PEG-LEG ARTERIOLES: AN ADAPTATION TO CHRONIC RETINAL HYPOPERFUSION

To describe a heretofore unreported retinal vascular sign related to chronic retinal hypoperfusion.

A case report of a 42-year-old woman who was found to have a novel pattern of retinal vascular remodeling in the setting of severe bilateral occlusive disease of the carotid and vertebral arteries.

The patient had a childhood history of nasopharyngeal carcinoma, treated with external beam radiation. At age 35, she suffered bilateral occipital infarctions. A cerebral angiogram showed complete occlusion of both common carotid arteries and complete occlusion of the proximal segments of both vertebral arteries. Seven years after her stroke, examination of her fundus revealed a remarkable pattern of vascular remodeling that involved nearly all of the major retinal arterioles in both eyes. In each vessel, a narrowed proximal segment abruptly dilated to a larger-than-normal caliber at a distance of 1 to 2 disk diameters from the optic disk. The abnormally increased caliber extended into the retinal periphery.

Chronic severe retinal hypoperfusion due to profound carotid occlusive disease can lead to adaptive remodeling of the retinal vasculature in a pattern that closely resembles the iconic image of a pirate's peg leg.