Retinal Arterial Occlusion and Patent Foramen Ovale: A Case Study-Based Review; [Occlusion Arterielle Retinienne Et Foramen Ovale Permeable: Examen Base Sur Des Etudes De Cas] Publisher Pubmed



Fekri S^{1, 2} ; Mahmoudimehr P³ ; Jafari Fesharaki M⁴ ; Hosseinjani E⁴ ; Abtahi SH^{1, 2} ; Nouri H^{1, 3} Show Affiliations
Source: Journal Francais d'Ophtalmologie Published:2024

Abstract

Purpose: To identify all reported cases of retinal artery occlusion (RAO) associated with patent foramen ovale (PFO) in the literature and present a similar case of CRAO from our clinic. Methods: PubMed database was searched for studies reporting RAO in individuals with PFO. Relevant data were tabulated and reviewed. We estimated each case's Risk of Paradoxical Embolism (RoPE) score. Results: 23 cases of CRAO (n = 10; including ours), BRAO (n = 10), and CILRAO (n = 3) were reviewed. Most cases were under 50 years of age (78.3%). The reported predisposing factors were: hypertension (26.1%), migraine (17.3%), smoking (13.0%), recent immobilization (13.0%), strenuous exertion (8.7%), pregnancy (8.7%), and diabetes (4.3%). A high RoPE score (≥7; suggestive of paradoxical embolism via PFO) was estimated for 71.4% of patients. In most cases, the neurological and cardiovascular examinations, laboratory studies, and imaging were unremarkable, except for the PFO ± atrial septal aneurysm (present in 21.7%). In only 28.6% of cases, transthoracic echocardiography (TTE) (± saline contrast) could visualize the PFO; transesophageal echocardiography (TEE) was necessary to detect the PFO in 71.4%. Approximately one-half of the patients underwent percutaneous closure of the PFO; no complications or subsequent acute ischemic events ensued. The visual prognosis was poorer for CRAO than for BRAO or CILRAO. Conclusion: Timely diagnosis, acute management, and ensuring urgent initiation of stroke workup in cases with RAO or transient monocular vision loss are crucial. Clues to a possible paradoxical embolism as the cause include the absence of known cardiovascular risk factors, young age, migraine, recent immobility, vigorous exercise, and pregnancy. © 2023 Elsevier Masson SAS