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Shah P, Shah VM, Saravanan VR, Kumar K, Narendran S. Evaluation of macular and peripapillary structure and microvasculature with optical coherence tomography angiography in migraine in the Indian population. World J Methodol 2025; 15:100950. [DOI: 10.5662/wjm.v15.i3.100950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2024] [Revised: 11/21/2024] [Accepted: 12/09/2024] [Indexed: 03/06/2025] Open
Abstract
BACKGROUND Migraine has been proposed as a potential contributing factor to ischemic complications involving the retina and optic nerve. Ophthalmic disorders connected with migraine encompass occlusions of the branch and central retinal arteries and veins, alongside anterior and posterior ischemic optic neuropathy. With the advent of optical coherence tomography angiography (OCTA), it is easy to identify these macular subclinical microvascular and structural changes.
AIM To evaluate macular and peripapillary structural and microvasculature changes in patients with migraine with aura (MA), migraine without aura (MW), and healthy control (HC) participants using OCTA.
METHODS In this observational cross-sectional study, we studied a total of 100 eyes: (1) 32 eyes of 16 patients with MA; (2) 36 eyes of 18 patients with MW, recruited based on the International Classification of Headache Disorders; and (3) 32 eyes of 16 age and sex-matched healthy participants. Foveal flux, foveal avascular zone (FAZ), peripapillary flux obtained from OCTA, and foveal and peripapillary ganglion cell layer (GCL) thickness calculated via optical coherence tomography were compared among the groups.
RESULTS The mean FAZ area measured in patients with MA and MW was significantly larger than that in the control participants (P = 0.002). However, there was no significant difference between the FAZ of the MA and MW groups. Macular perfusion in the superficial capillary plexus in patients with MA was significantly lower compared to MW (P = 0.0018) and HCs (P = 0.002). There was also significant thinning of the GCL in patients with MA and MW (P = 0.001) compared to HCs. However, there was no significant difference in temporal GCL thickness between the MA and MW groups.
CONCLUSION Significant changes have been found in structural and microvascular parameters in patients with migraines compared with HCs. OCTA can serve as a valuable non-invasive imaging technique for identifying microcirculatory disturbances, aiding in better understanding the pathogenesis of different types of migraine and establishing their link with other ischemic retinal and systemic pathologies.
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Affiliation(s)
- Pankti Shah
- Department of Neuro Ophtalmology, Aravind Eye Hospital, Coimbatore 641014, Tamil Nādu, India
| | - Virna M Shah
- Department of Neuro Ophtalmology, Aravind Eye Hospital, Coimbatore 641014, Tamil Nādu, India
| | | | - Karthik Kumar
- Department of Neuro Ophtalmology, Aravind Eye Hospital, Coimbatore 641014, Tamil Nādu, India
| | - Siddharth Narendran
- Division of Microbiology, Department of Cataract Services, Aravind Medical Research Foundation Regional Centre, Aravind Eye Hospital, Coimbatore 641014, Tamil Nādu, India
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Rodrigues SG, Gouveia RG. Persistent monocular visual loss in migraine patients. Acta Neurol Belg 2022; 122:437-440. [PMID: 34324151 DOI: 10.1007/s13760-021-01750-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
The relationship between migraine and vision is complex. Besides migraine aura status and persistent visual aura without infarction, recognized by International Headaches Classification 3, cases of persistent monocular alterations have been described in migraineurs. To discuss the role of migraine as a risk factor for persistent monocular visual loss. We present five new cases of persistent monocular visual loss in migraineurs, discuss the differential diagnosis and possible relationship with migraine. Five young healthy patients are reported (three women) with a history of migraine (four with visual aura), that developed persistent monocular visual defects, four during an episode of migraine with aura. All patients were submitted to an extensive investigation. In three patients the scotoma was identified on automated perimetry; one of these patients had retinal hemorrhagic lesions, with fluorescein angiography revealing an isolated retinal vasculitis. In two patients fundoscopy revealed transient cotton wools spots. Except for the patient with retinal vasculitis, etiologic investigation was not conclusive. Monocular visual loss can occur in the setting of multiple pathologies that affect the eye and related structures. Although diseases requiring emergent intervention should always be excluded, we propose migraine should be considered as a contributing factor for unexplained monocular persistent scotoma.Monocular visual loss can occur in the setting of multiple pathologies that affect the eye and related structures. Although diseases requiring emergent intervention should always be excluded, we propose migraine should be considered as a contributing factor for unexplained monocular persistent scotoma.
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3
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McKendrick AM, Nguyen BN. The eye in migraine: a review of retinal imaging findings in migraine. Clin Exp Optom 2021; 105:186-193. [PMID: 34538219 DOI: 10.1080/08164622.2021.1971045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Migraine is a common headache disorder with neurovascular involvement. Because eyecare practitioners are likely to encounter people with migraine in their everyday practice, it is important to understand how migraine might impact on ocular health. In this narrative review, we provide an update on the latest ophthalmic imaging evidence for retinal involvement in migraine, derived from studies of retinal structure and retinal vascular perfusion using spectral domain and swept source optical coherence tomography (OCT) and OCT angiography. Combined structural OCT evidence from a recent meta-analysis indicates subtle and non-specific thinning of the peripapillary retinal nerve fibre layer (RNFL) in people with migraine, whereas there is little consistent evidence for structural abnormalities of the macular region. Recent advances in OCT angiography technology have also provided an opportunity to visualise microstructural damage and vascular dysregulation in the eyes of people with migraine. However, given that OCT and OCT angiography studies have been exclusively cross-sectional, it is not possible to demonstrate the causal effect of migraine events. Furthermore, the lack of common methodology (different ophthalmic imaging devices and analysis algorithms), and very limited datasets (small samples, heterogenous migraine groups), lead to an inability to make strong conclusions regarding the nature of altered retinal structure and vascular perfusion in migraine. Nevertheless, we discuss the clinical implications of such observations for eyecare practitioners and provide practical advice for the monitoring and management of patients with a history of migraine.
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Affiliation(s)
- Allison M McKendrick
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Bao N Nguyen
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia
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Hamurcu MS, Gultekin BP, Koca S, Ece SD. Evaluation of migraine patients with optical coherence tomography angiography. Int Ophthalmol 2021; 41:3929-3933. [PMID: 34291402 DOI: 10.1007/s10792-021-01962-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/16/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare optical coherence tomography angiography (OCTA) findings in cases with migraine and healthy controls. METHODS Thirty-eight eyes of 19 patients with migraine with aura and 38 eyes of 19 healthy subjects were enrolled in this prospective and comparative study. All patients and healthy controls were evaluated with OCTA (Triton, Topcon®, Tokyo, Japan). Central macular thickness (CMT), optic disc parameters (such as retinal nerve fibre layer [RNFL] thickness and rim and disc areas), foveal avascular zone (FAZ) and parafoveal superficial vessel density (VD) measurements were analysed. RESULTS The optic disc rim area was significantly larger in the migraine group compared to the control group (p = 0.009). In OCTA measurements, the FAZ area was significantly larger in migraine patients (p = 0.001). The parafoveal superficial VD measurements were found to be lower in the migraine patients in all quadrants, but not statistically significant. Weak negative correlations were found between superior parafoveal VD and disease duration in migraine patients. CONCLUSION Migraine with aura was associated with optic disc rim changes, but without any remarkable foveal vascular decrements. It is possible for migraine to cause structural changes due to its chronic nature.
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Affiliation(s)
- Mualla S Hamurcu
- Department of Ophthalmology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Burcu P Gultekin
- Department of Ophthalmology, Ankara Bilkent City Hospital, Ankara, Turkey.
| | - Semra Koca
- Department of Ophthalmology, Denizli State Hospital, Denizli, Turkey
| | - Seyma D Ece
- Department of Ophthalmology, Mus State Hospital, Mus, Turkey
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5
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Storimans CW, Van Schooneveld MJ, Oosterhuis JA, Bos PJ. A New Autosomal Dominant Vascular Retinopathy Syndrome. Eur J Ophthalmol 2018; 1:73-8. [PMID: 1821204 DOI: 10.1177/112067219100100204] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We describe a new syndrome with autosomal dominant transmission whose most striking feature is vascular retinopathy. The retinopathy is often associated with migraine, Raynaud's phenomenon and mental changes, mainly forgetfulness, aggression and depression. To define this syndrome we collected medical data on 110 family members. General ophthalmological examination and fluorescein angiography were performed in 61 persons. The retinopathy, as diagnosed in 22 persons, is characterized by central and peripheral microangiopathy, areas of capillary non-perfusion, haemorrhages, cotton wool spots and, in a more advanced stage, occlusion of large retinal vessels, which can induce a neovascular response. A vascular occlusive disorder may be the common aetiological factor of the various manifestation of this syndrome.
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Affiliation(s)
- C W Storimans
- Department of Ophthalmogenetics, The Netherlands Ophthalmic Research Institute, Amsterdam
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6
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Chang MY, Phasukkijwatana N, Garrity S, Pineles SL, Rahimi M, Sarraf D, Johnston M, Charles A, Arnold AC. Foveal and Peripapillary Vascular Decrement in Migraine With Aura Demonstrated by Optical Coherence Tomography Angiography. Invest Ophthalmol Vis Sci 2017; 58:5477-5484. [PMID: 29059314 PMCID: PMC5656414 DOI: 10.1167/iovs.17-22477] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Purpose Migraine, particularly with aura, has been associated with ocular and systemic ischemic complications, but there are limited data on the ocular vasculature in migraine. We used optical coherence tomography angiography (OCTA) to assess perfusion of the macula and optic nerve in migraine patients, with (MA) and without (MO) aura, compared to healthy controls (HC). Methods We recruited 15 MA (mean age 42 years), 12 MO (mean age 46 years), and 22 HC (mean age 39 years) participants from neurology and neuro-ophthalmology clinics. Participants underwent optical coherence tomography and 3 × 3 mm OCTA of the macula and optic nerve. Foveal avascular zone area was automatically measured using AngioVue software, and vessel density was calculated as blood vessel length divided by scan area (mm-1) after skeletonization of OCTA images. Results On macular OCTA, MA participants had an enlarged foveal avascular zone area when compared with HC (0.300 ± 0.019 vs. 0.220 ± 0.066 mm2, P = 0.006). In addition, superficial foveal vessel density was decreased in MA participants when compared with MO participants (7.8 ± 0.31 vs. 9.3 ± 0.44, P = 0.04) and HC (7.8 ± 0.31 vs. 9.4 ± 0.21 mm-1, P = 0.002). On optic nerve OCTA, the MA participants had reduced superior peripapillary vessel density when compared with the MO participants (12.0 ± 0.45 vs. 14.0 ± 0.38 mm-1, P = 0.031) and HC (12.0 ± 0.45 vs. 14.1 ± 0.53 mm-1, P = 0.035). There were no significant differences between the MO and HC groups. Conclusions Migraine with, but not without, aura was associated with foveal and peripapillary vascular decrements, which may possibly mediate increased risk of ocular and systemic vascular complications in these patients. OCTA could potentially be useful as a biomarker for migraine with aura.
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Affiliation(s)
- Melinda Y Chang
- Stein Eye Institute, University of California, Los Angeles, California, United States.,Doheny Eye Institute, University of California, Los Angeles, California, United States.,Department of Ophthalmology, University of California, Los Angeles, California, United States
| | - Nopasak Phasukkijwatana
- Stein Eye Institute, University of California, Los Angeles, California, United States.,Department of Ophthalmology, University of California, Los Angeles, California, United States.,Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sean Garrity
- Stein Eye Institute, University of California, Los Angeles, California, United States.,Department of Ophthalmology, University of California, Los Angeles, California, United States
| | - Stacy L Pineles
- Stein Eye Institute, University of California, Los Angeles, California, United States.,Department of Ophthalmology, University of California, Los Angeles, California, United States
| | - Mansour Rahimi
- Stein Eye Institute, University of California, Los Angeles, California, United States.,Department of Ophthalmology, University of California, Los Angeles, California, United States
| | - David Sarraf
- Stein Eye Institute, University of California, Los Angeles, California, United States.,Department of Ophthalmology, University of California, Los Angeles, California, United States
| | - Mollie Johnston
- Department of Neurology, University of California, Los Angeles, California, United States
| | - Andrew Charles
- Department of Neurology, University of California, Los Angeles, California, United States
| | - Anthony C Arnold
- Stein Eye Institute, University of California, Los Angeles, California, United States.,Department of Ophthalmology, University of California, Los Angeles, California, United States
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7
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Abstract
Retinal migraine is usually characterized by attacks of fully reversible monocular visual loss associated with migraine headache. Herein we summarize the clinical features and prognosis of 46 patients (six new cases and 40 from the literature) with retinal migraine based upon the International Classification of Headache Disorders-2 (ICHD-2) criteria. In our review, retinal migraine is most common in women in the second to third decade of life. Contrary to ICHD-2 criteria, most have a history of migraine with aura. In the typical attack monocular visual features consist of partial or complete visual loss lasting <1 h, ipsilateral to the headache. Nearly half of reported cases with recurrent transient monocular visual loss subsequently experienced permanent monocular visual loss. Although the ICHD-2 diagnostic criteria for retinal migraine require reversible visual loss, our findings suggest that irreversible visual loss is part of the retinal migraine spectrum, perhaps representing an ocular form of migrainous infarction. Based on this observation, the authors recommend migraine prophylactic treatment in an attempt to prevent permanent visual loss, even if attacks are infrequent. We also propose a revision to the ICHD-2 diagnostic criteria for retinal migraine.
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Affiliation(s)
- B M Grosberg
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, NY, USA.
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8
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Sacco S, Ricci S, Carolei A. Migraine and vascular diseases: a review of the evidence and potential implications for management. Cephalalgia 2012; 32:785-95. [PMID: 22711902 DOI: 10.1177/0333102412451361] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The higher-than-expected incidence of vascular diseases reported in migraineurs suggests that migraine may, in some cases, be a dangerous condition rather than just a distressing but harmless disorder. We provide a systematic review of data linking migraine to vascular diseases. MIGRAINE AND VASCULAR DISEASES Available data indicate an increased risk of ischemic stroke in subjects suffering from migraine with aura. In addition, evidence suggests an association between migraine with aura and cardiac disease, intracerebral hemorrhage, retinal vasculopathy and mortality that needs to be further corroborated; consequently, for those conditions, migraine with aura can be only considered among the less-well-documented risk factors. As the absolute risk of ischemic stroke in the overall migraineur population is low, subjects suffering from migraine with aura should be made aware of the possible link but not unduly alarmed. It is a common notion that the vascular risk of migraineurs may be further increased by the presence of easily treatable vascular risk factors such as arterial hypertension, cigarette smoking and oral contraceptive use. CONCLUSIONS Forthcoming guidelines should appropriately recommend supporting migraineurs not only with measures aimed at decreasing headache frequency, thus improving quality of life, but also with general measures and preventive strategies aimed to reduce the overall vascular risk. In fact, headache specialists should take care not only of relieving pain but also of assessing and treating concurrent vascular risk factors, while gynecologists, in particular, should routinely consider the presence and type of migraine before prescribing oral contraceptives.
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Affiliation(s)
- Simona Sacco
- Department of Neurology, University of L'Aquila, Italy.
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9
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Sacco S, Cerone D, Carolei A. Comorbid neuropathologies in migraine: an update on cerebrovascular and cardiovascular aspects. J Headache Pain 2008; 9:237-48. [PMID: 18600300 PMCID: PMC3451940 DOI: 10.1007/s10194-008-0048-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Accepted: 06/03/2008] [Indexed: 01/01/2023] Open
Abstract
Several conditions are comorbid with migraine; our review is focused on the relation between migraine, and cerebrovascular and cardiovascular diseases. Despite many studies showed an association between migraine and patent foramen ovale, it is still not known whether its presence might be causal for the migraine pathogenesis and currently its closure cannot be recommended for migraine prevention. On the contrary, conflicting epidemiological data link migraine to arterial hypertension and the use of antihypertensive agents acting on the renin-angiotensin system sounds promising in migraine prevention. A complex bidirectional relation exists between migraine and stroke, and new evidences show a clear association between migraine and coronary heart disease. In both conditions, migraine represents a defined risk factor although the magnitude of the risk varies across the different studies. However, since the risk is low in the general population, it is not possible to identify which migraineurs will develop a cardiovascular or a cerebrovascular event making difficult to apply preventive measures.
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Affiliation(s)
- Simona Sacco
- Department of Neurology, University of L'Aquila, Piazzale Salvatore Tommasi, L'Aquila, Italy
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10
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Hill DL, Daroff RB, Ducros A, Newman NJ, Biousse V. Most Cases Labeled as “Retinal Migraine” Are Not Migraine. J Neuroophthalmol 2007; 27:3-8. [PMID: 17414865 DOI: 10.1097/wno.0b013e3180335222] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Monocular visual loss has often been labeled "retinal migraine." Yet there is reason to believe that many such cases do not meet the criteria set out by the International Headache Society (IHS), which defines "retinal migraine" as attacks of fully reversible monocular visual disturbance associated with migraine headache and a normal neuro-ophthalmic examination between attacks. METHODS We performed a literature search of articles mentioning "retinal migraine," "anterior visual pathway migraine," "monocular migraine," "ocular migraine," "retinal vasospasm," "transient monocular visual loss," and "retinal spreading depression" using Medline and older textbooks. We applied the IHS criteria for retinal migraine to all cases so labeled. To be included as definite retinal migraine, patients were required to have had at least two episodes of transient monocular visual loss associated with, or followed by, a headache with migrainous features. RESULTS Only 16 patients with transient monocular visual loss had clinical manifestations consistent with retinal migraine. Only 5 of these patients met the IHS criteria for definite retinal migraine. No patient with permanent visual loss met the IHS criteria for retinal migraine. CONCLUSIONS Definite retinal migraine, as defined by the IHS criteria, is an exceedingly rare cause of transient monocular visual loss. There are no convincing reports of permanent monocular visual loss associated with migraine. Most cases of transient monocular visual loss diagnosed as retinal migraine would more properly be diagnosed as "presumed retinal vasospasm."
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Affiliation(s)
- Donna L Hill
- Departments of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
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11
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Abstract
Retinal migraine is a primary headache disorder, clinically manifested by attacks of transient monocular visual loss associated with migraine headache. Although isolated reports suggest that retinal migraine is rare, it likely is under-recognized. Retinal migraine usually is reported in women of childbearing age who have a history of migraine with aura. It typically is characterized by negative monocular visual phenomena lasting less than 1 hour. More than half of reported cases with recurrent transient monocular visual loss subsequently experienced permanent monocular visual loss. Although the International Headache Society diagnostic criteria for retinal migraine require reversible visual loss, our findings suggest that irreversible visual loss is part of the retinal migraine spectrum, likely representing an ocular form of migrainous infarction.
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Affiliation(s)
- Brian M Grosberg
- Department of Neurology, Albert Einstein College of Medicine and The Montefiore Headache Unit, Montefiore Medical Center, Bronx, NY 10467, USA.
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12
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Abstract
Ocular migraine, an uncommon cause of transient monocular visual loss, is an entity physicians should be able to recognize in order to provide appropriate treatment and to avoid unnecessary testing. The following text provides an overview of ocular migraine, including discussion of accepted terminology, clinical presentation, and pathophysiology. An ocular and systemic differential diagnosis, appropriate evaluation, therapy, and prognosis are also discussed.
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Affiliation(s)
- Shilpi Pradhan
- Departments of Ophthalmology and Neurology, Saint Louis University School of Medicine, 1755 South Grand Boulevard, Saint Louis, MO 63104, USA
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13
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Narita AS, Elder JE. Ocular migraine in an eight-year-old girl. AUSTRALIAN AND NEW ZEALAND JOURNAL OF OPHTHALMOLOGY 1994; 22:275-7. [PMID: 7727107 DOI: 10.1111/j.1442-9071.1994.tb00797.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND A case of ocular migraine in an eight-year-old girl is presented. This is believed to be the youngest reported patient with ocular migraine. CONCLUSION The choroid was noted to darken during an episode of visual loss, suggesting choroidal ischaemia as the cause of the visual loss.
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Affiliation(s)
- A S Narita
- Royal Victorian Eye and Ear Hospital, East Melbourne
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14
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Johnson MW, Thomley ML, Huang SS, Gass JD. Idiopathic recurrent branch retinal arterial occlusion. Natural history and laboratory evaluation. Ophthalmology 1994; 101:480-9. [PMID: 8127568 DOI: 10.1016/s0161-6420(94)31309-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE To investigate the long-term visual and systemic prognosis of patients with idiopathic recurrent branch retinal artery occlusions, and to test recent hypotheses regarding possible causes of this syndrome. METHODS The authors retrospectively reviewed the medical and photographic records of 16 eligible patients. Each of 15 living patients was interviewed by one of the authors, then underwent follow-up ophthalmic examination, formal visual field testing, and a battery of clinical laboratory tests. RESULTS Over a mean follow-up of 9 years, only three eyes (9%) lost visual acuity from foveal ischemia, although nine eyes (28%) had central and/or extensive peripheral visual field loss at final examination. Ocular neovascular complications developed in eight eyes (25%). Eight patients (50%) had associated vestibuloauditory and/or transient sensorimotor symptoms, but serious permanent neurologic deficits or recurrent systemic thromboembolic events did not develop. Although most patients had one or more vaso-occlusive risk factors, extensive laboratory testing failed to define the etiology of the arterial occlusions. CONCLUSIONS On long-term follow-up, the visual, neurologic, and systemic prognosis for most patients with idiopathic recurrent branch retinal arterial occlusions remains favorable. Although it is probable that such patients are etiologically heterogeneous, the authors theorize that many have mild or partial manifestations of the microangiopathic syndrome of encephalopathy, hearing loss, and retinal arteriolar occlusions.
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Affiliation(s)
- M W Johnson
- W.K. Kellogg Eye Center, Department of Ophthalmology, University of Michigan School of Medicine, Ann Arbor 48105
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15
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Wisotsky BJ, Engel HM. Transesophageal echocardiography in the diagnosis of branch retinal artery obstruction. Am J Ophthalmol 1993; 115:653-6. [PMID: 8488919 DOI: 10.1016/s0002-9394(14)71465-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We examined a 28-year-old man and a 19-year-old woman with branch retinal artery obstruction. Both were examined exhaustively. In each patient, a patent foramen ovale was demonstrated by transesophageal echocardiography after a transthoracic study disclosed no abnormalities. These observations suggest that transesophageal echocardiography is valuable in examining young patients with retinal emboli in whom cardiac abnormalities are suspected.
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Affiliation(s)
- B J Wisotsky
- Department of Ophthalmology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York 10467
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16
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Glenn AM, Shaw PJ, Howe JW, Bates D. Complicated migraine resulting in blindness due to bilateral retinal infarction. Br J Ophthalmol 1992; 76:189-90. [PMID: 1540572 PMCID: PMC504207 DOI: 10.1136/bjo.76.3.189] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Retinal migraine is not uncommon, but permanent sequelae in the anterior visual pathway are rare. We describe the case of a young woman in whom blindness developed over a six-year period due to recurrent episodes of migraine-related occlusions of a branch retinal artery.
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Affiliation(s)
- A M Glenn
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne
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17
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Abstract
We present a consensus on the pathophysiology, etiology, diagnosis, and treatment of amaurosis fugax. The phenomenon is defined and described, and the roles that extracranial and ocular vascular diseases play are discussed. Nonvascular ophthalmic and neurologic disorders that can be confused with amaurosis fugax are listed, and an algorithm for evaluation (which includes ophthalmic examination, laboratory studies, and noninvasive carotid artery studies) is given. Treatment of atherosclerosis, carotid artery disease, and other causes of amaurosis fugax are also discussed.
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18
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Nelson ME, Talbot JF, Preston FE. Recurrent multiple-branch retinal arteriolar occlusions in a patient with protein C deficiency. Graefes Arch Clin Exp Ophthalmol 1989; 227:443-7. [PMID: 2806931 DOI: 10.1007/bf02172896] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
A 34-year-old woman is presented who has recurrent, multiple, retinal arteriolar occlusions associated with a deficiency in protein C, a vitamin K-dependent anticoagulant. Protein C is a naturally occurring anticoagulant and if there is a deficiency, it can lead to episodes of thrombosis; the deficiency can be acquired or congenital. This is the first documented case of retinal arteriolar occlusion associated with a congenital deficiency of this protein. The mechanism for arteriolar occlusion in this patient is discussed, and whilst the role of protein C deficiency remains presumptive, it is strongly implicated.
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Affiliation(s)
- M E Nelson
- Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, United Kingdom
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19
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Newman NJ, Lessell S, Brandt EM. Bilateral central retinal artery occlusions, disk drusen, and migraine. Am J Ophthalmol 1989; 107:236-40. [PMID: 2923150 DOI: 10.1016/0002-9394(89)90305-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A central retinal artery occlusion occurred in the left eye of a 25-year-old woman with migraine and bilateral intrapapillary drusen. An extensive investigation failed to establish the presence of any systemic disease or vasculopathy. Eight years later she had a central retinal artery occlusion in her right eye. Optic disk drusen and migraine may have combined to produce this patient's bilateral visual loss consequent to retinal vaso-occlusion.
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Affiliation(s)
- N J Newman
- Department of Ophthalmology, Harvard Medical School, Boston, MA
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20
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Abstract
Migraine, a clinical syndrome of unknown etiology, is a common cause of a variety of visual disturbances. This review describes the visual alterations associated with migraine syndromes of particular interest to the ophthalmologist; acephalgic, ocular, and ophthalmoplegic. Several current theories of migraine pathophysiology are discussed. Migrainous episodes are common and must be differentiated from neurologic dysfunction due to ischemia, inflammation, seizure, and compression. The differentiating characteristics of these conditions as well as a diagnostic algorithm are presented.
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Affiliation(s)
- S L Hupp
- Department of Surgery, University of South Alabama College of Medicine, Mobile
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Coppeto JR, Kawalick M. Ocular pseudomigraine after posterior chamber intraocular lens implantation. Am J Ophthalmol 1986; 102:393-4. [PMID: 3752207 DOI: 10.1016/0002-9394(86)90020-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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