Author: Moctar ISSIAKA BOUKARI (Morocco)
Co-authors: Youness HIDAN, Mariem CHOKAYRI, Adil MCHACHI, Leila BENHMIDOUNE, Rayad RACHID, Mohamed EL BELHADJI
Purpose
We report the case of an occlusion of the central retinal artery in a 58-year-old patient revealing an anti phospholipid antibody syndrome.
Setting/Venue
Occlusion of the central retinal artery is a serious accident that represents one of the rare ophthalmologic emergencies where the delay in treatment is a crucial element. But it also represents an alarm signal that should lead to a search for an underlying systemic pathology that could threaten the vital prognosis. The assessment must be oriented according to the terrain, the interrogation, the ophthalmologic and general examination, because the etiologies are multiple and varied
Methods
This is the case of a 58-year-old patient, with no particular pathological history, who had a brutal and painless unilateral decrease in visual acuity.
Results
Examination revealed a collapsed visual acuity limited to light perception with areflective mydriasis and at the fundus an ischemic white retinal edema and cherry red macula associated with a diffuse narrowing of the arterial caliber. The examination of the contralateral eye was unremarkable. Fluorescein angiography showed a delay in arterial perfusion followed by a prolongation of the retinal arteriovenous filling time. An emergency sedimentation rate was 80 mm and CRP was 20 mg/L. The patient received 3 boluses of corticoids in emergency. The workup was completed by a blood glucose level of 0.9g/l, a normal lipid profile, a blood count (leukocytes 7000/ul, platelets 375000/ul, hemoglobin 12g/ml), a normal hemostasis workup (PT, APTT, protein C, protein S, antithrombin III), Auscultation for carotid murmur was negative, Doppler of the neck vessels normal, ECG and cardiac ultrasound normal, temporal artery biopsy negative, ANCA and antinuclear antibody negative. In addition, the patient had a high blood pressure of 200/100 mm Hg and high anti phospholipid antibodies, which justified a hypotensive treatment and aspirin at a dose of 160 mg/day to avoid a possible recurrence.
Conlusions
Occlusions of the central retinal artery are often the translation of a suffering of the vascular system as a whole. They should constitute an "alarm signal" which should lead to the search for vascular risk factors.
Financial Disclosure
none
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