Título / Title

Branch retinal artery occlusion associated with patent foramen ovale in a pregnant patient: a case report.

Introdução / Purpose

To describe a case of a pregnant patient with branch retinal artery occlusion (BRAO) associated to patent foramen ovale (PFO).

Material e Método / Methods

A 28 years-old woman presented at the clinic 20 hours after an appearance of an acute, painless spot in the inferior temporal visual field of the right eye (OD). At the time, she was 18 weeks pregnant and had no report of complications in her previous pregnancy. Best-corrected visual acuity was 1.0 in both eyes. Color fundus photo, perimetry and OCT angiography were required.

Resultados / Results

Color fundus photo in OD clearly showed an embolus in the superior nasal retinal arteriole associated with a pallor in the distal retina. En face OCT also showed an artery embolus, and OCT angiography has demonstrated decorrelation signal in the superior nasal artery, indicating reperfusion. Perimetry confirmed total scotomas in the inferior temporal visual field. Patient was reffered to a cardiologist and transcranial doppler with contrast evidenced a severe amount of bubbles passing even at rest, indicating the presence of an intracardiac right-to-left shunt. A transesophageal echocardiography confirmed the presence of a patent foramen ovale (PFO) with atrial septal aneurism. Trombophilic conditions were ruled out. Enoxaparin 1mg/kg was started and will be kept until the delivery, when a PFO surgical closure will be done.

Discussão e Conclusões / Conclusion

BRAO has a higher incidence in the elderly population, being rare in young patients. The most frequent cause of BRAO is embolic obstruction, being cardiac valvular diseases, atrial fibrillation and the carotid artery the commonest sources of endogenous emboli. Furthermore, there are no more than a handful reports of PFO as a source of emboli for BRAO in literature and only two of those cases ocurring in pregnancy.
This case highlights the noteworthiness of considering PFO as a source of embolism for RAO in young patients.

Palavras Chave

BRAO, PFO, pregnancy, OCT, retina, embolus