Central retinal artery occlusion following laser treatment for ocular ischemic aortic arch syndrome.
OBJECTIVE
Ocular ischemic syndrome is a rare blinding condition generally caused by disease of the carotid artery. We describe a 69-year-old female with a 50 pack-year smoking history with aortic arch syndrome causing bilateral ocular ischemic syndrome.


METHODS
The patient presented with progressive visual loss and temple pain. Slit lamp biomicroscopy revealed bilateral iris neovascularization. This finding prompted a cardiovascular work up. Panretinal photocoagulation with retrobulbar block was performed in the right eye.


RESULTS
A temporal artery biopsy was negative. The carotid duplex ultrasound showed only a 1-39% stenosis. MRA revealed a more proximal occlusion of the aortic branch for which she underwent subclavian carotid bypass surgery. At the one month follow up, the right eye suffered profound vision loss secondary to a central retinal artery occlusion.


CONCLUSIONS
Ocular neovascularization may be one of the clinical manifestations of aortic arch syndrome. This case also illustrates the limitations of relying solely on carotid duplex ultrasound testing. We caution against overly aggressive panretinal photocoagulation utilizing retrobulbar anesthesia.
Riverside Methodist Hospital, Columbus, OH, USA.
Payal J
PJ
Shah
WVU Eye Institute, Morgantown, WV, USA.
Brian
B
Ellis
Regional Eye Associates, Morgantown, WV, USA.
Lauren R
LR
DiGiovine
West Virginia University Hospital, Morgantown, WV, USA.
Jeffery P
JP
Hogg
WVU Eye Institute, Morgantown, WV, USA.
Monique J
MJ
Leys
MRI; aortic arch; carotid artery stenosis; carotid duplex ultrasound; ocular ischemic syndrome; panretinal laser; retrobulbar block