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Paper text:
a 68-year - old woman presented with decreased visual acuity ( va ) , and 20 hours earlier had noticed a visual field defect in the superior half of her right eye .
slit lamp biomicroscopy and fundus examination revealed intraretinal edema with inferior retinal whitening in addition to a visible hollerenhorst plaque .
fluorescein angiography ( fa ) revealed an arterial filling defect along the inferotemporal arcade , distal to the corresponding embolus with foveal ischemia ( fig .
the initial treatment involved anterior chamber paracentesis , use of an iop - lowering agent , and ocular massage .
a goldmann three mirror lens was used to focus an nd : yag laser onto the arterial embolus .
the laser energy level commenced at 0.5 mj and was increased to 1 mj ( about 12 pulses ) until the embolus was partially or completely shattered .
after shattering the embolus , a small amount of vitreous hemorrhage was noted inferior to the optic disc .
five days after treatment , fa showed no evidence of the emboli , and retinal arteriolar blood flow had been restored .
bcva improved to 20/80 . at two months after nye , bcva was 20/25 with no remaining vitreous hemorrhage . at three months after nye , bcva was 20/20 and fa showed that the branch retinal artery and all arterioles were patent with good flow . at ten months after nye ,
an 82-year - old woman presented with a four - day history of progressive decrease in va in her left eye .
her medical history was unremarkable . at presentation , bcva was 20/200 , which was lower than the reading of 20/32 taken six months earlier .
slit - lamp biomicroscopy revealed a large plaque in the associated branch retinal artery on the disc of the left eye .
fa showed an arterial filling defect along the superotemporal arcade distal to the corresponding embolus ( fig .
2 ) . a macular contact lens was used to deliver the nd : yag laser to the plaque .
pulsing commenced with one pulse at 0.5 mj , and the energy was increased to 1 mj , at which a total of eight pulses were applied to the plaque .
a small amount of vitreous hemorrhage over the arteriole was noted which resulted in cessation of the laser treatment despite the remaining embolus .
the following day , vitreous hemorrhage decreased slightly and laser treatment was recommenced ( 1 mjten pulses ) .
however , a partial embolus fragment remained in the associated arteriole . on the second day after nye ,
bcva had improved to 20/100 , and the vitreous hemorrhage remained present . on the third day after nye , fa showed restoration of the retinal arteriolar blood flow .
forty days after nye , bcva had improved to 20/32 . at four months after nye , fa showed no retinal neovascularizations , and bcva remained at 20/32 .
a 68-year - old woman presented with decreased visual acuity ( va ) , and 20 hours earlier had noticed a visual field defect in the superior half of her right eye .
slit lamp biomicroscopy and fundus examination revealed intraretinal edema with inferior retinal whitening in addition to a visible hollerenhorst plaque .
fluorescein angiography ( fa ) revealed an arterial filling defect along the inferotemporal arcade , distal to the corresponding embolus with foveal ischemia ( fig .
the initial treatment involved anterior chamber paracentesis , use of an iop - lowering agent , and ocular massage .
a goldmann three mirror lens was used to focus an nd : yag laser onto the arterial embolus .
the laser energy level commenced at 0.5 mj and was increased to 1 mj ( about 12 pulses ) until the embolus was partially or completely shattered .
after shattering the embolus , a small amount of vitreous hemorrhage was noted inferior to the optic disc .
five days after treatment , fa showed no evidence of the emboli , and retinal arteriolar blood flow had been restored .
bcva improved to 20/80 . at two months after nye , bcva was 20/25 with no remaining vitreous hemorrhage . at three months after nye , bcva was 20/20 and fa showed that the branch retinal artery and all arterioles were patent with good flow . at ten months after nye ,
an 82-year - old woman presented with a four - day history of progressive decrease in va in her left eye .
her medical history was unremarkable . at presentation , bcva was 20/200 , which was lower than the reading of 20/32 taken six months earlier .
slit - lamp biomicroscopy revealed a large plaque in the associated branch retinal artery on the disc of the left eye .
fa showed an arterial filling defect along the superotemporal arcade distal to the corresponding embolus ( fig .
2 ) . a macular contact lens was used to deliver the nd : yag laser to the plaque .
pulsing commenced with one pulse at 0.5 mj , and the energy was increased to 1 mj , at which a total of eight pulses were applied to the plaque .
a small amount of vitreous hemorrhage over the arteriole was noted which resulted in cessation of the laser treatment despite the remaining embolus .
the following day , vitreous hemorrhage decreased slightly and laser treatment was recommenced ( 1 mjten pulses ) .
the large embolus was ruptured , and recirculation around the macula was noted . however , a partial embolus fragment remained in the associated arteriole . on the second day after nye , bcva had improved to 20/100 , and the vitreous hemorrhage remained present . on the third day after nye , fa showed restoration of the retinal arteriolar blood flow .
forty days after nye , bcva had improved to 20/32 . at four months after nye , fa showed no retinal neovascularizations , and bcva remained at 20/32 .
recent reports showed immediate restoration of retinal blood flow after nye , in addition to rapid restoration of bcva .
however , complications such as vitreous hemorrhage and subretinal hemorrhage were observed.3,4 in the present cases , laser treatment resulted in dramatic improvement in bcva and restoration of retinal blood flow despite a small amount of vitreous hemorrhage .
mason et al.5 reported that visual prognosis after brao appeared to correlate with presenting va , and that eyes with an initial va of 20/40 or better usually remained at 20/40 or better .
individuals with poor va ( e.g. , 20/100 or worse ) generally did not show significant improvement .
they concluded that it may be misleading to indicate that 80% of eyes with brao improve to 20/40 or better ( as described in previous reports ) when final bcva is so closely related to presenting bcva . in conclusion
therefore , nye should be considered an effective treatment in patients with brao with visible emboli .
the purpose of this paper was to report a successful treatment of transluminal nd : yag laser embolysis ( nye ) for branch retinal artery occlusion ( brao ) with visible emboli . 
 two patients with acute , severe vision loss secondary to a branch retinal artery occlusion with visible emboli in one eye underwent nye . 
 a complete ocular examination was performed which included biomicroscopy of the posterior pole of the retina , intraocular pressure measurement , fundus color photographs , and fluorescein angiography ( fa ) . 
 after the nye , the two patients showed dramatic improvements in best - corrected visual acuity , as well as , immediate and dramatic restorations in flow past the obstructed arteriole in fa . 
 nye is a treatment modality to be considered in patients with brao who present acutely with severe vision loss and a visible embolus .