Presence of retinal ischemic perivascular lesions prior to an ischemic stroke event

Presença de lesões perivasculares isquêmicas na retina antes de um AVC isquêmico

An 81-year-old male patient with systemic hypertension, diabetes mellitus, and dyslipidemia presented with sudden visual acuity loss in the right eye (RE) due to a branch retinal artery occlusion (BRAO) associated with macular edema. Despite treatment with intravitreal bevacizumab, the patient developed persistent inner retinal ischemia, evidenced by optical coherence tomography (OCT) findings of retinal inner plexiform layer (RIPL) alterations. Years later, he suffered an ischemic stroke, highlighting the association between retinal ischemic changes and systemic vascular risk. This case underscores the role of RIPLs as potential early markers for cerebrovascular and cardiovascular events, emphasizing the need for multidisciplinary management and vigilant cardiovascular monitoring in patients with ischemic retinal findings. The identification of RIPLs through noninvasive imaging may offer a valuable opportunity for early intervention, although further studies are necessary to establish their routine clinical use as predictive biomarkers.

Keywords:
Ischemic stroke; Diabetes mellitus; Dyslipidemias; Retinal artery occlusion; Biomarkers