Hypoperfusion of the deep capillary plexus associated with acute on chronic cocaine use

PURPOSE: To illustrate a case of decreased perfusion in the deep capillary plexus seen on ocular coherence tomography angiography in a patient with acute on chronic cocaine use. OBSERVATIONS: A 69-year-old male who presented with a sudden loss of vision in his right eye following recent use of cocaine. Ocular coherence tomography of the right eye revealed hyperreflectivity within layers of the retina and ocular coherence tomography angiography showed decreased vascular density and flow in the deep capillary plexus. CONCLUSIONS AND IMPORTANCE: Cocaine use has been associated with systemic and cardiac effects, as well as ocular sequelae. It has been hypothesized to have a role in the pathogenesis of acute macular neuroretinopathy. Here we present the first case of ocular coherence tomography angiography findings of hypoperfusion of the deep capillary plexus in a patient with acute on chronic cocaine use.