A middle hyper-reflective band on spectral domain optical coherence tomography in a case of acute nonarteritic central retinal artery occlusion with sparing of cilioretinal artery

Clinical Manifestations and Visual Prognosis of Cilioretinal Artery Sparing Central Retinal Artery Occlusion

Purpose

To investigate the clinical manifestations and prognosis of eyes with cilioretinal artery sparing central retinal artery occlusion (CRAO).

Methods

A retrospective study was conducted on 90 eyes diagnosed with complete CRAO, including 16 cases of cilioretinal artery sparing CRAO. Clinical features, visual outcome, papillomacular bundle involvement, and remnant visual field were analyzed according to cilioretinal artery sparing.

Results

Among eyes with complete CRAO, the proportion of cilioretinal artery sparing CRAO was 17.8% (16 / 90). Mean initial best-corrected visual acuities (BCVAs) (2.04 ± 0.69 vs. 2.34 ± 0.47, p = 0.039) and final BCVAs (1.65 ± 0.87 vs. 2.22 ± 0.84, p = 0.001) were significantly better in eyes of the cilioretinal artery sparing group than the non-sparing group. The proportion with poor visual outcome (final BCVA <20 / 200) was 81.3% in the cilioretinal artery sparing group and 97.3% in the non-sparing group (p = 0.01). In sub-group analysis within cilioretinal artery sparing CRAO eyes, ischemic involvement of the papillomacular bundle at disease onset was significantly more frequent in the poor vision group (BCVA <20 / 200, 12 / 13 [92.3%]) than in the good vision group (BCVA ≥20 / 200, 1 / 3 [33.3%], p = 0.016) and it was associated with preserved central visual field.

Conclusions

Although cilioretinal artery sparing is common in CRAO and has a better prognosis than complete CRAO, the visual outcome is generally poor and only a small proportion of eyes has preserved small central visual field. Ischemic injury of the papillomacular bundle at the acute stage of CRAO correlates with poor visual outcome and could be a prognostic sign.