Case was decided to continue on dual antiplatelet therapy without heparin therapy. The condition remained stable and patient was informed for the guarded prognosis for further visual field recovery. Computed tomography (CT) scan of the brain was performed and no abnormalities were detected.ĭespite immediate conventional treatment for his BRAO was given, his RE inferior hemi-field loss was persistent. ECG was stable without evidence of arrhythmia. Complete neurological examination revealed no neurological deficit. The superior retina was swollen and pale (Fig. Fundus examination revealed BRAO involving the superior branches of the retinal artery with the presence of multiple emboli or Hollenhorst plaque in the branches of the superior retinal artery (Fig. Visual acuity in the RE was 6/18 with an inferior visual hemifield defect. However, immediately after it the patient complained of loss of vision in his right eye (RE), specifically involving the lower visual field. Bedside echocardiography showed good left ventricular ejection fraction without evidence of clot. Electrocardiogram (ECG) showed sinus rhythm throughout and after the procedure. On top of the dual antiplatelet therapy (aspirin and clopidrogrel) started prior to the procedure, patient was loaded with clopidrogrel as well during the PCI. Good angiographic flow was obtained post stents dilatation. Coronary angioplasty was performed using drug-eluting stent (DES) for right coronary artery (RCA), left main stem coronary artery (LMS) and left anterior descending artery (LAD). Diagnostic coronary angiogram revealed severe CAD with stenosis at the bifurcation of the artery. Both cases were complicated by significant visual morbidity.Ī 74-year-old gentleman with coronary risk factors of diabetes mellitus and hypertension was electively admitted for PCI for CAD in UKMMC. Herein, we report two cases of retinal artery occlusion following PCI in our centre. , and the most recent being that in 2010 by Selton et al. To the best of our knowledge, since the introduction of PCI in 1977, case reports of retinal artery occlusion (CRAO & BRAO) post-PCI have comprised ten individual case reports from around the world, with the earliest being that in 1985 by Stefansson et al. Therefore, there should be a high index of suspicion and immediate attention should be given to any visual disturbance in this group of patients. One of the possible thromboembolic events in the eyes is retinal artery occlusion, either branch (BRAO) or central (CRAO), which will lead to a wide spectrum of visual problems from asymptomatic, partial loss of vision to complete blindness. Thromboembolic events are one of its major risks leading to end organ infarction, especially in the brain, kidney, and the eyes. This procedure is currently a standard procedure for both diagnostic and therapeutic purpose in management of coronary artery diseases (CAD). However some complications still could not be avoided. In acute setting, it is a life saving procedure. There are two access routes frequently described with regards the procedure: the transfemoral and transradial approaches. Percutaneous coronary intervention (PCI) or coronary angioplasty is a cardiac procedure to treat a significant coronary artery disease and as part of revascularisation to restore coronary artery flow and improved patients outcome. Patients need to be informed especially in high risk cases. In conclusion, retinal artery occlusion is a possible complication post PCI. He was diagnosed to have central retinal artery occlusion. He noticed sudden dropped of vision in his right eye immediately after the procedure. In case 2, a 49-year-old gentleman presented with ST segment elevation myocardial infarction (STEMI) and had an emergency PCI performed 2 h upon admission. He was found to have branch retinal artery occlusion. Few hours after the procedure, patient complained of sudden blurring of vision in the right eye. In case 1, a 74-year-old gentleman with pre-existing diabetes mellitus and hypertension was electively admitted for PCI for coronary artery disease (CAD) in our centre (UKMMC). We are reporting one case of branch RAO and one case of central RAO after percutaneous coronary intervention (PCI).
#KALEIDOSCOPE VISION STROKE SERIES#
The purpose of this study was to report case series of retinal artery occlusion (RAO) as one of the significant complication post cardiac intervention.
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