| OCR Text |
Show f. Clin. Neuro-ophthalmol. 3: 191-192, 1983. Appearance of Cholesterol Embolism in the Retina AVINOAM B. SAFRAN, MD. Abstract A case is reported of cholesterol crystal embolus in the retina. Up until now, no in vivo demonstration in the form of a printed photograph seems to have been published, showing changes in cholesterol embolus reflection, when the light and gaze incidence is modified. The cholesterol crystal embolus in the retina has a characteristic appearance. This embolus usually shows a bright orange-yellow reflection which may flash on and off when the incidence of the light beam of the ophthalmoscope is changed, or when the segment of the arterioles containing the crystal is made to pulsate by compression of the globe. 1.2 This observation has often been reported in the literature. However, to my knowledge, no in vivo demonstration in the form of a printed photograph has been published of changes in cholesterol embolus reflection, when the light and gaze incidence is modified. The present paper reports a case in which we were able to photograph this phenomenon in a 78year- old woman who presented with sudden bilateral homonymous defects in the visual fields. Both fundi showed diffuse arteriosclerotic changes. In addition, numerous orange-yellow, brightly refractile crystals were found in retinal arteriolar bifurcations in both eyes. One of these bright plaques, located in a left superior temporal arteriole, was photographed by means of a Zeiss fundus camera. The photographs which were taken when the eyes of the patient were in a horizontal plane show bright reflection of the crystal (Fig. 1), while the reflection was only slight in those taken when the patient's gaze was directed approximately 10° upward (Fig. 2). Location and shape of the crystal were the same in both pictures. Recognition of retinal emboli is an important part of the clinical evaluation of patients with occlusive vascular disorders. Patients suffering from a retinal stroke with visible emboli demonstrate a strikingly diminished rate of survival as From the Ophthalmology Clinic, Geneva University Hospital, Geneva, Switzerland. September 1983 Figure 1. Left fundus with the patient's eyes in primary position. Arrow indicates brightly reflective cholesterol embolus. Figure 2. Left fundus with the eyes looking approximately 10° upwards. Arrow indicates cholesterol embolus showing minimal light reflection. 191 Cholesterol Embolism compared to patients with retinal arteriole occlusion with no visible emboli.3 Fifteen percent of patients with cholesterol embolism die within 1 year; 29% within 3 years; and 54% within 7 years 4 Cholesterol emboli are crystalline shales, thin squames of cholesterol ester with doubly refractile optical characteristics.2 They generally lodge in arteriolar bifurcations without obstruction the blood flow, although infarcts of the retina presumably due to cholesterol embolism have been reported. 5 Obstruction of the vessel might be caused by the cumulative impact of several crystals in the same place6 or by leucocyte aggregates resulting from the activation of the complement by a cholesterol embolism.7 References 1. Hollenhorst, R. W.: Significance of bright plaques in the retinal arteriole. ].AM.A 178: 23-29, 1961. 2. David, N.j., Klintworth, G.K., Friedberg, S.j., and Dillon, M.: Fatal atheromatous cerebral embolism associated with bright plaques in the retinal arterioles. Report of a case. Neurology 13: 708-713, 1963. 3. Savino, P.j., Glaser, j.5., and Cassady, J.: Retinal stroke. [s the patient at risk? Arch. Ophthalmol. 95: 1185-1189, 1977. 4. Pfaffenbach, D.D., and Hollenhorst, R.W.: Morbidity and survivorship of patients with embolic cholesterol crystallisation in the ocular fundus. Am. ]. Ophthalmol. 75: 66-72, 1973. 5. Russell, R. W.R.: Atheromatous retinal embolism. Lancet 2: 1354-1365, 1963. 6. Steiner, T.j., Rail, D.L.H., and Rose, F.e.: Cholesterol crystal embolization in rat brain: A model for atheroembolic cerebral infarction. Stroke II: 184-189, 1980. 7. Greenberg, e.S., Hammerschmidt, D.E., Craddock, P.R.,et al.: Atheroma cholesterol (ch) activates complement (c) and aggregates PMNs: Possible role in myocardial infracts (M[) extension and in cholesterol embolization syndrome (ChES). Abstract. Clin. Res. 27: 509A, 1979. Write for reprints to: AB. Safran, M.D., Ophthalmology Clinic, Geneva University Hospital, CH-1211 Geneva, Switzerland. journal of Clinical Neuro-ophthalmology |
