Question
A 72-year-old hypertensive man awoke with acute, painless loss of vision. Examination reveals visual acuity of hand motions and an afferent pupillary defect. The fundus is shown in the image below. Which one of the following has not been advocated as a possible treatment for this condition?
| A. |
Hyperbaric oxygen
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| B. |
Anterior chamber tap
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| C. |
Acetazolamide and topical β-blockers
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| D. |
Anticoagulation with Coumadin
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Show Answer
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Correct Answer � D
Explanation
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Answer: D) Anticoagulation with Coumadin
Explanation: Various treatment modalities have been advocated for CRAOs, including methods to provide more oxygen to the ischemic retina (hyperbaric oxygen, carbogen), increasing perfusion of the retina (vasodilatory drugs, lowering IOP by anterior chamber paracentesis or administration of acetazolamide or mannitol), and fibrinolytic agents (intra-arterial t-PA). Animal studies have shown that irreversible damage occurs within 90 minutes of arterial obstruction. Warfarin requires several days to reach maximal effect and would not be helpful in an acute situation.
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