Rescue vitrectomy with blocked artery massage and bloodletting for branch retinal artery occlusion

A 61-year-old male suffered from sudden blurred vision and superior visual field defect oculus dexter. His vision was counting fingers at 20 cm. Fundoscopy demonstrated inferior pale retina and a large embolus located at the proximal inferior retinal artery. Branch retinal artery occlusion (BRAO) was diagnosed. Initial paracentesis, topical brimonidine tartrate, oral pentoxifylline, and hyperbaric oxygen therapy were performed but showed limited improvement. Hence, he received 25-gauge vitrectomy, artificial posterior vitreous detachment, blocked retinal artery massage, and bloodletting 5 days after onset. After the surgery, his vision improved to 20/25. Fundoscopy showed reperfused retina, and optical coherence tomography revealed resolved retinal edema. RAO is an ophthalmological emergency; however, no standard guideline is available. Vitrectomy with blocked retinal artery massage and bloodletting showed favorable results in this case of BRAO with a large embolus. More prospective clinical trials are needed for setting up the standard treatment.