Transluminal Nd: YAG laser embolysis for branch retinal artery occlusion

Abstract

Rationale:Central retinal artery occlusion and branch retinal artery occlusion (BRAO) result in partial or complete retinal ischemia and sudden loss of vision; to date there is no effective therapy for central retinal artery occlusion and BRAO. Transluminal Nd:YAG laser embolysis (TYE) could represent a therapeutic approach for retinal vascular occlusive diseases.Patient concerns:We report 2 cases with BRAO, 1 with inferor-temporal and 1 with superor hemiretinal BRAO. All the patients complained of a history of sudden blurry vision and impaired visual field and had a visible embolus within the intravascular, all of them treated with TYE, the laser applications being delivered directly to the embolus.Diagnosis:The diagnosis was based on the results from color retinography, optical coherence tomography and visual field testing. Fundus fluorescein angiography clearly indicated the location of retinal artery occlusion.Interventions:The patients’ symptoms could not be relieved after dilating the blood vessels in the eye, lowering intraocular pressure, massaging the eyeball, and inhaling oxygen. Informed consent was obtained from the patient for TYE and the patients were referred for this procedure.Outcomes:Upon the successful competition of the TYE procedure the embolus was removed completely, restoring the blood flow in the intraocular vessels and improving significantly the patients’ visual acuity.Lessons:World-wide experience with TYE is still limited, but the technique seems feasible for the treatment of RAO caused by visible emboli on the optic disc surface and the posterior pole of the fundus oculi.

Retinal Artery Reperfusion After Translumenal YAG Laser Embolysis in a Case of Branch Retinal Artery Occlusion

“…Previous case reports exploring the use of this procedure for the treatment of BRAO have also found improvements in functional outcomes after the procedure. [6][7][8][9] BRAO, however, typically has a favorable natural history, with a long-term VA of 20/40 or better in nearly 90% of cases. 10 By the time our patient was initially seen, the embolus may have moved from its original position inferior to the disc to a point just distal to the branch arteriole to the central macula, as suggested by the retinal edema visible on OCT, making it possible that the visual field defect improved on its own.…”

“…Previous case reports exploring the use of this procedure for the treatment of BRAO have also found improvements in functional outcomes after the procedure. 6 –9 BRAO, however, typically has a favorable natural history, with a long-term VA of 20/40 or better in nearly 90% of cases. 10…”

“…5 Several other case reports have shown success with this modality for BRAO secondary to emboli; however, a large series has yet to be reported and this treatment is not commonly used. 6,7 We report a successful case of translumenal YAG laser embolysis in a patient with BRAO and provide a review of the existing literature.…”

Aetiology, Diagnosis and Treatment of Arterial Occlusions of the Retina—A Narrative Review

“…If the occluding embolus is visible, transluminal YAG-Laser embolysis can be considered [81][82][83]. This procedure should be performed within 6 h after the onset of the symptoms.…”

“…Shots of 0.5 mJ (milli-Joule) were applied directly to the embolus in order to eject it into the vitreous via an opening in the arteriole. However, this procedure comes with risks of severe complications such as retinal or vitreous hemorrhage, retinal breaks, choroidal neo-vascularization and the formation of epiretinal membranes [1,[81][82][83].…”