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We describe a healthy 37-year-old man with Bartonella henselae (B. henselae) neuroretinitis with concurrent central retinal vein occlusion and ischemic optic neuropathy resulting in optic atrophy and choroidal ischemia.Case report.A 37-year-old man presented with unilateral decreased vision and a fundus examination consistent with neuroretinitis. Further imaging review supported a concurrent diagnosis of central retinal vein occlusion. Although initially negative, repeat serological testing for B. henselae infection was positive. Multimodal imaging displayed severe outer retinal disruption, ischemic optic neuropathy, and choroidal ischemia. The patient demonstrated near complete resolution of fundus findings and restoration of outer retinal architecture. Residual findings included optic disk pallor and ischemic choroidopathy.B. henselae neuroretinitis may be associated with concurrent retinal vascular occlusive disease and ischemic optic neuropathy. Central retinal vein occlusion and choroidal ischemia leading to optic nerve atrophy are additional sequelae further expanding the clinical spectrum of this entity.

The area of choriocapillaris nonperfusion on optical coherence tomography angiography correlated with the area of macular atrophy on fundus autofluorescence in eyes with exudative age-related macular degeneration. Choroidal ischemia might be involved in macular atrophy in treated age-related macular degeneration., Purpose: To compare the areas of choriocapillaris (CC) nonperfusion and macular atrophy (MA) in treated exudative age-related macular degeneration. Methods: This was a prospective, observational, cross-sectional study. Forty-four eyes exhibiting MA (42 patients with age-related macular degeneration), with a dry macula, underwent fundus autofluorescence and optical coherence tomography angiography. The area of MA detected by fundus autofluorescence and CC nonperfusion detected by optical coherence tomography angiography was measured using image analysis software. The rates of concordance between the MA and CC nonperfusion areas were calculated. We qualitatively and quantitatively compared the areas of MA and CC nonperfusion in age-related macular degeneration eyes. Results: The mean areas of MA and CC nonperfusion were 5.95 ± 4.50 mm2 and 10.66 ± 7.05 mm2, respectively (paired t-test, P < 0.001). In 39 eyes (88.6%), the CC nonperfusion area was larger than the MA area, and the mean CC nonperfusion area was significantly larger than the mean MA area. Fundus autofluorescence matching optical coherence tomography angiography showed that the CC nonperfusion area was almost included in the MA area. The mean concordance rate for the MA area inside the CC nonperfusion area was 87.7 ± 13.9%. Conclusion: The MA and CC nonperfusion areas markedly overlapped. The area of CC nonperfusion correlated with the MA area. Choroidal ischemia might be involved in the pathogenesis of MA in treated age-related macular degeneration.

Purpose To report the first case of a patient with essential thrombocythemia (ET) who presented with unilaterally extensive choroidal ischemia coinciding with central retinal artery occlusion (CRAO). Observations: A 64-year-old man presented with a classic sign of short posterior ciliary artery (SPCA) occlusion, Amalric triangular choroidal infarction, coinciding with CRAO in the left eye. He was later diagnosed as having ET due to a massive platelet count of 1,100,000 cells/mm3 and confirmed genetic testing. The magnetic resonance angiogram subsequently revealed severe occlusions of neuro-ophthalmic circulation. Interestingly, occult choriocapillaris occlusions were detected in the right eye despite being visually asymptomatic. Conclusion and importance Patients with ET can present with concurrent CRAO and SPCA occlusion. Identifying the causes of such events is crucial as these can precede systemic thrombocytosis or hemorrhagic complications.

A 62 year-old male patient presented with fluctuating vision in both eyes. On fundus fluorescein angiogram, there was an area of choroidal and retinal ischemia in the left eye. The carotid evaluation revealed complete stenosis of the right internal carotid artery and 90% stenosis of the left internal carotid artery for which he underwent left modified endarterectomy. The vision and angiographic features improved after the procedure. Eleven months after the procedure, he again presented with choroidal ischemia due to recurrent left internal carotid artery blockage which improved gradually after carotid stenting.

Severe systemic hypertension can cause significant damage to the eye. Although hypertensive retinopathy is a well-known complication, hypertensive optic neuropathy and hypertensive choroidopathy are much less common. The aim of this article is to report an unusual case of hypertensive choroidopathy with bullous exudative retinal detachments in both eyes. The retinal detachments spontaneously resolved after blood pressure was controlled. However, multiple large retinal pigment epithelial (RPE) rips were found in both eyes. These RPE rips may be related to severe choroidal ischemia, and their locations may be compatible with the watershed zones of the choroidal perfusions.

A 41-year-old gentleman with insulin dependent diabetes had decreased vision in the right eye due to non-ischemic central retinal vein occlusion with macular edema. One month following intravitreal ranibizumab, he developed retino-choroidal ischemia with further loss of vision. Authors show the fluorescein angiographic transition from non-ischemic central retinal vein occlusion to retino-choroidal ischemia.

This review aims to summarize existing information concerning visual disturbances in (pre) eclampsia that have been described in the literature. Preeclampsia is one of the leading causes of maternal and fetal morbidity and mortality worldwide. Visual disturbances in (pre) eclampsia seem to be frequent phenomena. Therefore, the obstetrician/gynecologist may encounter women with serious, and sometimes debilitating, pathology of the visual pathways. Established ophthalmic entities associated with (pre) eclampsia are cortical blindness, serous retinal detachment, Purtscher-like retinopathy, central retinal vein occlusions, and retinal or vitreous hemorrhages. Ensuing visual symptoms include blurry vision, diplopia, amaurosis fugax, photopsia, and scotomata, including homonymous hemianopsia. In general, aside from lowering the blood pressure and preventing (further) seizures with magnesium sulfate, no specific therapy seems indicated for (pre) eclamptic women who experience visual changes. Although in most cases visual acuity returns to normal within weeks to months after the onset of symptoms, rarely permanent visual impairment can occur. Health care providers such as emergency room physicians, obstetricians, family physicians, neurologists, and ophthalmologists should be aware that acute onset of visual symptoms in pregnant women can be the first sign of (pre) eclampsia. Given that visual changes are a diagnostic criterion for severe preeclampsia, obstetricians should appreciate the significance of these changes and discuss appropriate diagnostic options with the ophthalmologist. Affected women can be reassured that most cases are transient.Target Audience: Obstetricians and gynecologists, ophthalmologists, neurologists, family physicians, emergency room physiciansLearning Objectives: After completing this CME activity, obstetricians and gynecologists should be better able to classify visual disturbances at an early stage during pregnancy, interpret acute onset of visual disturbances as the first sign of preeclampsia, and evaluate possible residual visual symptoms during follow-up.

PURPOSE:: To report a case of choroidal ischemia in a professional diver after a decompression sickness accident. METHODS:: A 31-year-old man presented a decompression sickness accident without any systemic manifestation. The symptoms were exclusively ophthalmic with sudden decrease of vision and presence of scotoma predominantly on the left eye immediately after a dive. The patient had a complete clinical ophthalmologic examination as well as fluorescein angiography, optical coherence tomography, central visual field, visual-evoked potentials, and electroretinogram examinations that were repeated during the follow-up over a period of 18 months. RESULTS:: The examinations performed 1 week after the decompression sickness accident and the hyperbaric oxygen therapy showed diminution of foveal reflectivity associated with retinal pigment epithelium modifications, deficit of choroidal perfusion in the macular region, and important central scotoma in both eyes. During the follow-up, the central scotoma disappeared after 6 months. The retinal pigment epithelium presented pigmentary migrations without subretinal fluid accumulation. CONCLUSION:: This case report describes choroidal ischemia resulting from decompression-induced intravascular gaseous microemboli caused by a decompression sickness diving accident. Language: en

To report the association of a unilateral serous macular detachment with severe postoperative pain. A 71-year-old woman presented with a sudden decrease in vision in the right eye, seven days after a total knee replacement arthroplasty. The patient's history was unremarkable except for a severe pain greater than the visual analog scale of 8 points for about 2 days after surgery. Retinal examination showed a well differentiated serous detachment that was about 3.5 disc diameter in size and located in the macular area. Fluorecein angiography and indocyanine green angiography showed delayed perfusion of the choriocapillaris without leakage points in the early phase and persistent hypofluorescence with pooling of dye in the subretinal space in the late phase. There was a spontaneous resolution of the serous detachment and the choroidal changes with residual pigment epithelial changes. Severe postoperative pain may influence the sympathetic activity and introduce an ischemic injury with a focal, choroidal vascular compromise and secondary dysfunction of overlying RPE cells in select patients.

Purpose To describe a case of choroidal infarction as illustrated by the "triangular sign of Amalric" after cocaine inhalation. Methods Observational case report. Results A 52-year-old male presented with an acute loss of vision in his left eye immediately after cocaine inhalation. Color photography and fluorescein angiography revealed triangular areas of choroidal ischemia following the distribution of the posterior ciliary arteries. Conclusion Cocaine-induced vasospasm, specifically of the distal short posterior ciliary arteries, may explain the triangular wedge-shaped choroidal infarcts in our patient. A thorough drug history may circumvent unnecessary and costly investigations in such cases.

Temporal arteritis is a subacute systemic panarteritis with predilection over cranial arteries. Anterior ischemic optic neuropathy with or without the typical sectoral choroidal ischemia is the most common complication. However isolated multifocal choroidal ischemia is an uncommon finding in giant cell arteritis. We report a case of unilateral multifocal choroidal ischemia revealing a giant cell arteritis.

A 24-year-old healthy male presented with a chief complaint of blurred vision in the right eye for 1-week. Fundus examination indicated right exudative retinal detachment and choroidal ischemia. The patient responded well to anti-toxoplasmosis medications and steroids. Exudative retinal detachment and choroidal ischemia are atypical presentations of ocular toxoplasmosis. However, both conditions responded well to anti.parasitic therapy with steroid.

Taweevat Attaseth,1 Kavin Vanikieti,1 Anuchit Poonyathalang,1 Pisit Preechawat,1 Panitha Jindahra,2 Duangkamon Wattanatranon3 1Department of Ophthalmology, 2Department of Medicine, 3Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Abstract: Giant cell arteritis is a systemic granulomatous vasculitis affecting medium to large arteries. An arteritic anterior ischemic optic neuropathy is the most common cause of permanent visual loss. Giant cell arteritis is very rare among Asians. We report six patients with biopsy-proven arteritic anterior ischemic optic neuropathy. Demographic data, clinical manifestations, laboratory findings, treatment, and visual outcome are described in detail and compared with Caucasian patients. We found no differences in any clinical features except for sex preference. Moreover, perioptic nerve sheath enhancement was observed in half of our patients. Keywords: giant cell arteritis, temporal artery biopsy, perioptic nerve sheath enhancement, choroidal ischemia, Asian

We describe a patient who, during tapering of corticosteroids prescribed for temporal arteritis (TA), developed nocardiosis that was mimicking a specific relapse. An isolated choroidal ischemia was thought to be a symptom of TA. Steroid therapy was intensified and, while on aggressive steroid therapy, the patient died of septic shock. Autopsy revealed occult disseminated nocardiosis with septic arteritis and apparently cured TA. Visual loss occurring during TA treatment should lead clinicians to consider a specific relapse as well as an opportunistic infection like nocardiosis.

The use of krypton red laser photocoagulation (KRLPC) to treat subretinal neovascular membranes (SRNVM) is increasing. The complications of this treatment in a large series of patients have not been reported. Over a 15-month period, 195 patients had KRLPC to SRNVM of the following etiologies: senile macular degeneration (151), presumed ocular histoplasmosis (33), miscellaneous (11). Fourteen patients had the following complications attributable to KRLPC: choroidal hemorrhage (9), retinal pigment epithelial tears (3), choroidal ischemia (1) and choroidal folds (1). The visually significant complication rate was 3.6%. Proper patient selection and treatment technique may decrease the risk of complications.

The authors describe in seven eyes of four patients a form of serpiginous choroiditis beginning in the macula without initial peripapillary activity. Eyes with macular serpiginous choroiditis often had a poor visual prognosis and sometimes developed subretinal neovascularization. Fluorescein angiography of the acute lesions showed hypofluorescence; some cases were thus initially diagnosed as having choroidal ischemia. Fluorescein angiography in one eye, however, suggested that at least some of the hypofluorescence seen acutely in eyes with serpiginous choroiditis is secondary to blocked fluorescence from "opaque" retinal pigment epithelium.

Combined lensectomy-vitrectomy was performed on 25 eyes in 20 patients with cataracta complicata associated with uveitis from various etiologies. Postoperative follow-up averaged 15 months, with visual improvement in 24 of the 25 eyes. Primary cause of postoperative decreased vision was cystoid macular edema. Operative complications included retinal detachment and choroidal ischemia. The technique employed and the effect of lensectomy-vitrectomy on decreasing the number and severity of recurrent attacks of uveitis are discussed.

• Sudden, transient loss of vision in one eye (amaurosis fugax) is associated frequently with atherosclerosis of the internal carotid artery in adults and may herald a stroke. Thus, cerebral angiography is often performed. Amaurosis fugax in children is uncommon and an underlying cause is rarely demonstrated. Recurrent episodes of amaurosis fugax occurred in five adolescents. A characteristic evolution and pattern of visual loss, consistent with choroidal ischemia as the underlying mechanism, was described by four of them. Although none of the episodes were accompanied by headache, four patients had a history of common migraine at other times or a family history of migraine. These episodes of visual loss may represent a migraine variant, and cerebral angiography is not indicated in adolescents with such a history. (AJDC1988; 142:331-333)