Nd:Yag Laser Transluminal Embolysis: A Therapeutic Approach in Retinal Artery Occlusion

Background: Central and branch retinal artery occlusion (CRAO and BRAO) are critical causes of acute vision loss, predominantly affecting older adults with systemic vascular pathology. These occlusions typically result from embolic events, leading to partial or complete retinal ischemia. Methods: This retrospective case series report details of our 10-year experience using the 1064 nm Nd:YAG laser for Transluminal Nd:YAG Embolysis (TYE) in order to lyse visible emboli within the retinal arteries. Results: We conducted a retrospective case series involving 18 patients treated by TYE for different retinal arteries occlusions between 2014 and 2024. TYE effectively restored blood flow in the occluded arteries, with variable but generally favorable visual outcomes. Our article highlights significant clinical and interventional aspects of three treated patients: a BRAO case with multiple transluminal emboli, a case of double BRAO and a CRAO case. We also report the successful use of TYE for intraluminal lysing of an embolus located outside the optic disc. The procedures were well-tolerated, with minor complications such as preretinal or vitreous hemorrhages resolving spontaneously. Conclusions: TYE is a minimally invasive therapeutic option for retinal artery occlusion with visible emboli, particularly when intervention occurs shortly after the onset of symptoms. Compared to observation, TYE can improve visual outcomes and reduce the risk of permanent vision loss, presenting a significant advancement in the management of this ophthalmic emergency. The worldwide experience with TYE is continuously increasing. Further research with larger cohorts is recommended to validate these results and refine the treatment protocol.