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Traumatic Prepapillary Loop Torsion and Associated Branch Retinal Artery Occlusion

Ehsan Rahimy, MD1; Nadim Rayess, MD1; Christine L. Talamini, MD1; Richard S. Kaiser, MD1
[+] Author Affiliations
1Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania
JAMA Ophthalmol. 2014;132(11):1376-1377. doi:10.1001/jamaophthalmol.2014.2415.
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Prepapillary vascular loops are a congenital anomaly characterized as having both an ascending and a descending branch, and they are thought to be arterial in origin in 95% of cases.1,2 As such, complications that may spontaneously arise include branch retinal artery occlusion (BRAO) and, less commonly, amaurosis fugax, vitreous hemorrhage, and hyphema.3 We describe and videographically demonstrate the first case, to our knowledge, of trauma-induced prepapillary vascular loop torsion with associated BRAO in a young patient.

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Figure.
Prepapillary Vascular Loop and Associated Branch Retinal Artery Occlusion

A, Color fundus photograph of the right eye demonstrates a coiled prepapillary vascular loop with inferior superficial retinal whitening along the distribution of the inferotemporal arcade sparing the fovea. B, Magnified view shows the vascular loop torsion with intraluminal columns of stagnant deoxygenated blood. C, Color fundus photograph of the left eye shows a perfused prepapillary vascular loop.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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Fluorescein Angiogram of Prepapillary Vascular Loop With Associated Branch Retinal Artery Occlusion

Retinal vascular nonperfusion is noted along the inferotemporal arcade with subsequent retrograde venous and arterial filling of dye. Pulsatile blood flow within an occluded prepapillary vascular loop can be appreciated as rising and falling of an intraluminal blood column, corresponding to cardiac systole and diastole, respectively.

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