Analysis of Multimodal Imaging Characteristics of Transient Central Retinal Artery Occlusion

Background To observe and analyze the multimodal imaging characteristics of transient central retinal artery occlusion (T-CRAO). Methods Retrospective observational study. Eight patients (8 eyes) diagnosed as T-CRAO in Tianjin Medical University Eye Hospital were included in this study. There were 6 males (6 eyes) and 2 females (2 eyes) with an average age of 63.8 years (38-78years). The clinical manifestation was acute vision loss. All patients underwent best corrected visual acuity (BCVA), slit lamp microscope, color fundus photography (CFP), fundus fluorescein angiography (FFA), optical coherence tomography (OCT) and OCT angiography (OCTA). The clinical data and multimodal imaging characteristics of patients were analyzed. Results There were 4 eyes with BCVA from 0.05 to 0.1 and 4 eyes from 0.1 to 0.3. CFP demonstrated multiple patchy “cotton-wool spot”-like lesions in posterior pole, without typical cherry-red spot. FFA manifested as sluggish filling of arteries, filling front, and delayed filling of vein. The filling was completed within 5 to 10 seconds. The “cotton-wool spot”-like lesions showed low fluorescence in early stage. Some lesions filled gradually; others still showed low fluorescence in late stage. OCT showed inner layer and local nerve fiber layer of retina was thickened. The reflexes of lesions were enhanced intermittently, especially the “hump-like” change of inner nuclear layer (INL). OCTA revealed the vascular density (VD) of superficial capillary plexus (SCP) and deep capillary plexus (DCP) of retina was decreased, the shape of the arcade was damaged, and the foveal avascular zone (FAZ) area was enlarged. En-face image showed isolated patchy hyperreflective lesions at SCP and fused patchy hyperreflective lesions at DCP.Conclusions CFP demonstrated multiple patchy “cotton-wool spot”-like lesions in posterior pole; OCTA revealed decreased VD of SCP and DCP. After treatment, the “cotton-wool spot”-like lesions gradually vanished, and the VD partially recovered.

Paracentral Acute Middle Maculopathy following Surgically Induced Branch Retinal Artery Occlusion During Vitrectomy

Paracentral acute middle maculopathy (PAMM) is a spectral-domain OCT finding of a thickened hyperreflective band at the level of the intermediate layers of the inner retina, attributed to the acute phase of intermediate capillary ischemia. The purpose of this paper is to report a case of PAMM deriving from a surgically induced branch retinal artery occlusion (BRAO) during vitrectomy for vitreous hemorrhage. A 70-year-old female referred to the posterior segment office with a 1-month history of visual loss in her right eye. Best-corrected visual acuity (BCVA) was “counting-fingers” (CF) due to a dense vitreous hemorrhage. She underwent a standard 23-gauge vitrectomy with a relatively close to the optic disc endodiathermy application to an avulsed vessel. Follow-up examination revealed a well-demarcated retinal whitening involving the inferior macula. SD OCT showed a surgically induced branch retinal artery occlusion exhibiting both a cotton wool spot and a PAMM lesion. Our case affords an insight into those pathological processes involved with PAMM, providing angiographic evidence of the retinal ischemic changes responsible for its development, by angiographically proving that branch retinal artery occlusion leads to a prompt formation of both a cotton wool spot and a PAMM lesion. Our aim is to raise awareness of this potential complication of vitrectomy surgery, especially when involving multiple traumatic manipulations onto the retinal surface.