Branch Retinal Artery Occlusion

A patient with a past medical history of fusiform aneurysm of the right anterosuperior M2 trunk measuring 7 x 15 mm underwent a pipeline assisted coil embolization of the right middle cerebral artery M2 fusiform aneurysm, which led to almost complete obliteration of the aneurysm with very mild proximal stagnant flow noted after embolization. When the patient woke up in the post-anesthesia care unit, she noticed a superior visual field defect in her right eye. Vision in her left eye was unchanged. She reported no pain or irritation in either eye. Her exam was notable for visual acuity of 20/800 in the right eye and 20/20 in the left eye. Intraocular pressure was 10 in the right eye and 13 in the left eye. Slit lamp exam was notable only for bilateral LASIK flaps and anterior-posterior cortical haze of the lens bilaterally. Dilated fundus exam of the right eye showed an area of retinal whitening along the distribution of the inferior arcade, consistent with a branch retinal artery occlusion. Patient wasoutside thetime window for thrombolysis. Patient was started on brimonidine eye drops to lower intraocular pressure. On follow up, the patient’s visual acuity was stable in both eyes. Fundus photos and optic coherence tomography showed improvement.

Presentation Date: 09/22/2022

Issue Date: 11/11/2022