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Photo Essay
December 2001

Combined Occlusion of the Central Retinal Artery and Vein in a Pediatric Patient Secondary to Infective Endocarditis

Arch Ophthalmol. 2001;119(12):1868-1869. doi:10.1001/archopht.119.12.1868

A 14-YEAR-OLD girl had experienced general fatigue, weight loss, and fever for 3 months when she developed sudden unilateral visual loss. Visual acuity in the right eye was no light sense. Ophthalmologic examination revealed a combined occlusion of the central retinal artery and vein on the first day (Figure 1 and Figure 2) and flame-shaped retinal hemorrhage on the second day (Figure 3). She was diagnosed as having infective endocarditis (IE) with group D streptococcus. Congenital atrial septal defect and mitral valve insufficiency were also found, which probably caused IE and subsequent ophthalmic events. Despite treatment with fibrinolysis (urokinase and low molecular dextran; Otsuka Pharmaceutical Co Ltd, Tokyo, Japan), her visual acuity improved only to hand movement with resolution of the cherry red spot. Two weeks after the first ophthalmologic examination, she underwent mitral valve replacement and surgery to close the atrial septal defect. After 10 years of follow-up, her visual acuity in the right eye has remained hand movement. No iris neovascularization has developed.

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