The latter corresponded to fundoscopy examination showing a severe optic disc swelling and vascular tortuosities reflecting pre-stasis. 1E, F) while the optic disc edema became more severe (Fig. Within a week, the macular edema began to decrease (Fig. Within 2 days, VA recovered to normal (20/20) and remained stable during the entire follow-up. Initial OCT and fundus autofluorescence (Spectralis, Heidelberg Engineering) showed foveal involvement with edema of the inner retinal layers mainly of the superior macular area (Fig. Fundoscopy revealed a cilioretinal artery occlusion (CLRAO) accompanied by a non-ischemic central retinal vein occlusion (CRVO). The ophthalmological history was otherwise unremarkable. ![]() RAO were detected using OCT and OCTA, thus initiating the evaluation of systemic risk factors.Ī 32-year-old Caucasian pregnant woman (week 19) with a 2-day history of a scotoma of her right eye presented with visual acuity (VA) of 5/200 (Snellen). Here we present a case series of three patients who visited our clinic owing to acute visual impairment. OCTA has made it for the first time possible to analyze microvascular changes such as in diabetes mellitus and hypertension during pregnancy. Optical coherence tomography angiography (OCTA) is a novel, noninvasive method for visualization of the functional retinal vessels measuring the movement of red blood cells and therefore represents a good method for analyzing the perfusion of retinal vessels in pregnant patients. However, its use should be avoided during pregnancy. It has been established that fluorescein dye crosses the placenta into the fetal circulation, yet detrimental effects of fluorescein dye on a fetus have not been documented. ![]() Normally, fluorescein angiography is a central part of diagnosing a retinal vascular occlusion. Guidelines recommend exclusion of PFO and other sources of embolism in the case of RAO. ![]() Furthermore and independent of pregnancy, patent foramen ovale (PFO)-related stroke is increasingly recognized as an important etiology of ischemic embolic stroke. These adaptions not only increase the risk of a retinal vascular occlusive event but also of stroke during pregnancy. These include complex cardiovascular, hormonal, hemostaseological, and immunological changes. There are many physiologic adaptions during pregnancy that can induce vascular occlusive events. In pregnancy however, retinal vascular occlusive diseases may arise spontaneously or a preexisting constitution may deteriorate. Only 11.4% of all RAO occur in people under 50 years of age. Retinal arterial occlusive diseases (RAO) in young patients are rare. Together with regular optical coherence tomography, it allows one to predict functional outcome according to the existing retinal occlusion-related atrophy. ConclusionsĪs shown here, optical coherence tomography angiography enables risk-free imaging of retinal vessel perfusion during pregnancy. ![]() All patients regained normal visual acuity and had otherwise uncomplicated pregnancies, and laboratory blood tests did not reveal any defects or alterations. In the third patient (32 years old), 8 weeks after onset of scotoma, optical coherence tomography angiography revealed atrophy of the middle layers and impaired perfusion in the deep capillary plexus, and thus a paracentral acute middle maculopathy was diagnosed. However, transient ischemia led to retinal atrophy after a few weeks. In both cases, optical coherence tomography angiography revealed reperfusion of the cilioretinal artery occlusion. We report two patients (30 and 32 years old) who developed cilioretinal artery occlusion but whose etiology differed: one was of thromboembolic origin associated with patent foramen ovale, while the other was caused by hemodynamic blockade secondary to central retinal vein occlusion. Using regular optical coherence tomography and optical coherence tomography angiography, retinal vascular occlusions were detected, thus initiating the evaluation of systemic risk factors. Here we present a case series of three patients (Caucasian, nonsmoker) who visited our clinic owing to acute visual impairment and central scotoma. Since fluorescein angiography, a central tool in the evaluation of these occlusions, should be avoided during pregnancy, optical coherence tomography angiography, a novel technique, offers a good opportunity for visualizing vascular perfusion of retinal tissue. In addition, a patent foramen ovale is a risk factor for an ischemic thromboembolic event. However, because of physiological multifactorial adaptations during pregnancy, retinal vascular occlusive disease may occur spontaneously. Retinal arterial occlusive events in young patients are rare.
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