A 60-year-old Chinese man presented with 2 day-long painless loss of vision in his right eye. He had systemic diseases, including diabetes mellitus, hypertension, coronary heart disease, lung cancer, and hyperlipidemia, for decades. The best-corrected visual acuity was 20/50 oculus dexter and 20/20 oculus sinister. Fundus examination revealed pale, edematous lesions in the region of the occlusive arteries, as well as multiple visible retinal cholesterol emboli, in the affected arteries. Fundus fluorescein angiography showed delayed fluorescein filling in the early phase (Figure A), and color Doppler ultrasonography showed right internal carotid artery occlusion (Figure B). The patient was immediately treated with sublingual nitroglycerin, massage, salvia miltiorrhiza injection, and oxygenation in the supine position. During the 2-week follow-up, the retinal edema resolved, and partial degradation, peripheral migration, or no movement of the emboli were noted (Figure C). However, the best-corrected visual acuity remained at 20/50.

Branch retinal artery occlusion is a severe form of retinal artery occlusive disease, which is characterized by sudden visual reduction and ill-defined retinal infarct. The presence of retinal emboli is linked to cardiovascular disease, stroke, and renal disease. The most common cause of retinal cholesterol emboli is severe carotid artery stenosis.

REFERENCES

1. Cho KH, Ahn SJ, Cho JH, Jung C, Han MK, Park SJ, et al. The Characteristics of Retinal Emboli and its Association With Vascular Reperfusion in Retinal Artery Occlusion. Invest Ophthalmol Vis Sci. 2016;57(11):4589-98.

2. Cheung N, Teo K, Zhao W, Wang JJ, Neelam K, Tan NYQ, et al. Prevalence and Associations of Retinal Emboli With Ethnicity, Stroke, and Renal Disease in a Multiethnic Asian Population: The Singapore Epidemiology of Eye Disease Study. JAMA Ophthalmol. 2017;135(10):1023-8.

Submitted for publication: June 3, 2022.
Accepted for publication: June 9, 2022.

Funding: This study received no specific financial support.

Disclosure of potential conflicts of interest: None of the authors have any potential conflicts of interest to disclose.