Branch retinal artery occlusion with embolic movements.

A 59-year-old man with poorly controlled hypertension presented with an acute, painless, partial visual loss in the left eye for 5 days. Ultra-wide field retinal color and red-free image of the left eye showed retinal whitening in the inferior macular region along the distribution of the affected inferior branch retinal artery. The site of obstruction with a tiny refractile emboli at the first bifurcation of the inferior temporal arteries was noted [Fig. 1a and c; arrow]. Branch retinal artery occlusion was diagnosed and anterior chamber paracentesis was performed immediately. Three days later, repeated examination showed the emboli had moved forward to the third bifurcation [Fig. 1b and d; arrow], and no new retinal edema was found in the distal part of the new obstruction. The patient's visual acuity was unchanged with best corrected 20/20 and he was left with a deficit in the superior visual field. In addition to hypertension, no other systemic abnormalities were found.

Figure 1

Ultra-wide field retinal image of the left eye with inferior branch retinal artery occlusion from an embolus. The embolus movement from a to b arrow and red-free photograph (Panel c and d) greatly accentuates the retinal whitening and embolus

Branch retinal artery occlusions occur secondary to an embolus which is most likely to occur at the bifurcation of an artery.[1] Surgical embolectomy and rescue vitrectomy with blocked artery massage for retinal artery occlusion caused by a visible embolus have been reported.[234] The purpose of surgical intervention is to move the visible emboli to the distal end of the retinal artery with external force. It is rare for the visible embolus to move forward by itself after paracentesis for the patient.

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