An abnormal origin of cilioretinal artery presenting as altitudinal field defect in case of Central Retinal Vein Occlusion(CRVO) with Cillioretinal artey occlusion.

Author: Devanshi Mehta (India)

Co-authors: Devendra Saxena, Devanshi Mehta

Purpose

An abnormal location of cilioretinal artery could save patient from severe visual loss .

Setting/Venue

40 year female came to ophthalmology OPD of tertiary care hospital in Gujarat,India with chief complains of right eye sudden onset of painless dimness of vision for near and distance both x 2 days which was associated with decrease in inferior visual field defect.

Methods

On examination Best Corrected Distant Visual Acuity(DVA) on Snellen’s chart was 6/9 in right eye and 6/6 in left eye.Best Corrected Near Visual Acuity (NVA) on Roman’s chart was N10 in right eye and N6 in left eye. Both eye pupillary reaction was normal .Both eye anterior segment examination was normal. Pachymetry corrected Intra Ocular Pressure(IOP) on Goldman’s Applanation Tonometry, was 19.9 mm of hg in both eyes. Fundus examination in right eye showed superficial hemorrhages present at disc; deep hemorrhage present superonasally adjascent to disc; cloudy white oedematous area of retinal infarct of 4.5 DD present superior to fovea 1 DD away from disc with dot and blot hemorrhages present in all four quadrants .In left eye disc and macula were normal. Octopus perimetry Macular programme showed right eye inferior altitudinal field defect. Optical coherence tomography in right eye showed hyperrefractivity of inner retinal layers suggestive of thickening due to edema. Patient was given Nepafenac (0.1 %) eye drops 3 times a day topically in her right eye. Blood pressure of the patient was measured(140/80 mm of hg). Serum homocysteine was advised and asked for follow up after a week.

Results

On follow up Best Corrected DVA in right eye was 6/9 .Best corrected NVA in right N6.Left eye findings were same.Pachymetry corrected IOP was 22.9 mmof hg in right eye and 21.9 mmof hg in left eye. Right eye pupillary reaction showed no Relative Afferent Pupillary Defect. Fundus findings were same as before.Patient was referred to physician for blood pressure control. Serum homocysteine was 13.07 micromol/litre . As it was on higher side of normal range, patient was started on Tablet Meganeuron od + once a day orally. Right eye topically Nepafenac eye drops continued and Dorzolamide (2%) eye drops were given topically in both eyes for IOP control. Follow up was advised after 2 weeks .

Conlusions

As presence of cilioretinal artery is a blessing in a case of Central Retinal Artery Occlusion preserving central vision of patient ,its occlusion in CRVO could result in loss of central vision. However in this case abnormal origin of cilioretinal artery from superior part of optic disc has resulted only in altitudinal field defect with preserved central vision.

Financial Disclosure

Shree Krishna Hospital ,Pramukh Swami Medical College. Being Resident of same.

Comments

-