VISUAL RECOVERY AFTER ACUTE CHOROIDAL ISCHEMIA WITH PARTIAL RETINAL HYPOPERFUSION, DEMONSTRATED BY FLUORESCEIN ANGIOGRAPHY

Background: Compared with retinal vascular disease, choroidal ischemia has received little attention. Patients: The case histories of three patients are described. During embolization, a 32-year-old man complai ned of sudden deterioration in vision. An 82-year-old man with arteria l hypertension, diabetes mellitus, and hyperlipoproteinemia reported a complete unilateral visual loss. A 72-year-old man (cigarette smoker) with arterial hypertension, diabetes mellitus, and a high-degree inte rnal carotid artery stenosis developed a headache accompanied by sudde n unilateral loss of vision. Results: The three patients showed ischem ic signs predominantly in the choroid, but also subtle signs in the re tina (patient 2) and branch retinal artery occlusion (patient 3). On o phthalmoscopy alone, no clear-cut choroidal hypoperfusion was detected in two patients. However, diagnosis of choroidal hypoperfusion was es sentially made by fluorescein angiography. The choroidal hypoperfusion almost completely surrounded the optic disk in two patients. Normal v ision returned spontaneously in one patient, in spite of an almost com plete temporal choroidal ischemia. In patient 2, a partial recovery fo llowed treatment of his arterial hypertension. Patient 3 also showed a good visual recovery after treatment with heparin, massage of the glo be, and antihypertensive drugs. The circulation time of the choroidal angiographic filling defects was Io sec and longer, but it became much shorter after several weeks. Conclusion: Visual recovery was good in all patients despite ischemic signs in the choroid. No scarring of the central retinal pigment epithelium was observed.