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Ophthalmic Images
February 17, 2021

Pulsating Cilioretinal Artery From Ocular Hypertension

Author Affiliations
  • 1University of California, San Francisco, Department of Ophthalmology, San Francisco
  • 2Zuckerberg San Francisco General Hospital and Trauma Center, Department of Ophthalmology, San Francisco, California
  • 3Francis I. Proctor Foundation, University of California, San Francisco, San Francisco
JAMA Ophthalmol. 2021;139(2):e204108. doi:10.1001/jamaophthalmol.2020.4108

A 42-year-old man presented with a central scotoma in the right eye on waking. His visual acuity was 20/200 OD and 20/20 OS, and his intraocular pressure (IOP) was 45 mm Hg OD and 40 mm Hg OS, with open angles on gonioscopy. An ophthalmoscopic examination showed dilated retinal veins and retinal whitening, presumably from intracellular swelling secondary to ischemia, around the fovea (Figure). Fluorescein angiography revealed a pulsating cilioretinal artery, delayed perfusion of the inferotemporal macula, and delayed arteriovenous transit (Video). The patient was diagnosed with cilioretinal artery obstruction in the setting of ocular hypertension, with presumably concurrent retinal venous occlusion, potentially from swelling of the optic nerve contributing to compression of the cilioretinal artery along with increased IOP.

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