field Tests; D014794:Visual Fields