OCT Angiography Use in Pregnancy: Branch Retinal Artery Occlusion Associated with Patent Foramen Ovale – A Case Report and Multimodal Analysis

Abstract

This case report is a multimodal analysis of a pregnant patient with branch retinal artery occlusion (BRAO) associated to patent foramen ovale (PFO). A 28-year-old woman presented at the clinic 20 h after an acute, painless black spot appearance in the inferior temporal visual field of the right eye (OD). At that time, she was 18 weeks pregnant and had no report of complications in her previous pregnancy. Best-corrected visual acuity was 1.0 in both eyes. Color fundus photo, perimetry, and OCT angiography were required. The results clearly showed an embolus in the superior nasal retinal arteriole, associated with a pallor in the distal retina. Patient was referred to a cardiologist and a transcranial Doppler with contrast indicated a right-to-left intracardiac shunt, confirmed by the presence of a PFO at the transesophageal echocardiography. Thrombophilic conditions were excluded. Enoxaparin 1 mg/kg was started and kept until the delivery. Now, a PFO surgical closure is on schedule. This case highlights the noteworthiness of considering PFO as a source of embolism for BRAO in young patients, the capability of OCTA as a dye-free method for use in pregnancy and emphasizes the importance of systemic evaluation in patients with BRAO.

Retinal artery occlusion after facial filler injection in a patient with patent foramen ovale: a case report and literature review

“…1,5,8 Vision loss and visual field defects after facial filler injection can be triggered by RAO, a disease involving retinal artery obstruction and the corresponding lack of retinal perfusion; these phenomena result in acute ischemia and hypoxia, intracellular edema, and rapid death of cells throughout the retina, ultimately leading to visual impairment. 14 Prompt and appropriate action is essential to preserve vision in an affected patient. 24 Emergency treatment is intended to restore retinal perfusion within 90 minutes.…”

“…12 Additionally, 67% of patients with RAO have at least one cardiovascular risk factor. 13,14 Current guidelines recommend excluding patent foramen ovale (PFO) and other sources of embolism in patients with suspected RAO. 15 PFO, a risk factor for ischemic thromboembolic events, is present in approximately 30% of healthy adults.…”

“…16,17 There have been multiple reports of PFO as a source of emboli in patients with RAO. 14,[17][18][19][20][21][22][23] Here, we describe a young woman who developed multiple RAO in the right eye after HA injection into the nasal root. She had a concurrent PFO and experienced vision loss in two stages, leading to a gradual decline in visual acuity.…”