Purpose

To report a rare case of a combined central retinal artery (CRA) and medial posterior ciliary artery (MPCA) occlusion due to an atherosclerotic lesion in the common trunk supplying both arteries.

Observations

A 75-year-old man presented with acute vision loss associated with elevated intraocular pressure in the right eye. Multi-modal imaging revealed a combined retinal and choroidal infarction in the distribution of the CRA and MPCA, localizing the lesion to the common trunk of the ophthalmic artery supplying both the CRA and MPCA. Neurovascular imaging provided supportive evidence for the diagnosis.

Conclusions and importance

A simultaneous retinal and choroidal vascular occlusion is an uncommon presentation. Familiarity with the anatomy of the ophthalmic arteries and its branches facilitates localizing the lesion.

PURPOSE: Arthrographis kalrae is an opportunistic fungus that can cause a severe and atypical endophthalmitis. In limited studies, low-dose povidone iodine has been shown to be effective in treating fulminant bacterial endophthalmitis. In this case report, we describe the successful treatment of recalcitrant Arthrographis kalrae keratitis-associated endophthalmitis with intraocular povidone iodine during pars plana vitrectomy. OBSERVATIONS: A patient with Arthrographis kalrae keratitis-associated endophthalmitis had persistent disease despite aggressive medical management. The infection resolved following pars plana vitrectomy with infusion of dilute povidone iodine. No toxicity was noted postoperatively. CONCLUSIONS AND IMPORTANCE: Povidone iodine-infused pars plana vitrectomy offers promise as a treatment for infectious endophthalmitis that fails medical management. This is the first report demonstrating eradication of fungal endophthalmitis using povidone iodine-infused pars plana vitrectomy.