title: Sudden visual loss after cardiac resynchronization therapy device implantation.
abstract: OBJECTIVE
  To report a case of sudden decrease in visual acuity possibly due to a cardiogenic embolism in a patient who underwent cardiac resynchronization therapy (CRT) device implantation.
  
  
  METHODS
  A 62-year-old man with severe left ventricular systolic dysfunction and a left bundle branch block was referred to our department because of a sudden decrease in visual acuity. Nine days earlier, he had undergone cardiac transapical implantation of a CRT device, which was followed, 2 days later, by an inflammatory reaction. The patient underwent several general and ophthalmologic examinations, including multimodal imaging.
  
  
  RESULTS
  At presentation, right eye (RE) best-corrected visual acuity (BCVA) was counting fingers and RE pupil was hyporeactive. Fundus examination revealed white-centered hemorrhagic dots suggestive of Roth spots. Fluorescein angiography showed delay in vascular perfusion during early stage, late hyperfluorescence of the macula and optic disk, and peripheral perivascular leakage. The first visual field test showed complete loss of vision RE and a normal left eye. Due to suspected giant cell arteritis, temporal artery biopsy was performed. Thirty minutes after the procedure, an ischemic stroke with right hemisyndrome and aphasia occurred. The RE BCVA worsened to hands motion. Four months later, RE BCVA did not improve, despite improvement in fluorescein angiography inflammatory sign.
  
  
  CONCLUSIONS
  We report a possible cardiogenic embolism secondary to undiagnosed infective endocarditis causing monocular visual loss after CRT device implantation. It remains unclear how the embolus caused severe functional damage without altering the retinal anatomical structure.
authors.affiliation:  Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan - Italy.
authors.forename: Luigi A
authors.initials: LA
authors.lastname: De Vitis
authors.affiliation:  Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan - Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Marchese
authors.affiliation:  Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan - Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Giuffrè
authors.affiliation:  Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan - Italy.| Department of Ophthalmology, University of "Magna Graecia", Catanzaro - Italy.
authors.forename: Adriano
authors.initials: A
authors.lastname: Carnevali
authors.affiliation:  Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan - Italy.
authors.forename: Lea
authors.initials: L
authors.lastname: Querques
authors.affiliation:  Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan - Italy.
authors.forename: Livia
authors.initials: L
authors.lastname: Tomasso
authors.affiliation:  Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan - Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Baldin
authors.affiliation:  Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan - Italy.
authors.forename: Gisella
authors.initials: G
authors.lastname: Maestranzi
authors.affiliation:  Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan - Italy.
authors.forename: Rosangela
authors.initials: R
authors.lastname: Lattanzio
authors.affiliation:  Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan - Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Querques
authors.affiliation:  Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan - Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Bandello
mesh_terms: D001766:Blindness / Q000209:etiology*; D058409:Cardiac Resynchronization Therapy Devices / Q000009:adverse effects*; D004617:Embolism / Q000175:diagnosis / Q000209:etiology*; D004696:Endocarditis / Q000175:diagnosis / Q000209:etiology*; D005451:Fluorescein Angiography; D006331:Heart Diseases / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology; D058609:Visual Field Tests