Transluminal Nd: YAG Laser Embolysis for Branch Retinal Artery Occlusion: A case Report

Abstract

A 57-year-old, male, type 2 diabetic patient with the diagnosis of acute form of right eye inferotemporal branch retinal artery occlusion which occurred three days ago was reported. The patient complained of right eye visual field deficit (horizontal upper quadrant) with decreased visual acuity of finger counting from two meters. On fundus examination, calcific embolus was noted with inferotemporal branch artery occlusion and macular edema. The embolus was fragmented (embolysis) with the Nd:YAG laser technique. Subhyaloid hemorrhage developed and was drained by posterior hyaloidotomy with Nd:YAG laser at the same session. Visual acuity increased and hemorrhage gradually absorbed on follow-up period. Final visual acuity was 8/10 with eccentric fixation. Recovery of blood flow in the occluded arteriole both in fundus examination and fluorescein angiography were noted.

Transluminal Nd: YAG laser embolysis for branch retinal artery occlusion

“…The power ranged from 2 to 6mJ, and led to the developed of a subhyaloid hemorrhage overlying the occluded vessel area. [13] Our patients also had a minor preretinal hemorrhages, and the bleeding stopped after proper pressure using the contact laser lens. The hemorrhages were completely reabsorbed after 10 to 14 days.…”

“…The time of meaningful treatment for RAO, is determinant as the sooner the treatment is performed, the better results are achieved, but even in prolonged occlusions (<8-10 days) with persistent macular edema TYE embolysis can help. [12,13] Currently, we cannot prove the benefits of late TYE. It is very difficult to decide if the retina lesions are for good after one week of BRAO or there are still some viable retinal cells able to survive if the blood flow is restablished.…”

“…The absolute therapeutic role of TYE in BRAO is debatable as it is known that over 70% of cases can heal by themselves, but the efficiency of the technique is clear when speaking about the speed of emboli destruction and the recovery of blood flow. [13] Despite the set of inherent risks of any surgical intervention, the moment of emboli destruction as close as possible to the onset of occlusion is decisive for regaining visual function. We emphasize the importance of individualized analysis of any BRAO patient in deciding the treatment.…”

“…We emphasize the importance of individualized analysis of any BRAO patient in deciding the treatment. The time of meaningful treatment for RAO, is determinant as the sooner the treatment is performed, the better results are achieved, but even in prolonged occlusions (<8–10 days) with persistent macular edema TYE embolysis can help [12,13] …”

“…Kocak et al [13] report a case where a patient who had BRAO and the clinical efficacy of the TYE on BRAO with visible embolus. The power ranged from 2 to 6mJ, and led to the developed of a subhyaloid hemorrhage overlying the occluded vessel area [13] .…”