Visual recovery after acute choroidal ischemia with partial retinal hypoperfusion, demonstrated by fluorescein angiography

Abstract

Background: Compared with retinal vascular disease, choroidal ischemia has received little attention. Patients: The case histories of three patients are described. During embolization, a 32-year-old man complained of sudden deterioration in vision. An 82-year-old man with arterial hypertension, diabetes mellitus, and hyperlipoproteinemia reported a complete unilateral visual loss. A 72-year-old man (cigarette smoker) with arterial hypertension, diabetes mellitus, and a high-degree internal carotid artery stenosis developed a headache accompanied by sudden unilateral loss of vision. Results: The three patients showed ischemic signs predominantly in the choroid, but also subtle signs in the retina (patient 2) and branch retinal artery occlusion (patient 3). On ophthalmoscopy alone, no clear-cut choroidal hypoperfusion was detected in two patients. However, diagnosis of choroidal hypoperfusion was essentially made by fluorescein angiography. The choroidal hypoperfusion almost completely surrounded the optic disk in two patients. Normal vision returned spontaneously in one patient, in spite of an almost complete temporal choroidal ischemia. In patient 2, a partial recovery followed treatment of his arterial hypertension. Patient 3 also showed a good visual recovery after treatment with heparin, massage of the globe, and antihypertensive drugs. The circulation time of the choroidal angiographic filling defects was 10 sec and longer, but it became much shorter after several weeks. Conclusion: Visual recovery was good in all patients despite ischemic signs in the choroid. No scarring of the central retinal pigment epithelium was observed.

Key Words:

• Acute choroidal ischemia
• arterial hypertension
• internal carotid artery obstruction
• embolization
• branch retinal artery occlusion