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Occlusion de branche artérielle et veineuse rétinienne associée à des plaques de Hollenhorst et à des taches de Roth

To report a case of retinal artery and vein occlusion associated with cholesterol emboli(Hollenhorst plaques) and Roth spots, revealing an atheromatous carotid disease.

We report the case of a middle-aged woman who presented a retinal artery and venous branch occlusion associated with Hollenhorst plaques and Roth spots.

A 56-year-old female with a medical history of hypertension, renalfailure, myocardial infarction, and pulmonary embolism, presented with a progressive visualblurring of the left eye (LE). Best-corrected visual acuity was limited to counting fingers in theLE and 7/10 in the right eye (RE). No rubeosis was noted. Fundus examination showed inboth eyes, multiples Roth spots along the temporal arcades and multiple cholesterol embolior Hollenhorst plaques. In the LE, we noted a macular ischemic whitening. Fluoresceinangiography showed a bilateral delayed retinal arterial filling and a complete interruption offilling in a branch of the inferotemporal artery of the LE with extensive non-perfusion areas.We also noticed a delayed arteriovenous transit time with late venous staining of the leftsuperotemporal vein. At this stage, the diagnosis of bilateral Hollenhorst plaques complicatedwith a branch artery and vein occlusion on the LE was made. Macular swept-source opticalcoherence tomography (SS-OCT) revealed a para-foveal fiber layer thickening of the retinalfiber layer in the LE associated with irregular inner retinal layers. OCT-angiography showedmultiple hypointense areas especially in the deep retinal capillary plexus in both eyes. Acomplete blood workup revealed increased high-density lipoprotein cholesterol andincreased triglycerides levels. Duplex ultrasound of the neck showed the presence ofmultiple plaques of atheroma at the carotid bifurcation. No vegetations neither calcificationswere seen in cardiac echography. Cardiac ultrasound showed heart failure (no vegetations orcalcification).

Cholesterol emboli or Hollenhorst plaques are key markers to atheromatouscarotid disease, with potential narrowing and neurologic involvement. Roth spots are typicallyassociated with infectious endocarditis and hemopathy. In this case, they are probablysecondary to retinal hypoxia.

In the case of a symptomatic Hollenhorst plaque, urgent embolic evaluationincluding carotid ultrasound analysis is indicated.