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From questions on page 503
Describe the colour fundus photograph and fluorescein angiogram findings. Colour fundus photography revealed left temporal retinal pallor, a ‘cherry red spot’ with cilioretinal sparing, and a peripapillary ring of non-oedematous retina with no disc oedema (figure 1B). Although central retinal artery occlusion was seen clinically, fluorescein angiography revealed delayed filling of both the retinal and choroidal arterial systems and of the cilioretinal artery (figure 1D–F). However, the posterior ciliary arteries around the optic disc remained perfused in all sectors. Although not shown, fluorescein angiography of the unaffected right eye showed no abnormalities.
What is the diagnosis? What are the possible mechanisms for such a process in this patient? These findings are consistent with occlusion of the distal branches of the ophthalmic artery. We postulate that this condition may have arisen due to a number of causes. Prolonged intraoperative hypotension caused lowering of perfusion pressure within the ophthalmic artery. Combined with the presence of a relative polycythaemia and activated protein C resistance, this will have facilitated thrombus formation. On recovery, the subsequent rise in blood pressure would have dislodged thrombo-emboli into the posterior choroidal and central retinal arteries.
How would you manage this patient? Management of this patient is centred on two factors: diagnosis and treatment of the underlying clotting disorder and correction …
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