Images in Clinical Medicine
Blurred Vision after Cardiac Catheterization
N Engl J Med 2009; 361:2366December 10, 2009
- Article
A 56-year-old woman with hypertension presented with a sudden onset of painless impaired vision in the right eye. On the previous day, she had undergone cardiac catheterization for evaluation of hypertensive emergency (chest pain and blood pressure of 235/110 mm Hg) with mild troponin elevation. On physical examination, the visual acuity in the right eye was 20/100 with significant visual-field defects in the inferior temporal quadrant. Biomicroscopy revealed cholesterol emboli (Panel A, arrows) with surrounding white lucency representing retinal edema. Fluorescein angiography confirmed occlusion of the cilioretinal artery with nonperfusion of the tissue bed in the hypofluorescent areas (Panel B). Cholesterol emboli are crystals that are released in the arterial bloodstream from ulcerated or disrupted atherosclerotic plaques and can be an initial sign of vascular disease. Such embolic events are a rare but serious complication of cardiac catheterization. The patient was treated with isovolemic hemodilution and intravenous heparin for 5 days in an attempt to enhance the perfusion of the vessel. At the 3-month follow-up visit, her vision had improved from 20/100 to 20/60.
Carsten H. Meyer, M.D.
Frank G. Holz, M.D.
University of Bonn, Bonn, Germany
meyer_eye@yahoo.com
