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R. G. Tanawade, D. Shukla, R. Kim; Combined Occlusion of Medial Posterior Ciliary Artery (MPCA) and Central Retinal Artery (CRA) - A Rare Entity. Invest. Ophthalmol. Vis. Sci. 2008;49(13):6113.
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To report a rare case of spontaneous combined occlusion of the medial posterior ciliary artery (MPCA) and central retinal artery (CRA) secondary to cardiac emboli.
A 56 year male non-smoker presented with a sudden loss of vision in the right eye. A complete ocular examination, fluorescein angiography (FA) and ocular doppler was performed. An appropriate referral for a cardiovascular assessment was arranged. Relevant haematological investigations, echocardiography and carotid doppler were performed. The patient was followed up for over one year.
At initial presentation, the right eye demonstrated no perception of light and a relative afferent pupillary defect. Fundus in the right eye revealed a cherry red spot and retinal pallor involving the macula, peripapillary region and most part of the nasal half of the retina. A few triangular patchy white chorioretinal lesions were noted largely in the superonasal periphery. FA showed borderline delay in arteriovenous transit time and macular infarction with pruning of vessels. The most striking feature was a bright well defined area of patchy hyperfluorescence involving the peri-papillary region extending into the nasal retina with brightly hyperfluorescent sharply-defined triangular staining patches being seen in the periphery corresponding to the fundal lesions. A diagnosis of a combined MPCA and CRA occlusion was made. Systemic assessment showed an underlying cardiac disease; echocardiography revealed a dilated left ventricle and a thickened aortic valve. At one year, the visual acuity remained unaltered and the fundus showed pigmentary changes in the affected region in a similar pattern as seen in the initial visit.
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