Transluminal Nd:YAG laser embolysis in a case of hemiretinal arterial occlusion

Retinal artery occlusion causes catastrophic,sudden visual loss. It is a true ophthalmic emergency in which every minute of delay increases the risk of irreversible retinal damage [1]. More than 90% of eyes with central retinal artery occlusion (CRAO) have a sudden, painless decrease in visual acuity to a level of counting fingers to light perception [2].More than 150 years since the description of the characteristic features and the presumedcause of CRAO by von Graefe, this disease remains a therapeutic dilemma [3]. A variety of treatments have been proposed, but none of them show a clear therapeutic benefit or have wide acceptance [3]. Thus most physicians tend to use a combinationof treatments with low potential side-effects. The most popular of these are ocular massage, rebreathing with carbogen, oral acetazolamide and topical antiglaucomatous agents. Attempts have been made to treat the disease with systemic anticoagulation/antiaggregation therapy, transluminal laser embolysis and selective intra-arterial lysis of the clot [3]. Heparin and acetylsalicylic acid are not very effective, and intra-arterial lysis is under active investigation by the European Assessment Group for Lysis in the Eye (EAGLE) trial [3].To the best of our knowledge, there are few reports on laser-assisted transluminal embolysis, and there are only 2 reports on successful neodymium:yttrium-aluminium-garnet (Nd:YAG) laser treatment of embolic CRAO [4,5]. We report here on another successful use of Reynard and Hanscom’s method [4], with some modifications, for the treatment of retinal artery occlusion.