Treatment of Branch Retinal Artery Occlusion With Transluminal Nd:YAG Laser Embolysis

Abstract

The purpose of this paper was to report a successful treatment of transluminal Nd:YAG laser embolysis (NYE) for branch retinal artery occlusion (BRAO) with visible emboli. Two patients with acute, severe vision loss secondary to a branch retinal artery occlusion with visible emboli in one eye underwent NYE. A complete ocular examination was performed which included biomicroscopy of the posterior pole of the retina, intraocular pressure measurement, fundus color photographs, and fluorescein angiography (FA). After the NYE, the two patients showed dramatic improvements in best-corrected visual acuity, as well as, immediate and dramatic restorations in flow past the obstructed arteriole in FA. NYE is a treatment modality to be considered in patients with BRAO who present acutely with severe vision loss and a visible embolus.

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…”

Transluminal Nd: YAG laser embolysis for branch retinal artery occlusion

“…Sixty-one treated cases were reported in the world, 47 with BRAO and 14 with CRAO. In a weighted analysis vitreous/sub-retinal hemorrhage was estimated to occur in 54% of cases and required vitrectomy in 18% of cases [8–11] . Unfortunately, TYE has not been recognized by the academic community due to the condition of equipment and the lack of treatment experience.…”

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].…”