Bilateral prepapillary loops with unilateral branch retinal artery occlusion following thrombus at the loop apex

Multimodal imaging of congenital peri-papillary arterial loops presenting with vitreous hemorrage in a young male: A case report

INTRODUCTION

Congenital arterial peripapillary loops are rare entities and very few cases are described in literature.

CASE DESCRIPTION

A 25-year-old Asian man presented a diffuse vitreous hemorrhage in his Left Eye (LE). OCT-A revealed the presence of bilateral vascular loops at the optic nerve head. Fluorescein angiography (FA) confirmed the vascular abnormality in both eyes, with arterial filling in early phases and no dye leakage. At twenty days of follow up, the vitreous hemorrhage in the LE completely reabsorbed and BCVA improved from 20/63 to 20/20.

CONCLUSION

Congenital peripapillary loops should be considered in the differential diagnosis of vitreous hemorrhage, especially in young patients with no history of ocular/head trauma. Multimodal imaging is highly recommended to properly manage the patients, avoiding unnecessary therapeutic choices.

Prepapillary Arterial Loop Associated with Central Retinal Artery Occlusion: A Case Report

Purpose:

To report a case of central retinal artery (CRA) occlusion secondary to prepapillary loop in a 13-year-old girl.

Methods:

A 13-year-old girl presented with a history of sudden visual loss in her left eye.

Results:

Fundus examination confirmed thrombosis in a prepapillary arterial loop causing CRA occlusion and extensive retinal ischemia. Macular region was watered by an anomalous macular branch, which explained her 20/20 vision central vision.

Conclusion:

Congenital prepapillary vascular loops are rare and usually asymptomatic. We report a case of central artery occlusion confirmed by multimodal imaging.

Prepapillary vascular loop-a new classification

BACKGROUND/OBJECTIVES

To analyze the ophthalmic characteristics of congenital prepapillary vascular loop (PVL) and to propose a new morphologic classification dividing the loops into six types.

SUBJECTS/METHODS

Collaborative multinational multicentre retrospective study of PVL cases.

RESULTS

There was a total of 49 cases (61 eyes), 37 unilateral (75.5%) and 12 bilateral (24.5%), 32 arterial type (65.3%) and 18 venous type (36.7%) (one patient had either kind in each eye). The mean number of loops per eye was 2.7 (range, 1-7). The loops were asymptomatic in 42 cases (85.7%). Other findings included: the presence of cilioretinal artery (14 cases), retinal vascular tortuosity (26 cases), amaurosis fugax (1 case), branch retinal artery occlusion (1 case) and vitreous haemorrhage (3 cases). Six morphologic loop types could be discerned based on elevation (flat vs. elevated), shape (figure of 8 or corkscrew with hyaline sheath), number (multiple or single), location (central or peripheral), lumen size (arterial vs. arteriolar) and presence of vascular tortuosity or vitreous traction.

CONCLUSIONS

PVL are usually asymptomatic and can be divided into six morphologic types with different pathogenesis during early embryogenesis.

Frequency of prepapillary vascular loops in Congolese patients

PURPOSE

To determine the frequency of prepapillary vascular loops in the population of Congolese patients.

METHODS

We performed a retrospective cross-sectional and descriptive analysis of the data collected between January 2005 and August 2014 from patients diagnosed with prepapillary vascular loops, in an outpatient eye clinic, a general ophthalmology practice.

RESULTS

Out of 16,016 patients seen during the study period, 24 patients (27 eyes) were diagnosed with prepapillary vascular loops, for a frequency of 0.15%. The mean age of the patients with prepapillary vascular loops was 37.8 years±14 (SD) (range, 18 to 60 years). Male were more frequently diagnosed with prepapillary vascular loops than female (62.5% vs 37.5%). Unilateral prepapillary vascular loops were found in 77.8% and bilateral in 22.2% of eyes. Most of PPLs were estimated to be arterial (88.9% of eyes) based on clinical observation alone, as fluorescein angiography was not systematically performed. Ophthalmoscopically, the vessels appeared as simple (44.6%) or took more serial turns (corkscew or spiral-shaped) (55.6%). The average length of PPLs was 1.02mm (range 0.6 to 1.5mm) with an orientation (an axis orientation) in the superior nasal sector (50%), inferior nasal sector (33%) and superior temporal sector (17%); and a mean axis of 143° relative to the horizontal. Refractive errors were found in 16 eyes (59.3%) and included simple myopia (4 eyes, 14.8%), myopic astigmatism (8 eyes, 29.6%), hyperopic astigmatism (one eye, 3.7%), hyperopia (3 eyes, 11.1%); One patient (one eye, 3.7%) with high hyperopia had anisometropia. Primary open angle glaucoma was found in 5 (18.5%) eyes; vascular tortuosity was seen in two (7.4%) eyes. No complication such as retinal arterial occlusion, vitreous hemorrhage, or any other complication was found.

CONCLUSION

The frequency of 0.15% found in this study suggests that although rare, prepapillary vascular loops seem to be a bit more common in black people than in white and Asian people. An association between PPLs and refractive errors may be possible.

Combined occlusion of branch retinal artery and vein secondary to prepapillary arterial loops

A middle-aged diabetic and hypertensive man presented with diminished vision in the left eye. Fundus examination revealed prepapillary arterial loops, but with features of venous rather than arterial occlusion. Fluorescein angiography and optical coherence tomography confirmed the presence of a branch retinal vein occlusion along with two branch retinal artery occlusions. The resultant macular edema responded well to intravitreal triamcinolone and laser photocoagulation though the visual improvement was moderate.

Branch retinal artery occlusion secondary to prepapillary arterial loop

PURPOSE

To report a case of branch retinal artery occlusion and prepapillary loop in a 10-year-old girl.

METHODS

Case report with funduscopic and fluorescein angiography imaging.

RESULTS

A 10-year-old girl presented with a history of the sudden onset of a superior visual field defect in her right eye. Fundus findings were consistent with thrombosis in a prepapillary arterial loop causing an inferior branch retinal artery occlusion.

CONCLUSION

Bilateral congenital prepapillary vascular loops are rare, and are usually asymptomatic. However, they can be complicated by vitreous hemorrhage and thrombosis. Such thrombotic events may be precipitated by hemodynamic or intravascular changes associated with exercise.

Prepapillary vascular loops complicated by suspected macroaneurysm rupture

We present a case of prepapillary vascular loops complicated by a suspected macroaneurysm rupture which was treated with intravitreal bevacizumab (IVB). A 62-year-old woman presented with decreased vision and myodesopsia in her left eye. Her best-corrected visual acuity (BCVA) was 0.6 in the left eye. Fundus examination disclosed an elevated, round, and reddish lesion, retinal hemorrhage at the superior aspect of the optic disc, retinal opacification along the superior branch retinal artery, and a small vitreous hemorrhage. Optical coherence tomography showed a serous retinal detachment, and indocyanine green angiography demonstrated prepapillary vascular loops and a hypofluorescent area with hyperfluorescent margins. These findings suggested the presence of a macroaneurysm. No filling of the dye in the aneurysm-like dilatation suggested a blockage of the lumen with a thrombus which might be associated with a branch retinal artery occlusion (BRAO). A diagnosis of prepapillary vascular loops complicated by a suspected macroaneurysm rupture and BRAO was made. Because of a persistent serous retinal detachment, IVB was performed. One month later, the BCVA improved to 1.0. Fundus examination disclosed an organized yellowish-white macroaneurysm and resolution of the serous retinal detachment. We recommend careful monitoring of patients with prepapillary vascular loops because of complications such as macroaneurysm rupture and BRAO.

The clinical study of congenital looped/coiled peripapillary retinal vessels

PURPOSE

To present clinical manifestations of eyes with peculiar looped/coiled peripapillary retinal vessels.

METHODS

Seven patients with looped/coiled retinal vessels on or near the optic disc were enrolled. All patients went through detailed ophthalmologic examinations and fluorescein angiography (FAG).

RESULTS

There were two men and five women. Patients' age ranged from 15 to 71 years (mean: 39 years). The follow-up period ranged from 3 to 74 months (average: 27 months). One patient had bilateral involvement. Five of the seven patients noticed sudden onset of floaters in one eye. The colour fundus photography revealed looped/coiled retinal vessels on or near the optic disc, and most of the vessels were arteries. Accompanied retinal, preretinal, or vitreous haemorrhage was noted in all five patients who had sudden onset of floaters. Fluorescein angiography showed no leakage from the looped/coiled retinal vessels. No specific underlying diseases were noted in any patients. Follow-up examination revealed reabsorption of haemorrhage, and no change of the abnormal vessel patterns in any eyes.

CONCLUSIONS

The peculiar fundus lesion of looped/coiled peripapillary retinal vessels is likely a benign congenital retinal vascular anomaly that does not progress. Floaters secondary to preretinal or vitreous haemorrhage is the most frequent complaint. The prognosis is excellent.