Peculiar Intra-arteriole Emboli
Detection of a Cluster of Novel Intra-arteriole Microembolic Events in Consecutive Patients in the Chicago Metropolitan Area
Abstract
Purpose
To characterize a novel appearing micro embolic events that have presented in increasing frequency in a clinical practice in the Chicago metropolitan area over the course of the last seven weeks.
Methods
In this retrospective observational case series over one week, we analyze patients schedule for routine visits and acute appointments in for retinal evaluation and/or treatment on the course of a week. Patients with routine follow up with age-related macular degeneration, retinal detachment, macular hole, glaucoma, and an assortment of anterior segments abnormalities. New and unscheduled patients were examined with acute changes in the acute vision or referral for recent detection diabetes or possible glaucoma. Vision screening and funduscopic examination were performed. Fluorescein angiography performed was if acute hemodynamic alterations were detected clinically. Photography of the posterior was performed when possible.
Results
Of 111 patients, 90% ages ranging 12 to 91 years old had microemboli in the arterioles or the capillary bed proximal to arteriole in one or both eyes. COVID was not associated with the emboli. The emboli were associated an overlying gliosis 50% of varying degree. Seventy percent of the emboli were refractile with a silver to white. Choroidal emboli were seen 15 percent of the time. Forty four percent patients, visual acuity decreased from baseline in one or both eyes range 2 lines to more. Most known patients were on treatments which would potentially ameliorate embolic sequelae to some degree. Emboli palpated Intraoperatively were nonmalleable and immobile with in the retinal substance. Occasional white dot floaters may be seen. Concomitant neurologic issues on occasion including vertigo, headache, new onset migraine, visual processing abnormalities, confusion were noted. Patient with vascular disease presented with acuity augmentation of disease.
Conclusion
We have coined the acronym PIE for peculiar intra-arteriole emboli that have been appearing a stark majority of patients seen in the practice over the last week. The emboli are not unique to the eye as they are potentially lodging in comparably sized arterioles throughout throughout the body. Emboli in the retina resemble a cross between the diamond dust of a Tanno scratcher or talc. And mostly are associated with fibrotic changes and possible capillary closure. Hemorrhages are not a major feature consistent with emboli events. Atherosclerosis seems less likely given the age range of presentation but certainly can exacerbate symptoms.. An environmental source must be excluded as soon as possible. And the pathology must be analyzed. Conservative measures such as intraocular pressure control and NSAIDS may have had an affect given the lower than anticipated level of symptomatology with these lesions. Enteric coated aspirin and other anticoagulants maybe helpful.
