Images in clinical medicine. Retinal arteriolar occlusions during a sickle cell crisis.

摘要

A 44-YEAR-OLD BLACK MAN WITH SICKLE CELL DISEASE PRESENTED TO THEeye clinic and reported that he had noticed acute, painless vision loss in his right eye when he awoke at 3 a.m. He reported drinking a "fair amount" of alcohol before going to sleep. On examination, the visual acuity in his left eye was 20/25 but in his right eye was limited to counting fingers directly in front of him. An examination of the anterior segment of both eyes was unremarkable. Intravenous fluorescein angiography was performed, and the angiogram showed multiple complete arteriolar occlusions in the retina of his right eye (Panel A). He was treated with intravenous hydration, and 1 week later, his vision had returned to 20/25 and his fluorescein angiogram was normal (Panel B). On follow-up, he continued to have recurrent "retinal attacks" involving both eyes. There was no evidence of retinal neovascularization, a common complication of recurrent arteriolar obstructions. Two years after presentation, his vision had deteriorated to 20/70 in both eyes. He has since been lost to follow-up.