A 49-YEAR-OLD woman was referred for evaluation of a sudden loss of vision in her right eye, which occurred the day before the ophthalmic examination. The right eye had no light perception, and diagnosis of central retinal arterial obstruction was made based on the typical findings of afferent pupillary defect and white edema of the posterior pole of the retina with a cherry-red spot (Figure 1). Bilateral fundus examination also showed features typical of tilted optic disc syndrome. Fluorescein angiography revealed a marked delay in arteriovenous transit time. Visual acuity did not improve after retrobulbar injection of vasodilators. Results of extensive systemic workup were unremarkable. Two years later, the patient experienced a transient cerebral stroke, and results of a second systemic workup revealed elevated levels of antinuclear antibodies. It was concluded that she had a collagen-vascular disease. Three years after the initial visit, fundus examination disclosed prepapillary vascular loops at the inferior portion of the optic disc (Figure 2). Fluorescein angiography showed that the loops filled during the arterial phase (Figure 2).
Cohen SY. Acquired Prepapillary Arterial Loop After Central Retinal Artery Obstruction. Arch Ophthalmol. 1998;116(10):1398-1399. doi:10.1001/archopht.116.10.1398