A 69-year-old male with a background of hypertension and hyperlipidemia presented with acute ischemic-type chest pain at rest. Initial electrocardiography showed inferolateral territory ST-segment elevation, and he was treated as standard with intravenous fibrinolysis. Ninety minutes post-therapy, the patient underwent rescue coronary angioplasty, performed via the right radial artery, with a single drug-eluting stent placed in the proximal right coronary artery. Four hours post-angioplasty, the patient noticed blurred vision in his left eye, and examination revealed a superior medial quadrantanopia and reduced visual acuity (20/100). Fundoscopy demonstrated a white embolus (Hollenhorst plaque) in the inferior branch of the central retinal artery (A, arrow) with associated retinal edema.

Retinal cholesterol emboli can be an initial sign of vascular disease (1) and are due to ulceration or disruption of an atheromatous plaque, frequently localized to the aortic arch (2). Such embolic events are a rare but serious complication of cardiac catheterization and can appear up to 24-h post-procedure (2).