Treatment of vision-threatening branch retinal artery occlusion following coronary angioplasty with surgical displacement of embolus.

Abstract

Purpose: To report a successful case of vision restoration and macular reperfusion following branch retinal artery occlusion (BRAO) using pars plana vitrectomy with undermining the artery off the retinal bed.

Methods: This case report involves a 75-year-old patient who was diagnosed immediately with BRAO following cardiac catheterization procedure. An embolus at the superior retinal artery bifurcation was noted. Initial treatments were ineffective, leading to a pars plana vitrectomy and mechanical elevation of the artery, performed six hours post-occlusion.

Results: The surgical intervention successfully dislodged the embolus, resulting in significant visual improvement. Post-operative day 1, 4, and 14 assessments showed visual acuity improvement to counting fingers at 2 meters, 20/40, and 20/20, respectively. Fundoscopic examination and OCT angiography confirmed improved macular perfusion and normalization of the flow signal in the affected artery.

Conclusion: This case highlights the efficacy of pars plana vitrectomy and mechanical elevation of the artery for BRAO where the embolus can be visualized. Prompt identification and referral for surgical intervention in BRAO cases with poor prognosis are crucial for favorable visual outcomes. Further research is needed to assess the efficacy of this surgical technique and other interventions for managing BRAO.