RETINAL ARTERY OCCLUSION AFTER INTRAVASCULAR PROCEDURES: Case Series and Literature Review

Purpose:To evaluate clinical characteristics and possible mechanisms of retinal artery occlusion (RAO) after intravascular procedures.Methods:This study is retrospective case series and literature review. Twenty-seven patients with intravascular procedure-associated RAO (10 new patients and 17 from previous reports) were divided into Groups 1 and 2 according to assumed etiology - dislodged and new emboli, respectively. Clinical features and etiology of RAO were analyzed.Results:Branch and central RAO were observed in 17 (63%) and 10 (37%) patients, respectively, and 61.1% of patients exhibited final BCVA ≥20/40. Intravascular procedures were performed at the carotid artery (48.1%), heart (25.9%), carotid artery or heart (3.7%), brain (11.1%), scalp/glabella (7.4%), and thyroid (3.7%). Ratio of patients with immediate and delayed (≥24 hours after procedure) onset of RAO was 17 (63.0%):10 (37.0%). In Group 1 (n = 16), RAO was associated with dislodged plaques in the carotid artery (9; 56.3%), heart (6; 37.5%), or carotid artery/heart (1; 6.3%), and one patient each experienced acute brain infarction and contralateral branch retinal artery occlusion. In group 2 (n = 11), RAO was associated with new thrombi (6; 54.5%) or emboli (5; 45.5%), and one patient experienced ocular pain, ophthalmoplegia, and blepharoptosis.Conclusion:Intravascular procedures might result in RAO because of embolic plaques dislodged from the carotid artery or heart, or new thrombi or embolic materials migrating through collateral channels. Branch retinal artery occlusion was more frequent than central retinal artery occlusion after intravascular procedures, which resulted in relatively good visual outcomes. Patients should be informed about immediate or delayed presentation of RAO after intravascular procedures.