J Neurocrit Care.  2024 Jun;17(1):24-28. 10.18700/jnc.240004.

Favorable outcome after intra-arterial thrombolysis in a patient with branch retinal artery occlusion: a case report

• Bang SJ
• Yang JE
• Park SK
• Park H
• Sohn SI
• Hong JH

• KMID: 2556730
• DOI: http://doi.org/10.18700/jnc.240004

Abstract

Background
Branch retinal artery occlusion (BRAO) is characterized by a sudden, painless monocular visual loss. The condition usually has a favorable prognosis but can sometimes cause severe visual loss. Currently, no clinical guidelines are available for the treatment of BRAO.
Case Report
A 38-year-old man presented with vision loss. Initial visual acuity was 0.08/1.0 and a lower-altitudinal visual field defect was detected in the right eye. Occlusion of the superior temporal branch of the retinal artery was observed using fluorescein angiography. The patient was diagnosed with BRAO, and intra-arterial thrombolysis (IAT) was performed 11 hours after the first abnormality. The patient demonstrated rapid improvement after IAT. Visual acuity recovered to 0.8/1.0 and only the cecocentral scotoma remained at 5-month follow-up.
Conclusion
For patients with BRAO and severe vision loss, IAT may be an effective treatment. However, owing to potential complications, this procedure should be reserved for selected patients.

Keyword

Branch retinal artery occlusion; Central retinal artery occlusion; Thrombolytic therapy

Figure

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  Fig. 1. Fluorescein angiography and fundus photograph of the right eye obtained before intra-arterial thrombolysis. (A) Occlusion of the superior temporal branch of the retinal artery on fluorescein angiography. (B) The pale retina of the occluded vascular branch on fundoscopy.

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  Fig. 2. Digital subtraction angiography. (A) The ophthalmic artery is selected using a microcatheter (arrow). (B) Tissue plasminogen activator is injected into the ophthalmic artery.

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  Fig. 3. Fluorescein angiography 3 days after the intra-arterial thrombolysis. Improved blood flow and recanalized superior temporal branch of the retinal artery are observed.

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  Fig. 4. Visual field test of the right eye 5 months after the treatment. No visual field defect is observed except mild cecocentral scotoma.

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