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

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