2013 Volume 41 Issue 5 Pages 368-372
We report a case of superficial temporal artery (STA)-middle cerebral artery (MCA) bypass for rapid deterioration of visual acuity due to retinal ischemia in a patient with chronic internal carotid artery occlusion.
A 72-years-old male suffered pain in the right eye that was diagnosed as neovascular glaucoma caused by ocular ischemia due to right internal carotid artery occlusion. Brain perfusion single-photon emission tomography imaging revealed normal cerebral blood flow and reduced cerebrovascular reactivity to acetazolamide in the right cerebral hemisphere. He was treated with medication and his symptom resolved. Five months later, a pain in the right eye recurred and intraocular pressure was abnormally elevated. Visual acuity in the right eye rapidly deteriorated during six days. Cerebral angiography showed retrograde blood flow of the right ophthalmic artery toward the right internal carotid artery. Antegrade blood flow to the right retina and right choroid retinal blush were not visualized. The patient underwent an urgent STA-MCA bypass when visual acuity in the right eye was light perception. The visual acuity was postoperatively improved and was 0.32 at four months after surgery. Postoperative cerebral angiography showed reduction in retrograde flow of the ophthalmic artery to the internal carotid artery and perfusion of the right central retinal artery by the collateral flow via the external carotid artery. The right choroid retinal blush was also visualized.
STA-MCA bypass for retinal ischemia due to chronic internal carotid artery occlusion may improve decreased visual acuity.
