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Fundus examination OD revealed a whitened posterior pole with sparing in the papillomacular bundle. Spectral-domain optical coherence tomography OD revealed inner retinal hyperreflectivity with fovea sparing.

Fig. 1A

 Fluorescein angiography showed a central retinal artery occlusion (CRAO) with cilioretinal sparing OD.

Fig. 1B

Title:

Luck of the Draw

Credits:

Fannie Nadeau, Ananda Kalevar MD

Location:

Department of Ophthalmology, HD Hospital, Sherbrooke University, Sherbrooke, Quebec

Description:

A 80-year-old female experimented nasal visual field loss in her right eye (OD) with preserved temporal visual field. Her past medical history was significant for age-related macular degeneration and hypertension. Best-corrected visual acuity was 6/6 OD and 6/9 OS. A pupillary afferent defect was present OD. Slip lamp examination was unremarkable in both eyes. Fundus examination OD revealed a whitened posterior pole with sparing in the papillomacular bundle. Spectral-domain optical coherence tomography OD revealed inner retinal hyperreflectivity with fovea sparing (Fig 1A). Fluorescein angiography showed a central retinal artery occlusion (CRAO) with cilioretinal sparing OD (Fig 1B).

Cilioretinal artery is an anatomic variant found in 15 to 30% of the population that often supplies the papillomacular bundle, but that supplies the foveola in only 10% of eyes 1, 2. Therefore, its presence and specifically its distribution makes it possible of maintaining central vision in the event of a CRAO 2, 3, 4.


References:

1 Biousse V, Newman N. Retinal and optic nerve ischemia. Continuum (Minneap Minn). 2014 Aug. 20 (4 Neuro-ophthalmology):838-56.

2 Lorentzen SE. Incidence of cilioretinal arteries. Acta Ophthalmol (Copenh). 1970. 48 (3):518-24.

3 Pirasath S, Suganthan N, Malaravan M, Cilioretinal Artery Sparing Central Retinal Artery Occlusion, Austin Journal of Clinical Ophthalmology, 2015; 2(5): 1059

4 Hayreh SS, Zimmerman MB. Central retinal artery occlusion: visual outcome. Am J Ophthalmol. 2005;140:376-391.

Fig. 1

Congenital macrovessel Fluorescein angiography (late phase) OS revealing congenital macrovessel coursing temporally and inferiorly from its origin at the central retinal artery, giving off multiple branches with no observable leakage.

Title:

The Road Less Travelled

Credits:

Amit V Mishra MD, Mark E Seamone MSc MD, Hesham Lakosha MD, Rishi Gupta MD

Location:

Department of Ophthalmology, QEII Hospital, Dalhousie University, Halifax, Nova Scotia

Description:

A 49-year-old male presented after blunt trauma OS. His past medical history was remarkable for blunt ocular trauma OD. Best-corrected visual acuity was 6/15 OD and 6/12 OS. Slit lamp examination of the anterior segment revealed traumatic mydriasis and an area of zonular insufficiency nasally from previous trauma OD. Slit lamp examination was unremarkable OS. Fundus examination OD revealed chronic chorioretinal scarring from previous trauma. Fundus examination OS revealed a retinal macrovessel extending through the macula and just inferior to the fovea. This finding was confirmed using fluorescein angiography (Figure 1A and B).

Congenital retinal macrovessels are large anomalous vessels that cross the horizontal raphe1,2. This is a rare finding3 that has been associated with decreased visual acuity and serous retinal detachments4.

References:

de Crecchio G, Mastursi B, Alfieri MC, Pignalosa B. Congenital retinal macrovessel. Ophthalmologica. 1986;193:143-5.

Jager R, Timothy N, Joseph M, et al. Congenital Retinal Macrovessel. Retina. 2005;25(4):538-540.

Hayasaka S, Katsube T, Ugomori S, Setogawa T. Abnormally Distributed Branches of the Retinal Vessels, Enlarged Macular Arteries and Long Cilioretinal Arteries. Ophthalmologica. 1990;200:194-197.

Arai J, Kasuga Y, Koketsu M, Yoshimura N. Development and spontaneous reolution of serous retinal detachment in a patient with a congenital retinal macrovessel. Retina. 2000;130:527-528.