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Attempts to Treat Retinal Artery Occlusion after 32 Hours - A Case Report

Uhlig C. E., Busse H.,
Westfälische Wilhelms-Universität Münster, Klinik und Poliklinik für Augenheilkunde (Münster)

Purpose: The medical treatment of acute retinal artery occlusion is often insufficient. Delayed beginning of treatment is considered as a very critical parameter in this context.
Method: Case report of a 71-year-old man, who presented in our clinics 32 hours after an acute decrease of his visual acuity and a suddenly remarked scotoma of his right eye.
Results: His general anamnesis was the history of a heart attack with a diminished acitivity of his left ventricle and a long-range sclerosis of both common carotids. Diagnosis in outward clinics two days before was central retinal artery occlusion but treatments had not been started. The visual acuity was 1/50 when the patient entered our hospital and there was a scotoma of his central and temporal upper visual field. Fundoscopy and fluorescein angiography demonstrated a macular edema, an occlusion of superior hemiretinal branch artery and an occlusion of a cilioretinal vessel both of which were close to the optic disc. The patient was heparinized (5.000 IE i.v. immediately, 900 IE/h continuously through a perfusion system) and additively treated with 500 mg acetazolamide i.v., and 100 mg aspirine. The globe was pressured intermittently over a period of 15 minutes. The next day the visual field was almost the same but the acuity of his right eye had increased and was 0.9. Due to an elevated haematocrit (46,9%) an isovolemic haemodilution was performed. A second fluorescein angiography demonstrated regularly perfused arteries seven days after. The visual acuity was stable.
Conclusions: The case report demonstrates that there is a chance of treating effectively retinal artery occlusion that even lasts for several hours.