scholarly journals Internal limiting membrane detachment in acute central retinal artery occlusion: a novel prognostic sign seen on OCT

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Ramesh Venkatesh ◽  
Chaitra Jayadev ◽  
Akhila Sridharan ◽  
Arpitha Pereira ◽  
Nikitha Gurram Reddy ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Central Retinal Artery Occlusion ◽  
Internal Limiting Membrane ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
Retinal Layer ◽  
Vitreous Opacities ◽  
Retinal Artery ◽  
Group 2

Abstract Background To present a series of acute central retinal artery occlusion (CRAO) cases showing internal limiting membrane detachment (ILMD) on optical coherence tomography (OCT) and to describe the possible etiopathogenesis and outcomes associated with it. Methods Demographic and OCT features of patients with acute CRAO were analysed retrospectively. OCT parameters noted were posterior vitreous opacities, ILMD, inner retinal layer stratification, hyperreflectivity and thickening, cystoid macular edema, neurosensory detachment. Eyes were grouped into Group (1) CRAO with ILMD; Group (2) CRAO with no ILMD. Results A total of 28 eyes of acute CRAO who had undergone OCT scans at the time of the acute episode were identified. Out of these, ILMD was noted in 5 eyes. The study findings suggested that cases of acute CRAO with ILMD are associated with poor presenting visual acuity and have more severe signs of retinal hypoperfusion on OCT, like inner retinal thickening, inner retinal hyperreflectivity and loss of inner retinal layer stratification. Patients with ILMD have poor final visual acuity and thinning and atrophy or necrosis of the inner retinal layers. Conclusion ILMD can occur in acute CRAO due to total retinal artery occlusion and severe retinal hypoperfusion. The presence of ILMD on OCT can be considered a sign of poor prognosis in cases of acute CRAO. Trial registration: Not applicable.

scholarly journals EMERGENCY TREATMENT FOR CENTRAL RETINAL ARTERY OCCLUSION ( CRAO )

2021 ◽  
Vol 1 (2) ◽  
pp. 7-8
Author(s):  
Nida Farida
Keyword(s):  
Visual Acuity ◽  
Emergency Treatment ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
Blurred Vision ◽  
Retinal Artery ◽  
Ocular Chamber ◽  
The Right

Central retinal artery occlusion (CRAO) is a blinding event but not considered as a common emergency problem. Since awareness of the case is low, patients usually come to the ophthalmologist later than the golden period and havingthe worst prognosis. We report the case of patient with a central retinal artery occlusion that had visual improvement after emergency treatment.A 47-year-old woman with no comorbidities presented with symptoms of a sudden blurred vision, no pain or redness in the right eye (RE). Best-corrected visual acuity in the RE was 1/60. A relative afferent pupillary defect was observed in the RE. Ocular fundus examination of RE was suggestive of CRAO. Emergency treatment were performed, including rebreathing of expired CO2, ocular massage and ocular chamber paracentesis. One week later, the visual acuity was improved.This case highlights that fast and accurate response in acute management of CRAO should be conducted, especially within the golden hours which is less than 6 hours after the accident, to prevent permanent visual loss of thepatient.

scholarly journals A Case of Incomplete Central Retinal Artery Occlusion Associated with Short Posterior Ciliary Artery Occlusion

2013 ◽  
Vol 2013 ◽  
pp. 1-4
Author(s):  
Shinji Makino ◽  
Mikiko Takezawa ◽  
Yukihiro Sato
Keyword(s):  
Visual Acuity ◽  
Optic Disc ◽  
Ophthalmic Artery ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
Posterior Ciliary Artery ◽  
Retinal Artery ◽  
Ciliary Artery

To our knowledge, incomplete central retinal artery occlusion associated with short posterior ciliary artery occlusion is extremely rare. Herein, we describe a case of a 62-year-old man who was referred to our hospital with of transient blindness in his right eye. At initial examination, the patient’s best-corrected visual acuity was 18/20 in the right eye. Fundus examination showed multiple soft exudates around the optic disc and mild macular retinal edema in his right eye; however, a cherry red spot on the macula was not detected. Fluorescein angiography revealed delayed dye inflow into the nasal choroidal hemisphere that is supplied by the short posterior ciliary artery. The following day, the patient’s visual acuity improved to 20/20. Soft exudates around the optic disc increased during observation and gradually disappeared. His hemodynamic parameters revealed subclavian steal syndrome as examined by cervical ultrasonography and digital subtraction angiography. We speculate that his transient blindness was due to ophthalmic artery spasms. In this particular case, spasms of the ophthalmic artery and occlusion of the short posterior ciliary artery occurred simultaneously. As the short posterior ciliary artery branches from the ophthalmic artery, the anatomical location of the lesion might be near the branching of both arteries.

scholarly journals Determination of Ischemia Onset Based on Automatically Generated Spectralis SD-OCT Values in Acute Central Retinal Artery Occlusion

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Maria Casagrande ◽  
Robert Kromer ◽  
Daniel A. Wenzel ◽  
Sven Poli ◽  
Martin S. Spitzer ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Time Window ◽  
Retinal Thickness ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
Retinal Layer ◽  
Retinal Artery ◽  
Sd Oct

Acute central retinal artery occlusion (CRAO) induces a time-dependent increase in retinal thickness. By manually measuring the relative retinal thickness increase (RRTI) in comparison to the contralateral eye based on optical coherence tomography (OCT), ischemia onset within the past 4.5 hours could be determined with 100% sensitivity and 94.3% specificity. To enable examiner-independent and quicker diagnostics, we analyzed the RRTI using the automatic retinal thickness measurement. In this retrospective study, 28 eyes were evaluated with an acute CRAO (<46 hours). All patients received a Spectralis SD-OCT image of both eyes. The RRTI was calculated for the ETDRS sectors using the Segmentation Module for Single Retinal Layer Analysis. Receiver operating characteristic (ROC) analysis was performed to determine patients ≤4.5 hours by RRTI. In all sectors, time to OCT (TTO) and RRTI correlated positively. The optimal cutoff point to detect CRAOs ≤4.5 hours was between 18.7% nasally and 22.9% RRTI temporally. Sensitivity and specificity varied between the sectors with 90–95% sensitivity and 89–100% specificity. In conclusion, the automatic measurement of RRTI also allows the differentiation of CRAOs within a possible therapeutic time window ≤4.5 hours and CRAOs ≥4.5 hours with a high sensitivity and specificity. Additionally, it offers quicker, easier, and a user-independent assessment of ischemia onset, helping to set a base for establishing automatic indices generated by the OCT machines.

scholarly journals Visual Improvement after Intra-Arterial Thrombolysis for Central Retinal Artery Occlusion Does Not Correlate with Time to Treatment

2016 ◽  
Vol 5 (3-4) ◽  
pp. 131-139 ◽  
Author(s):  
Paul S. Page ◽  
Alexander C. Cambon ◽  
Robert F. James
Keyword(s):  
Visual Acuity ◽  
Symptom Onset ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
Time To Treatment ◽  
Visual Improvement ◽  
Retinal Artery ◽  
Arterial Thrombolysis

Background: Intra-arterial thrombolysis (IAT) for the treatment of acute central retinal artery occlusion (CRAO) has demonstrated variable results for improving visual acuity and remains controversial. Despite limited evidence, time from symptom onset to thrombolysis is believed to be an important factor in predicting visual improvement after IAT. Methods: A comprehensive review of the literature was conducted and individual subject level data were extracted from relevant studies. From these, a secondary analysis was performed. Initial and final logarithm of the minimum angle of resolution (logMAR) scores were either abstracted directly from relevant studies or converted from provided Snellen chart scores. Change in logMAR scores was used to determine overall treatment efficacy. Results: Data on 118 patients undergoing IAT from five studies were evaluated. Median logMAR improvement in visual acuity was -0.400 (p < 0.001). There was no significant association between logMAR change and time to treatment when time (hours) was described as a continuous variable or described categorically [0-4, 4-8, 8-12, 12+ h; or 0-6, 6-12, 12+ h]. Conclusion: The visual improvement observed in this series had no relationship to the time from symptom onset to treatment with IAT. This suggests that patients may have the possibility for improvement even with delayed presentation to the neurointerventionalist. Other factors, such as completeness of retinal occlusion, may be more important than time to treatment. Additional studies to determine optimal patient selection criteria for the endovascular treatment of acute CRAO are needed.

scholarly journals Central Retinal Artery Occlusion after Filler Injection for Upper Lid Retraction

2021 ◽  
Vol 62 (11) ◽  
pp. 1560-1564
Author(s):  
Ui Seo Park ◽  
Young Jin Kim ◽  
Jae Wook Yang
Keyword(s):  
Visual Acuity ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
Hand Motion ◽  
Filler Injection ◽  
Cherry Red Spot ◽  
Upper Lid ◽  
Retinal Artery

Purpose: We report a case of central retinal artery occlusion after filler injection for upper lid retraction. Diagnosis and treatment were performed to recover visual acuity and good results.Case summary: A 40-year-old woman presented to our clinic with upper lid retraction. She was diagnosed with hyperthyroidism and thyroid orbitopathy. She had been examined regularly at a local clinic since 2016. At the first visit, her visual acuity was 1.0/1.0 and the intraocular pressure was 19 mmHg, with no unusual findings in the anterior segment. Hyaluronic acid filler was injected into the medial part of the left upper lid. As soon as the needle was removed, she complained of blurry vision and visual impairment. This was followed by the development of a relative afferent pupillary defect; her visual acuity was hand motion at 30 cm. After 5 minutes, we performed wide fundus imaging and optical coherence tomography, which revealed retinal artery occlusion and a cherry-red spot, along with inner retina hyperreflectivity. Under a diagnosis of central retinal artery occlusion, we performed anterior chamber paracentesis, intravenous mannitol and acetazole injection, and an ocular massage. Approximately 1.5 hours after filler injection, retinal artery reperfusion and loss of the cherry red spot were observed and, after about 3 hours, her vision had recovered to 1.0 from hand motion at 30 cm.Conclusions: Central retinal artery occlusion after filler injection, when diagnosed promptly, can be treated by anterior chamber paracentesis, intravenous mannitol and acetazole injection, and ocular massage.

scholarly journals Visual Loss Caused by Central Retinal Artery Occlusion After Bee Sting: A Case Report

2021 ◽  
Vol 8 ◽  
Author(s):  
Zhitao Su ◽  
Zhongli Hu ◽  
Lei Wang ◽  
Yao Wang ◽  
Xiaoyun Fang ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Visual Loss ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
Optic Disk ◽  
Bee Sting ◽  
Systemic Treatments ◽  
Retinal Artery

A bee sting can lead to an extremely rare case of visual loss caused by central retinal artery occlusion (CRAO). In this study, we report a 66-year-old healthy woman who was referred to our Eye Center because of visual loss, which had occurred after bee sting 2 days earlier. The visual acuity was no light perception (NLP). Examination revealed left eyelid edema, conjunctiva congestion, a 6-mm fixed pupil, scattered retinal hemorrhage, and white-appearing ischemic retina with one small area of the normal-appearing retina temporal to the optic disk. Fundus fluorescein angiography revealed CRAO with one cilioretinal artery sparing. Her systemic workup revealed hypersensitivity, hypercoagulable state, myocardial damage, and hepatic damage. After topical and systemic treatments, the visual acuity was still NLP with improved systemic workup. In brief, CRAO may occur after bee sting, and visual acuity should be monitored for early diagnosis.

scholarly journals Central Retinal Artery Occlusion Due to Subperiosteal Orbital Abscess Caused by Acute Sinusitis in a Child: A Case Report

2021 ◽  
pp. 014556132110167
Author(s):  
Xiumei Chen ◽  
Xuejing Man ◽  
Lei Dong ◽  
Jiangang Luan ◽  
Yuanbin Li ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
Acute Sinusitis ◽  
Orbital Abscess ◽  
Retinal Artery ◽  
The Right ◽  
Subperiosteal Orbital Abscess

Central retinal artery occlusion (CRAO) is an ophthalmic emergency and has poor visual prognosis. It is commonly found in elderly people and very rare in child. We reported an 8-year-old girl who suffered from acute sinusitis, periorbital swelling, and the visual acuity of her right eye was only light perception. She was diagnosed with CRAO, SPOA (subperiosteal orbital abscess), and acute sinusitis. Emergency treatments including surgery, antibiotics, glucocorticoids, intraocular-pressure-lowering drugs, and vasodilators were taken immediately in order to save the eyesight. The visual acuity of the right eye returned to 20/400. Conclusions: Severe intraorbital complications of acute sinusitis can lead to CRAO. Timely drainage, strong antibiotics, and glucocorticoids are the most effective methods for the treatments.

scholarly journals Retrospective Research of Central Retinal Artery Occlusion: Risk Factors and Onset-to-arrival Time

2020 ◽  
Vol 9 (3S) ◽  
pp. 313-316
Keyword(s):  
Risk Factors ◽  
Visual Acuity ◽  
Risk Factor ◽  
Arrival Time ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
Systemic Hypertension ◽  
Retinal Artery

Central Retinal Artery Occlusion (CRAO) is an ophthalmologic emergency. Various systemic conditions can become risk factors. The purpose of this study is to discover the risk factors, and awareness of the emergency of patients with CRAO which is indicated by patient’s onset-to-arrival time. The method used in this study is retrospective description from the medical record data of patients diagnosed with CRAO who comes to Saiful Anwar General Hospital for a period of 3 years. Sample collection is done consecutively, obtaining a total of 21 patients. The researched variables are age, visual acuity, risk factor, onset-to-arrival time, and acute-phase CRAO management success. Most of the CRAO patients found on this study are aged 60 years old, the highest amount of visual acuity upon arrival is 1/300, risk factor shows that 20 out of 21 samples have systemic hypertension, and almost all of the patients come for treatment 4-6 days after the onset. Most of the samples experience no change in their visual acuity after the therapy. The conclusion that hypertension is the highest risk factor of CRAO found on this study. The majority of patients come too late for treatment which causes not improving even worsening of their visual outcome.

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