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PHOTO ESSAY
Year : 2019  |  Volume : 67  |  Issue : 2  |  Page : 273-274

A rare case having hemi-retinal artery occlusion in one eye and hemi-retinal vein occlusion in the other: Diverse manifestations of retinal vascular occlusion


Dr RP Centre for Ophthalmic Sciences, AIIMS, New Delhi, India

Date of Submission15-Jul-2018
Date of Acceptance19-Oct-2018
Date of Web Publication23-Jan-2019

Correspondence Address:
Dr. Pulak Agarwal
R-31, South Extension Part 2, New Delhi - 110 049
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_987_18

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  Abstract 


Keywords: Hemi-retinal arterial occlusion, hemi-retinal vein occlusion, Hollenhorst plaque


How to cite this article:
Agarwal P, Agarwal V, Azad S. A rare case having hemi-retinal artery occlusion in one eye and hemi-retinal vein occlusion in the other: Diverse manifestations of retinal vascular occlusion. Indian J Ophthalmol 2019;67:273-4

How to cite this URL:
Agarwal P, Agarwal V, Azad S. A rare case having hemi-retinal artery occlusion in one eye and hemi-retinal vein occlusion in the other: Diverse manifestations of retinal vascular occlusion. Indian J Ophthalmol [serial online] 2019 [cited 2019 Feb 19];67:273-4. Available from: http://www.ijo.in/text.asp?2019/67/2/273/250694




  Case Top


A 58-year-old woman presented with sudden blurring of vision in OD for 15 days and in OS since 2 months. She was a known hypertensive and diabetic for past 10 years on insulin, on irregular treatment. Blood pressure (BP) noted was 160/100 mmHg, with HbA1c of 10.6 gm/dl. Best-corrected visual acuity (BCVA) was 20/200 in OD and 20/600 in OS. Anterior segment was unremarkable in OU. Fundus OD [Figure 1]a showed inferior hemi-retinal vein occlusion (HRVO). OS fundus [Figure 1]b revealed inferior hemi-retinal arterial occlusion (HRAO) with Hollenhorst plaque in infero-temporal artery (arrow, [Figure 1]b). Fundus fluorescein angiography (FFA) showed blocked fluorescence with perivascular leak and macular edema in OD [Figure 1]c and large areas of capillary non-perfusion in inferior retina and neovascularization of the disc (NVD) in OS [Figure 1]d. Swept-source optical coherence tomography (SS-OCT) showed intraretinal and subretinal fluid in OD [Figure 1]e and retinal atrophy in the inferior hemi-retina in OS with superior retina being normal [Figure 1]f. Patient was diagnosed to have inferior HRVO with macular edema in OD and old inferior HRAO with NVD in OS.
Figure 1: (a) Fundus photograph of OD showing multiple intraretinal hemorrhages in the inferior retina with dilated and tortuous vein suggestive of hemi-retinal vein occlusion. (b) Fundus photograph of OS showing Hollensorst plaque with sclerosed vessels with featureless retina suggestive of hemi-retinal arterial occlusion. (c) Fundus fluorescein angiography (FFA) of OD showing leakage in the inferior retina around the veins suggestive of increased permeability of vessels and retinal edema. (d) FFA of OS showing inferior capillary non-perfusion (CNP) area with macular involvement with hyperfluorescence at the disc suggestive of neovascularization of the disc (NVD). (e) Optical coherence tomography (OCT) of OD showing cystic spaces within the retinal layers and well-defined neurosensory detachment (NSD). (f) OCT of OS showing loss of architecture and atrophy of macular area with no well-defined foveal region

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Complete systemic workup was done for metabolic control and to rule out any source of emboli. Intravitreal bevacizumab was given in OD and inferior scatter laser was performed in OS. On last follow-up, patient had a vision of 20/60 in OD with no macular edema and vision in OS was 20/200 with regressed NVD.


  Discussion Top


Retinal vein occlusion (RVO) is the most common retinal vascular disorder following diabetic retinopathy (DR). Age, systemic hypertension, and diabetes mellitus (DM) are the common risk factors for both RVO and retinal arterial occlusion (RAO).[1],[2] Proportion of HRVO, branch retinal vein occlusion (BRVO), and central retinal vein occlusion (CRVO) is 60%, 54%, and 49%, respectively, in patients with age >65 years.[3] Only a handful of cases of HRAO are described in the literature so far.[4],[5] HRAO is seen in eyes with proximally bifurcated central retinal artery along with underlying systemic conditions.[4] This case highlights the different manifestations of similar underlying risk factors in two eyes of the same patient.

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.
Kolar P. Risk factors for central and branch retinal vein occlusion: A meta-analysis of published clinical data. J Ophthalmol 2014;2014:724780. doi: 10.1155/2014/724780.  Back to cited text no. 1
    
2.
Hayreh SS, Podhajsky PA, Zimmerman MB. Retinal artery occlusion: Associated systemic and ophthalmic abnormalities. Ophthalmology 2009;116:1928-36.  Back to cited text no. 2
    
3.
Hayreh SS, Zimmerman MB, Podhajsky P. Incidence of various types of retinal vein occlusion and their recurrence and demographic characteristics. Am J Ophthalmol 1994;117:429-41.  Back to cited text no. 3
    
4.
Karjalainen K. Occlusion of the central retinal artery and retinal branch arterioles. A clinical, tonographic and fluorescein angiographic study of 175 patients. Acta Ophthalmol Suppl 1971;109:1-95.  Back to cited text no. 4
    
5.
Rishi P, Rishi E, Sharma T, Mahajan S. Hemi-central retinal artery occlusion in young adults. Indian J Ophthalmol 2010;58:425-32.  Back to cited text no. 5
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