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ISSN: 2155-9570
Journal of Clinical & Experimental Ophthalmology
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Unilateral Central Retinal Artery Occlusion in Eisenmenger Syndrome

Lin Zhao*, Jia-lin Wang, Yu-ling Liu and Fang Qian
Peking University Third Hospital, Peking University Eye Center, Key Laboratory of Vision Loss and Education, Ministry of Education, Beijing 100191 P.R. China
Corresponding Author : Lin Zhao
Peking University Eye Center
Peking University Third Hospital
49 North Garden Road
Haidian District, Beijing 100191
P.R. China
Tel: +86-10-82265010
E-mail: [email protected]
Received July 04, 2012; Accepted August 02, 2012; Published August 13, 2012
Citation: Zhao L, Wang J, Liu Y, Qian F (2012) Unilateral Central Retinal Artery Occlusion in Eisenmenger Syndrome. J Clin Exp Ophthalmol 3:241. doi:10.4172/2155-9570.1000241
Copyright: © 2012 Zhao L, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Abstract

Background: To report a case of unilateral central retinal artery occlusion in a patient with Eisenmenger syndrome.
Methods: Full ophthalmic examination, physical examination and laboratory examination were performed.
Results: Ophthalmic examination revealed unilateral central retinal artery occlusion. Laboratory examination
revealed hemoglobin 22.3 g/dl, hematocrit 65.9%, and pO2 42 mmHg.
Conclusion: The unilateral central retinal artery occlusion in a patient with Eisenmenger syndrome is rarely
reported in the literatures.

Keywords
Eisenmenger syndrome, Central retinal artery occlusion
Introduction
Eisenmenger syndrome is defined by pulmonary hypertension accompanied by a reversed or bidirectional shunt through a large intracardiac defect [1,2].
Patients with Eisenmenger syndrome have congenital cardiac defects (most commonly, atrial septal defect, ventricular septal defect, or patent ductus arteriosus) with left-to-right shunting of blood. The resultant increased pulmonary artery pressure creates pulmonary vascular fibrosis and occlusion of pulmonary capillary beds. This increased resistance eventually reverses the intracardiac shunting of blood from left-to-right to right-to-left, thus bypassing the pulmonary circulation. As blood continues to bypass the lungs, the patient becomes hypoxic and develops erythrocytosis and resultant hyperviscosity.
We treated a patient with the Eisenmenger syndrome associated with an unoperated on congenital ventricular septal defect who developed unilateral central retinal artery occlusion.
Materials and Methods
A 24-year-old Asian boy with Eisenmenger syndrome secondary to a large congenital ventricular septal defect presented with a 2-hour history of decreased vision in right eye. Medical history was notable for prominent pulmonary hypertension and severe shortness of breath, but no symptomatic coronary artery disease, dizziness, or syncope. The patient was oxygen dependent and unable to ambulate secondary to dyspnea. The patient developed secondary erythrocytosis with hematocrit levels between 56% and 65.9%.
Results
Ophthalmic examination revealed corrected visual acuity of R.E.:20/200 and L.E.:20/20, normal intraocular pressure, no evidence of iris neovascularization. Funduscopy demonstrated retina edema and cherry-red spot in right eye (Figure 1) and retinal vessels dialation and tortuosity, small blot retinal hemorrhages in left eye (Figure 2). Fluorescein angiography showed delayed artery filling and late leakage in the macula of the right eye.
Physical examination revealed a harsh III/VI systolic murmur. Extremities showed mild clubbing. Chest x-ray demonstrated cardiomegaly. Electrocardiogram showed right ventricular hypertrophy. Laboratory examination revealed hemoglobin 22.3 g/dl, hematocrit 65.9%, and pO2 42 mm Hg.
Discussion
Krarup described a patient with multiple cardiac defects and Eisenmenger syndrome who developed bilateral rubeosis iridis with spontaneous hyphemas and minimal retinal findings [3]. An additional report by Harino and associates described two patients with atrial septal defects and Eisenmenger syndrome, whose findings included microaneurysms, blot hemorrhages, and capillary dilation in the temporal peripheral retina [4]. One of these patients developed bilateral rubeosis iridis. Rodriguez reported a patient with Eisenmenger syndrome who developed bilateral visual loss secondary to central retinal vein occlusion [5]. Our patient developed unilateral central retinal artery occlusion.
In adults, the most common causes of cyanotic congenital heart disease are tetrology of Fallot and Eisenmenger syndrome [6]. Patients with cyanotic congenital heart disease have arterial oxygen desaturation resulting from the shunting of systemic venous blood to the arterial circulation. The hemostatic changes associated with Eisenmenger syndrome may lead to thromboembolic events, cerebrovascular complications, or the hyperviscosity syndrome [7]. As erythrocytosis caused by arterial desaturation develops in patients with Eisenmenger syndrome, the blood viscosity increases commensurately, and blood flow and oxygen transport eventually decrease. As demonstrated by our patient, individuals with Eisenmenger syndrome and associated secondary polycythemia may develop unilateral retinal artery occlusive disease.
As demonstrated by our patient, individuals with ES and associated secondary polycythemia may develop unilateral retinal artery occlusive disease.
 
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