Images in Clinical Medicine
Retinal Arteriolar Cholesterol Emboli
N Engl J Med 2008; 358:826February 21, 2008
- Article
A 59-year-old man with a medical history of hypertension, hyperlipidemia, and coronary artery disease presented with transient, painless visual obscuration in the left eye, and he was referred for retinal evaluation. Two months earlier, he had undergone placement of a stent in the left carotid artery for severe stenosis. He was receiving antiplatelet therapy. Two years earlier, an eye examination had been unremarkable. Retinal examination of the left eye showed multiple, tiny refractile retinal arteriolar cholesterol emboli and a saddle embolus superior to the optic nerve (Panel A, arrow). Two months later, repeat examination showed an increase in the number of cholesterol emboli (Panel B). The patient's visual acuity was unchanged (20/25 bilaterally). Four weeks later, a sudden, painless loss of the left superior visual field occurred. Examination revealed whitening in the inferior macular region (Panel C, arrow), a finding that was consistent with an occlusion at the second major bifurcation of the inferior temporal branch of the retinal artery. After carotid stenting, ongoing deposition of retinal emboli may occur. The patient was left with a deficit in the superior visual field.
Michael Colucciello, M.D.
South Jersey Eye Physicians, Moorestown, NJ 08057
michael@macula.us
