Central retinal artery occlusion occurring intraoperatively during angiography for subarachnoid hemorrhage: a case report.
OBJECTIVE
To report a case of central retinal artery occlusion that occurred during cerebral angiography for the treatment of vasospasm secondary to subarachnoid hemorrhage.


RESULTS
Examination was notable for 20/Hand Motion vision and an afferent pupillary defect. Fundus examination at the time of the event revealed a cherry red spot typical of central retinal artery occlusion with surrounding edema of the retina and severe attenuation of the arterioles. There were no emboli noted. Review of the angiography confirmed flow to the ophthalmic artery and retina at the start of the procedure, with severely decreased flow noted at the end of the procedure. Five days after presentation, there were notable areas of potential choroidal infarction, indicating that the ophthalmic artery was also involved to some extent. The patient refused fluorescein angiography, which could have provided more insight to the extent of ischemia. Optical coherence tomography also showed diffuse retinal edema. She was monitored for complications resulting from this event with visual acuity remaining largely unchanged.


CONCLUSIONS
Ophthalmic and central retinal artery occlusions are devastating events that result in severe vision loss. Most patients have some underlying risk factors precluding the initial event. Undergoing angiography, or other invasive vascular procedure, may put the patient at risk for distal vascular occlusions. Our case is unique in that it shows intraoperative imaging of the acute event occurrence.
Department of Ophthalmology and Visual Sciences, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio.
Michael D
MD
Greenwood
Shawn C
SC
Wilker
D000328:Adult; D002533:Cerebral Angiography / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology*; D015356:Retinal Artery Occlusion / Q000175:diagnosis / Q000209:etiology*; D013345:Subarachnoid Hemorrhage / Q000601:surgery*