Ischemic Complication after Intra-arterial Thrombolysis for a Patient with Central Retinal Artery Occlusion: Case Report

Purpose: To report a case of foveal ischemic complication case following an intra-arterial thrombolysis (IAT) for a patient with central retinal artery occlusion (CRAO).Case summary: A 23-year-old male patient presented with a sudden painless visual loss in the right eye that began three hours earlier.He had no documented medical history of diabetes or hypertension.Initially, his best-corrected visual acuity (BCVA) in the right eye was counting fingers at 30 cm.The fundus examination revealed an ischemic retina on the posterior pole with a cherry-red spot sign on the posterior pole.Fundus fluorescein angiography (FFA) demonstrated markedly elongated arm-to-retina time and delayed retinal vascular filling.Optical coherence tomography (OCT) presented retinal swelling with hyperreflectivity.Emergency IAT was performed based on the diagnosis of CRAO.Consecutive FFA on the day after the intervention showed improved arm-to-retina time; however, multiple thrombi with capillary dropout in the foveal area were observed.His BCVA was reduced to hand motion, and retinal swelling with hyperreflectivity has worsened on OCT.Macular atrophy on OCT progressed, and BCVA did not recover despite additional treatments, including anterior chamber paracentesis and anticoagulant medication.Conclusions: This case suggests that ischemic maculopathy occurred after IAT in a patient with CRAO.It is presumed that dissolved thrombi caused CRAO and then migrated to the capillaries in the macular area after the IAT.Therefore, the possibility of ischemic maculopathy caused by migrating thrombi should be considered, and meticulous fundus examination and follow-up are required in patients undergoing endovascular intervention for CRAO.