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Year : 2021  |  Volume : 1  |  Issue : 3  |  Page : 423-424

Resolution of cystoid macular edema in acute central retinal artery occlusion on swept-source and en-face optical coherence tomography


Department of Vitreo-Retinal Services, Shri Ganapati Netralaya, Jalna, Maharashtra, India

Date of Submission03-Oct-2020
Date of Acceptance22-Feb-2021
Date of Web Publication02-Jul-2021

Correspondence Address:
Dr. Abhishek Desai
Department of Vitreo-Retinal Services, Shri Ganapati Netralaya, Jalna - 431 203, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_3036_20

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  Abstract 


Keywords: Central retinal artery occlusion, cystoid macular edema, swept-source and en-face OCT


How to cite this article:
Desai A, Trivedi M, Naigaonkar R. Resolution of cystoid macular edema in acute central retinal artery occlusion on swept-source and en-face optical coherence tomography. Indian J Ophthalmol Case Rep 2021;1:423-4

How to cite this URL:
Desai A, Trivedi M, Naigaonkar R. Resolution of cystoid macular edema in acute central retinal artery occlusion on swept-source and en-face optical coherence tomography. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Jul 26];1:423-4. Available from: https://www.ijoreports.in/text.asp?2021/1/3/423/320100



A 32-year-old gentleman presented with sudden loss of vision in right eye (OD) since 3 days. Best corrected visual acuity (OD) was light perception. On examination, a pale retina with cherry red spot was noted suggestive of acute central retinal artery occlusion (CRAO). Swept-source OCT (Topcon DRI OCT Triton, Japan®) showed cystoid macular edema (CME) and neurosensory detachment (NSD) with hyperreflectivity in inner retinal layers. OCT angiography showed deficient capillary network with presence of void areas around the fovea in superficial, deep, and choriocapillaris layers. En-face OCT showed “petaloid” pattern of CME at junction of inner plexiform and nuclear layers [Figure 1]a, [Figure 1]b, [Figure 1]c, [Figure 1]e, [Figure 1]f. He underwent ocular massage, AC paracentesis, and oral acetazolamide 250 mg TDS with topical dorzolamide was prescribed for 5 days. Carotid Doppler showed 90% occlusion of right internal carotid artery with deranged serum lipids. At 1-week follow-up, there was no functional improvement; however, there was complete resolution of CME and NSD on B scan and en-face OCT [Figure 2]a, [Figure 2]b, [Figure 2]c, [Figure 2]d, [Figure 2]e, [Figure 2]f.
Figure 1: (a) Fundus photo of the right eye showing a cherry red spot and pale retina suggestive of acute central retinal artery occlusion. (b) Swept-source optical coherence tomography (SS-OCT) showing increased hyperreflectivity of the inner layers with cystoid macular edema at the fovea. (c) En-face OCT shows presence of “petaloid” pattern of cystoid macular edema at the junction of the inner plexiform and nuclear layers. (d) OCT angiography at the level of superficial capillary plexus shows void areas around the fovea (e and f) OCT angiography at the level of choriocapillaris with corresponding colored representation showing void areas

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Figure 2: (a) Fundus photo at follow-up visit of 1 week showing resolution of the cherry red spot and early optic disc pallor. (b) SS-OCT shows complete resolution of the cystoid macular edema and reduction of the hyperreflectivity of the inner retinal layers. (c) En-face OCT shows resolution of the petaloid appearance of cystoid macular edema. (d) OCT angiography shows decrease in the void areas around the fovea. (e and f) OCT angiography at the level of choriocapillaris with colored representation showing reduction of void areas

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  Discussion Top


CRAO is a devastating event with grave prognosis presenting with cherry red spot and pale retina suggestive of diffuse intraretinal edema, mainly involving ganglionic cell layer.[1] OCT angiography shows reduced capillary density in superficial and deep capillary plexus with relative sparing of outer retina and choriocapillaris.[2],[3] Presence of CME in acute CRAO usually indicates concomitant venous occlusion seen as tortuosity of veins with hemorrhages.[4] An isolated case of acute CRAO with presence of CME is rare and indicates presence of outer retinal ischemia and compromise of outer blood–retinal barrier due to choroidal vascular insufficiency. Ng et al. reported case of CME with CRAO in a 76-year-old lady.[5] However, there was no recorded follow-up regarding the course of CME. In our case, there was complete resolution of CME but there was no functional improvement.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hayreh SS. Central retinal artery occlusion. Indian J Ophthalmol 2018;66:1684-94.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Yang S, Liu X, Li H, Xu J, Wang F. Optical coherence tomography angiography characteristics of acute retinal arterial occlusion. BMC Ophthalmol 2019;19:147.  Back to cited text no. 2
    
3.
Wu SC, Villegas VM, Kovach JL. Optical coherence tomography angiography of combined central retinal artery and vein occlusion. Case Rep Ophthalmol Med 2018;2018:4342158. doi: 10.1155/2018/4342158.  Back to cited text no. 3
    
4.
Delhiwala KS, Rao C. Cystoid macular edema with idiopathic acute central retinal artery occlusion in a healthy child. J Ophthalmic Vis Res 2017;12:348-50.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Ng WY, Wong DW, Yeo IY, Han DC. Cystoid macular edema in acute presentation of central retinal artery occlusion. Case Rep Ophthalmol Med 2012;2012:530128.  Back to cited text no. 5
    


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