Differentiating Branch Retinal Artery Occlusion From Normal Tension Glaucoma With Optical Coherence Tomography Angiography

Abstract

Background: To describe a patient with branch retinal artery occlusion that was misdiagnosed as normal tension glaucoma (NTG) Case Presentation: A female 76-year-old patient presenting inferior nasal visual field scotoma, neuroretinal thinning in the optic disk of the right eye with corresponding atrophy of superior retinal nerve fiber layer in optical coherence tomography (OCT). She was treated with latanoprost eye drops for NTG. However macular OCT angiography showed a localized thinning of the inner retina following the superior temporal branch retinal artery path, along with a superficial and medium capillary plexus reduction and superior macular ganglion cell layer atrophy. Further investigation with carotid arteries angio-tomography revealed an atheromatous lesion in the right and left carotid bulb with stenosis of 50–60%, in addition to aneurysms of the cavernous, pituitary and communicating segments of the left and right internal carotid artery, reinforcing the diagnosis of superior temporal branch retinal artery ischemic. Conclusion: This case highlights the importance of establishing differential diagnosis in cases of presumed NTG and reinforces the use of the OCT angiography in clinical practice.

Inner Retinal Thinning Comparison between Branch Retinal Artery Occlusion and Primary Open-Angle Glaucoma

“…Delayed or late presentation of BRAO, after the acute phase findings have resolved, may result in a relatively normal-looking fundus. There could be subtle signs making the diagnosis challenging, especially in cases where the BRAO involves a vessel in the temporal arcades, causing visual field changes similar to POAG [3,11,12].…”