Transluminal Nd:YAG laser embolysis in a case of hemiretinal arterial occlusion.

Retinal artery occlusion causes catastrophic, sudden visual loss. It is a true ophthalmic emergency in which every minute of delay increases the risk of irreversible retinal damage [1]. More than 90% of eyes with central retinal artery occlusion (CRAO) have a sudden, painless decrease in visual acuity to a level of counting fingers to light perception [2]. More than 150 years since the description of the characteristic features and the presumed cause of CRAO by von Graefe, this disease remains a therapeutic dilemma [3]. A variety of treatments have been proposed, but none of them show a clear therapeutic benefit or have wide acceptance [3]. Thus most physicians tend to use a combination of treatments with low potential sideeffects. The most popular of these are ocular massage, rebreathing with carbogen, oral acetazolamide and topical antiglaucomatous agents. Attempts have been made to treat the disease with systemic anticoagulation/ antiaggregation therapy, transluminal laser embolysis and selective intra-arterial lysis of the clot [3]. Heparin and acetylsalicylic acid are not very effective, and intra-arterial lysis is under active investigation by the European Assessment Group for Lysis in the Eye (EAGLE) trial [3]. To the best of our knowledge, there are few reports on laser-assisted transluminal embolysis, and there are only 2 reports on successful neodymium:yttrium-aluminiumgarnet (Nd:YAG) laser treatment of embolic CRAO [4,5]. We report here on another successful use of Reynard and Hanscom’s method [4], with some modifications, for the treatment of retinal artery occlusion.