Tắc động mạch trung tâm VM

1. What is central retinal artery occlusion?

As special emergency in ophthalmology, the disease usually occurs in adults. The cause is usually an embolism due to high blood pressure, cardiovascular disease. Sometimes it is the result of thrombosis due to Inflammation, Lupus disease, Behcet’s disease, Horton’s disease…

2. Clinical symptoms of central retinal artery occlusion

•  Patient was completely blind in one eye, suddenly. Sometimes discovered after waking up.
• Eye exam:
  + Anterior half: pupil is slightly dilated, reflexes to direct light, and reflexes are congruent.
  + Fundus: in the first stage, the artery is seen as small as a thread. No blood in the lumen – at the vascular body can reduce blood flow or the image of the blood column is expected for a long time.
  After the first hours is the phenomenon of saggy edema. The milky-white retina, mainly at the posterior pole, contrasts with the red color of the macula, the “cherry macular” sign because the macula is nourished by the black eye capillaries.

Clinical configurations available

• Transient blindness- arteriospasm:
  Sudden onset, complete blindness in one eye. Lasts for a few minutes. Apart from the attack, vision and fundus were completely normal. Cardiovascular examination is required, often with signs of organ or carotid obstruction.
• Central branch retinal artery occlusion:
  splenomegaly presents different clinical presentations depending on the site of obstruction. Sudden loss of vision, loss of vision corresponding to the damaged system area.
  Fundus: retinal edema in the area of occlusion, causing lack of blood. Sometimes the obstruction is a piece of cholesterol or calcium.
• Central retinal artery occlusion in people with central retinal vessels:
  Occupying about 20% of the population, there is an additional mi-vulva vascular system originating from the choroid, arising from the lateral disc margin that nourishes the area between the optic nerve and the macula. In this case, vision may be reduced more or less, but the market for electricity is still tubular. Fundus: there is also a triangular pink retina in the middle of the optic disc and the macula in the middle of the posterior pole retina is flooded. In contrast, isolated mi-retinal artery occlusion: Visual acuity decreased. There is white edema in the fundus of the eye between the optic disc and the macula, the surrounding retina is not damaged.

Central retinal artery occlusion

3. Treatment of central retinal occlusion

• Local: modify central arterial pressure to move the obstruction by : date the required label in minutes; can activate pre-room to reduce marks; injections to enlarge the eyeball.
• Full body:
  + Can use vasoconstrictor drugs, oral or infusion.
  + Antiplatelet drugs + Anticoagulant and fibrinolytic drugs only (used in the absence of contraindications and in young people in good health).
• Base control:
  + If it is high blood pressure: treat high blood pressure.
  + Horton’s disease: urgent corticosteroid therapy.
• Progress-prognosis: If the patient arrives on time (within 2 hours of illness), vision can be restored, macular edema disappears after a few days, arterial circulation is normal. In case of branch artery occlusion, the lesions are stable, there is a lack of visual field in the corresponding retinal area, there are also cases where the occlusion spreads to the entire retina. Often patients do not arrive in time because the development is not good. Total loss of vision, papilledema after 1 month, muscle contraction of retinal vessels, blood vessels may be white, possibly leading to neovascular glaucoma.