Retinal Changes in Different Grades of Retinal Artery Occlusion: An Optical Coherence Tomography Study.

Purpose: To investigate layer-by-layer changes in retinal thickness and reflectivity regarding the severity grade of acute retinal artery occlusion (RAO) using spectral-domain optical coherence tomography (SD-OCT). Methods: This study is a retrospective, observational case-control series that took place in an institutional setting and included 148 eyes from 74 patients diagnosed with acute RAO (central or branch). SD-OCT examinations were taken at baseline. Based on OCT findings, RAO was categorized into three grades (incomplete, subtotal, total). The thickness and reflectivity of selected retinal layers were measured from SD-OCT images. The data were compared across the three grades and against the contralateral eyes (controls). The main outcome measures were thickness and reflectivity of selected retinal layers. Results: The thickness of the inner and middle retinal layers differed significantly across the three RAO groups (P < 0.001), whereas the outer retinal layer thickness remained not significantly different. Reflectivity values showed statistically significant differences in the inner, middle, and outer retinal layers, but not in the vitreous body (P < 0.001). Conclusions: The reflectivity changes of selected retinal layers differ significantly regarding different grades of RAO. SD-OCT reflectivity measurement may be used as a noninvasive method to estimate the grade of retinal ischemia in RAO.

Retinal and choroidal changes and visual outcome in central retinal artery occlusion: an optical coherence tomography study.

PURPOSE: To investigate the retinal and choroidal changes using spectral-domain optical coherence tomography (SD OCT) and to identify factors associated with visual outcome in eyes with central retinal artery occlusion (CRAO). DESIGN: Retrospective, observational case series. METHODS: setting: Institutional. PATIENTS: A total of 134 eyes diagnosed with acute (symptom onset ≤ 7 days) nonarteritic CRAO examined with SD OCT at baseline and follow-up visits. OBSERVATIONS: Based on funduscopic and angiographic findings, CRAO was categorized into 3 stages: incomplete, subtotal, and total. Abnormal morphologic features were evaluated from SD OCT images. Central macular thickness (CMT), inner and outer retinal thicknesses, and subfoveal choroidal thickness (SFCT) were measured. The clinical and SD OCT features were correlated with the final best-corrected visual acuities (BCVA). MAIN OUTCOME MEASURES: Retinal and choroidal thickness and BCVA. RESULTS: Features of SD OCT at the initial presentation included inner and outer retinal thickening. At baseline, the frequency of inner and outer retinal thickening and macular edema (CMT > 300 µm) differed significantly among CRAO stages (all P < .05). SFCT in eyes with total CRAO was significantly thinner compared with that of the contralateral eyes (P = .009). A higher CRAO stage was associated significantly with macular edema at baseline (P < .001) and retinal thinning at the final visit (P = .010). Baseline CMT was correlated significantly with final BCVA (P < .001). Multivariate logistic regression analyses revealed that severe vision loss (BCVA < 20/200) was associated significantly with CRAO stage (P < .001) and baseline CMT (P = .005). CONCLUSIONS: CRAO resulted in inner and outer retinal thickening in the acute stages and subsequent atrophic changes in the inner and outer retina. SD OCT may be a useful noninvasive imaging tool for diagnosis, staging, and prognosis of CRAO.

Central retinal artery occlusion: visual outcome.

PURPOSE: To investigate systematically the natural history of visual outcome in central retinal artery occlusion (CRAO). DESIGN: Cohort study. METHODS: At entry, 244 consecutive patients (260 eyes) with CRAO (seen consecutively from 1973 to 2000) had a detailed ocular and medical history and ocular evaluation. CRAO eyes were classified into four categories: non-arteritic (NA) CRAO (171 eyes), NA-CRAO with cilioretinal artery sparing (35), transient NA-CRAO (41), and arteritic CRAO (13). RESULTS: Within 7 days of onset of CRAO, initial visual acuity differed among the four CRAO types (P < .0001). In eyes with vision of counting fingers or worse, it improved in 82% of eyes with transient NA-CRAO, 67% of eyes with NA-CRAO with cilioretinal artery sparing, and 22% of eyes with NA-CRAO. Visual acuity improved primarily within the first 7 days (P < .0001). In the central 30-degree visual field, central scotoma was most common. Central visual field improved in 39% with transient NA-CRAO, 25% with NA-CRAO with cilioretinal artery sparing, and 21% with NA-CRAO. Peripheral visual field was normal in 62.9% of eyes with transient NA-CRAO and 22.1% in those with NA-CRAO. In 51.9% of eyes with NA-CRAO, the only remaining visual field was a peripheral island. Peripheral fields improved in NA-CRAO (39%) and in transient NA-CRAO (39%). CONCLUSIONS: Classification of CRAO is crucial for understanding differences in visual outcome. Marked improvement in visual acuity and visual field can occur without treatment and is determined by several factors. Visual field information is essential to evaluate visual disability in CRAO.