A case of branch retinal artery occlusion following orbital cavernous hemangioma excision

To report the first case of branch retinal artery occlusion (BRAO) following surgical excision of orbital cavernous hemangioma.

A 34-year-old man was referred to our department with an orbital cavernous hemangioma compressing the optic nerve, the medial rectus muscle, and the eyeball, and resulting in a hyperemic optic disc, vascular tortuosity, and pronounced choroidal folds at fundus biomicroscopy. The patient underwent transconjunctival inferior orbitotomy and the lesion was excised entirely without intraoperative complications.

On the second postoperative day, best-corrected visual acuity (BCVA) decreased from 2/10 to counting fingers and fundus examination showed occlusion of the inferotemporal branch retinal artery. Fluorescein angiography and spectral-domain optical coherence tomography (SD-OCT) confirmed the diagnosis. One month of corticosteroid therapy and anticoagulation therapy were prescribed. The patient was followed up for 6 months; SD-OCT showed resolution of the retinal thickening and the retinoschisis but a new hyporeflective space in the outer retina at the fovea had appeared at 6 months follow-up. The patient's BCVA improved to 9/10 after 6 months but an absolute superior visual field defect was still present at the end of the follow-up.

We describe the first reported case of BRAO following orbital cavernous hemangioma excision with significant improvement of the BCVA at 6-month follow-up. The SD-OCT could be a useful tool to monitor morphologic changes of the area corresponding to the retinal ischemia.