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Venkatesh R, Joshi A, Maltsev D, Munk M, Prabhu V, Bavaskar S, Mangla R, Ruamviboonsuk P, Chhablani J. Update on central retinal artery occlusion. Indian J Ophthalmol 2024; 72:945-955. [PMID: 38905460 DOI: 10.4103/ijo.ijo_2826_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/13/2024] [Indexed: 06/23/2024] Open
Abstract
The medical condition referred to as "central retinal artery occlusion" (CRAO) was first documented by Albrecht von Graefe in 1859. Subsequently, CRAO has consistently been identified as a serious medical condition that leads to substantial visual impairment. Furthermore, it is correlated with vascular complications that have the potential to affect crucial organs such as the brain and heart. A considerable amount of research has been extensively published on the various aspects of this topic, which is marked by notable debates and misconceptions, especially regarding its management and outcomes. The primary aim of this review article is to analyze the latest developments in the understanding of CRAO, which includes its causes, techniques for retinal imaging, systemic evaluation, and therapeutic strategies, such as vitrectomy. This review article offers readers a comprehensive learning experience to gain knowledge on the fundamental principles and recent advancements in CRAO.
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Affiliation(s)
- Ramesh Venkatesh
- Department of Vitreo-retinal Services, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Aishwarya Joshi
- Department of Vitreo-retinal Services, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Dmitrii Maltsev
- Department of Ophthalmology, Military Medical Academy, St. Petersburg, Russia
| | - Marion Munk
- Department of Retina, Augenarzt Praxisgemeinschaft Gutblick AG, Pfäffikon, Switerland
- Department of Retina, University Hospital Bern, Inselspital, Bern, Switzerland
- Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Vishma Prabhu
- Department of Vitreo-retinal Services, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Snehal Bavaskar
- Department of Vitreo-retinal Services, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Rubble Mangla
- Department of Vitreo-retinal Services, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Paisan Ruamviboonsuk
- Department of Ophthalmology, College of Medicine, Rangsit University, Lak Hok, Thailand
- Center of Excellence for Vitreous and Retinal Disease, Rajavithi Hospital, Bangkok, Thailand
| | - Jay Chhablani
- Department of Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, Pittsburg, PA 15213, USA
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Kang DW, Jung KH, Yang W, Kim HM, Kim Y, Chung M, Ha J, Punsalan MT, Lee EJ, Jeong HY, Kim JM, Ko SB, Lee SH. Presence of Embolic Source and Outcome in Central Retinal Artery Occlusion. Neurology 2023; 101:e1364-e1369. [PMID: 37400246 PMCID: PMC10558162 DOI: 10.1212/wnl.0000000000207445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/07/2023] [Indexed: 07/05/2023] Open
Abstract
OBJECTIVES The etiology of central retinal artery occlusion (CRAO) is unclear in approximately 50% of patients, suggesting pathomechanical heterogeneity; moreover, little is known about outcomes according to etiology. This study investigated whether the presence of an embolic source affects outcome in CRAO. METHODS CRAO patients within 7 days of symptom onset were retrospectively enrolled. Clinical parameters, including initial and 1-month visual acuity, CRAO subtype, and brain images, were reviewed. CRAO etiology was categorized as CRAO with or without an embolic source (CRAO-E+ and CRAO-E-). Visual improvement was defined as a decrease in logarithm of the minimum angle of resolution ≥0.3 at 1 month. RESULTS A total of 114 patients with CRAO were included. Visual improvement was noted in 40.4% of patients. Embolic sources were identified in 55.3% of patients, and visual improvement group rather than no improvement group was more commonly associated with the presence of an embolic source. In multivariable logistic regression analysis, CRAO-E+ independently predicted visual improvement (odds ratio 3.00, 95% CI 1.15-7.81, p = 0.025). DISCUSSION CRAO-E+ was found to be associated with a better outcome. CRAO-E+ may be more prone to recanalization than that CRAO-E-.
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Affiliation(s)
- Dong-Wan Kang
- From the Department of Neurology (D.-W.K., K.-H.J., W.Y., Y.K., M.C., J.H., M.T.P., E.-J.L., H.-Y.J., J.-M.K., S.-B.K., S.-H.L.), Seoul National University Hospital & Seoul National University College of Medicine; Headquarters for Public Health Care (D.-W.K.), Seoul National University Bundang Hospital, Seongnam; Department of Ophthalmology (H.M.K.), Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Clinical Neurosciences (M.T.P.), University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines; and Korean Cerebrovascular Research Institute (J.-M.K., S.-H.L.), Seoul, South Korea
| | - Keun-Hwa Jung
- From the Department of Neurology (D.-W.K., K.-H.J., W.Y., Y.K., M.C., J.H., M.T.P., E.-J.L., H.-Y.J., J.-M.K., S.-B.K., S.-H.L.), Seoul National University Hospital & Seoul National University College of Medicine; Headquarters for Public Health Care (D.-W.K.), Seoul National University Bundang Hospital, Seongnam; Department of Ophthalmology (H.M.K.), Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Clinical Neurosciences (M.T.P.), University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines; and Korean Cerebrovascular Research Institute (J.-M.K., S.-H.L.), Seoul, South Korea.
| | - Wookjin Yang
- From the Department of Neurology (D.-W.K., K.-H.J., W.Y., Y.K., M.C., J.H., M.T.P., E.-J.L., H.-Y.J., J.-M.K., S.-B.K., S.-H.L.), Seoul National University Hospital & Seoul National University College of Medicine; Headquarters for Public Health Care (D.-W.K.), Seoul National University Bundang Hospital, Seongnam; Department of Ophthalmology (H.M.K.), Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Clinical Neurosciences (M.T.P.), University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines; and Korean Cerebrovascular Research Institute (J.-M.K., S.-H.L.), Seoul, South Korea
| | - Hyeong Min Kim
- From the Department of Neurology (D.-W.K., K.-H.J., W.Y., Y.K., M.C., J.H., M.T.P., E.-J.L., H.-Y.J., J.-M.K., S.-B.K., S.-H.L.), Seoul National University Hospital & Seoul National University College of Medicine; Headquarters for Public Health Care (D.-W.K.), Seoul National University Bundang Hospital, Seongnam; Department of Ophthalmology (H.M.K.), Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Clinical Neurosciences (M.T.P.), University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines; and Korean Cerebrovascular Research Institute (J.-M.K., S.-H.L.), Seoul, South Korea
| | - Youngjoon Kim
- From the Department of Neurology (D.-W.K., K.-H.J., W.Y., Y.K., M.C., J.H., M.T.P., E.-J.L., H.-Y.J., J.-M.K., S.-B.K., S.-H.L.), Seoul National University Hospital & Seoul National University College of Medicine; Headquarters for Public Health Care (D.-W.K.), Seoul National University Bundang Hospital, Seongnam; Department of Ophthalmology (H.M.K.), Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Clinical Neurosciences (M.T.P.), University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines; and Korean Cerebrovascular Research Institute (J.-M.K., S.-H.L.), Seoul, South Korea
| | - Matthew Chung
- From the Department of Neurology (D.-W.K., K.-H.J., W.Y., Y.K., M.C., J.H., M.T.P., E.-J.L., H.-Y.J., J.-M.K., S.-B.K., S.-H.L.), Seoul National University Hospital & Seoul National University College of Medicine; Headquarters for Public Health Care (D.-W.K.), Seoul National University Bundang Hospital, Seongnam; Department of Ophthalmology (H.M.K.), Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Clinical Neurosciences (M.T.P.), University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines; and Korean Cerebrovascular Research Institute (J.-M.K., S.-H.L.), Seoul, South Korea
| | - Jiyeon Ha
- From the Department of Neurology (D.-W.K., K.-H.J., W.Y., Y.K., M.C., J.H., M.T.P., E.-J.L., H.-Y.J., J.-M.K., S.-B.K., S.-H.L.), Seoul National University Hospital & Seoul National University College of Medicine; Headquarters for Public Health Care (D.-W.K.), Seoul National University Bundang Hospital, Seongnam; Department of Ophthalmology (H.M.K.), Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Clinical Neurosciences (M.T.P.), University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines; and Korean Cerebrovascular Research Institute (J.-M.K., S.-H.L.), Seoul, South Korea
| | - Monique Therese Punsalan
- From the Department of Neurology (D.-W.K., K.-H.J., W.Y., Y.K., M.C., J.H., M.T.P., E.-J.L., H.-Y.J., J.-M.K., S.-B.K., S.-H.L.), Seoul National University Hospital & Seoul National University College of Medicine; Headquarters for Public Health Care (D.-W.K.), Seoul National University Bundang Hospital, Seongnam; Department of Ophthalmology (H.M.K.), Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Clinical Neurosciences (M.T.P.), University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines; and Korean Cerebrovascular Research Institute (J.-M.K., S.-H.L.), Seoul, South Korea
| | - Eung-Joon Lee
- From the Department of Neurology (D.-W.K., K.-H.J., W.Y., Y.K., M.C., J.H., M.T.P., E.-J.L., H.-Y.J., J.-M.K., S.-B.K., S.-H.L.), Seoul National University Hospital & Seoul National University College of Medicine; Headquarters for Public Health Care (D.-W.K.), Seoul National University Bundang Hospital, Seongnam; Department of Ophthalmology (H.M.K.), Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Clinical Neurosciences (M.T.P.), University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines; and Korean Cerebrovascular Research Institute (J.-M.K., S.-H.L.), Seoul, South Korea.
| | - Han-Yeong Jeong
- From the Department of Neurology (D.-W.K., K.-H.J., W.Y., Y.K., M.C., J.H., M.T.P., E.-J.L., H.-Y.J., J.-M.K., S.-B.K., S.-H.L.), Seoul National University Hospital & Seoul National University College of Medicine; Headquarters for Public Health Care (D.-W.K.), Seoul National University Bundang Hospital, Seongnam; Department of Ophthalmology (H.M.K.), Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Clinical Neurosciences (M.T.P.), University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines; and Korean Cerebrovascular Research Institute (J.-M.K., S.-H.L.), Seoul, South Korea
| | - Jeong-Min Kim
- From the Department of Neurology (D.-W.K., K.-H.J., W.Y., Y.K., M.C., J.H., M.T.P., E.-J.L., H.-Y.J., J.-M.K., S.-B.K., S.-H.L.), Seoul National University Hospital & Seoul National University College of Medicine; Headquarters for Public Health Care (D.-W.K.), Seoul National University Bundang Hospital, Seongnam; Department of Ophthalmology (H.M.K.), Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Clinical Neurosciences (M.T.P.), University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines; and Korean Cerebrovascular Research Institute (J.-M.K., S.-H.L.), Seoul, South Korea
| | - Sang-Bae Ko
- From the Department of Neurology (D.-W.K., K.-H.J., W.Y., Y.K., M.C., J.H., M.T.P., E.-J.L., H.-Y.J., J.-M.K., S.-B.K., S.-H.L.), Seoul National University Hospital & Seoul National University College of Medicine; Headquarters for Public Health Care (D.-W.K.), Seoul National University Bundang Hospital, Seongnam; Department of Ophthalmology (H.M.K.), Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Clinical Neurosciences (M.T.P.), University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines; and Korean Cerebrovascular Research Institute (J.-M.K., S.-H.L.), Seoul, South Korea
| | - Seung-Hoon Lee
- From the Department of Neurology (D.-W.K., K.-H.J., W.Y., Y.K., M.C., J.H., M.T.P., E.-J.L., H.-Y.J., J.-M.K., S.-B.K., S.-H.L.), Seoul National University Hospital & Seoul National University College of Medicine; Headquarters for Public Health Care (D.-W.K.), Seoul National University Bundang Hospital, Seongnam; Department of Ophthalmology (H.M.K.), Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Clinical Neurosciences (M.T.P.), University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines; and Korean Cerebrovascular Research Institute (J.-M.K., S.-H.L.), Seoul, South Korea.
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Mangla R, Venkatesh R, Sangoram R, Acharya I, Parmar Y, Prabhu V, Yadav NK, Chhablani J. Retinal OCT findings in acute central retinal artery occlusion of varying severity at different disease stages - a retrospective, observational study. Int J Retina Vitreous 2023; 9:37. [PMID: 37349781 DOI: 10.1186/s40942-023-00475-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/11/2023] [Indexed: 06/24/2023] Open
Abstract
PURPOSE To study the optical coherence tomography (OCT) changes in eyes with acute central retinal artery occlusion (CRAO) of different severity and at different disease stages. METHODS The study included acute CRAO cases of < 7 days duration, imaged on OCT at various time points. Based on the OCT findings at presentation, cases were classified into three severity groups: mild, moderate, and severe. OCT scans were evaluated and classified into four-time intervals based on symptom duration. RESULTS There were 39 eyes from 38 patients with acute CRAO who underwent 96 OCT scans. At presentation, the study had 11, 16, and 12 cases of mild, moderate, and severe CRAO, respectively. Middle retinal layer opacification was more common in mild CRAO cases, which caused inner retinal layer thinning over time. Moderate CRAO cases had total inner retinal layer opacification, which resulted in retinal thinning over time. Prominent middle limiting membrane (p-MLM) sign was seen in mild and moderate CRAO eyes while were not visualised in severe CRAO. This sign gradually faded out over time. Other OCT findings in higher grades of CRAO included inner retinal fluid, neurosensory detachment, internal limiting membrane detachment, hyperreflective foci, and posterior vitreous opacities. Regardless of the CRAO grade, the final end-point seen was inner retinal layer thinning over time. CONCLUSION OCT in CRAO is a useful for determining the severity of retinal ischemia, disease stage, tissue damage mechanism, and final visual outcome. More prospective studies analysing a larger number of cases at fixed time points will be required in the future. TRIAL REGISTRATION Trial Registration Number: Not applicable.
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Affiliation(s)
- Rubble Mangla
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, 560010, Bengaluru, Karnataka, India
| | - Ramesh Venkatesh
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, 560010, Bengaluru, Karnataka, India.
| | - Rohini Sangoram
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, 560010, Bengaluru, Karnataka, India
| | - Isha Acharya
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, 560010, Bengaluru, Karnataka, India
| | - Yash Parmar
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, 560010, Bengaluru, Karnataka, India
| | - Vishma Prabhu
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, 560010, Bengaluru, Karnataka, India
| | - Naresh Kumar Yadav
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, 560010, Bengaluru, Karnataka, India
| | - Jay Chhablani
- Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, 203 Lothrop Street, Suite 800, Pittsburg, PA, 15213, USA
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