[COEXISTENCE OF ORBITAL VARICOSE VEIN AND THYROID ORBITOPATHY].

PURPOSE: To describe a thyroid orbitopathy patient who had asymmetric progression of exophthalmos due to orbital varicose vein. PATIENT: A 55-year-old patient with thyroid orbitopathy had asymmetric progression of exophthalmos without complaints over 4 years of follow-up. RESULTS: In repeated computerized tomography (CT) of the orbit, a dilation of the superior ophthalmic vein was noted on the more proptotic eye, in addition to bilateral excessive orbital fat. This finding was also confirmed on color Doppler imaging in valsalva manoeuver. CONCLUSIONS: In patients with thyroid orbitopathy who have atypical progression course of their exophthalmos, repeated orbital CT scan is advocated to rule out other concurrent orbital disorders such as varicose veins.

[Leber's idiopathic stellate neuroretinitis].

AIM: To report a rare case of swollen optic disc with hard exudates at the center of the retina (macula) with an unknown etiology (idiopathic). CASE REPORT: A 49 years old male complained of blurred vision in his left eye. He reported that ten years earlier a similar episode occurred in the right eye. Upon resolution of the macular edema we recognized hard exudates with a macular star pattern. After six months his central vision returned to normal with mild to moderate defects in his lower visual field. IN SUMMARY: The literature describes various etiologies that have been reported due to the rare presentation of the macular star In our case we did not find any clear etiology, therefore, the diagnosis of Leber's idiopathic stellate neuroretinitis can be presumed.

Efficacy comparison between povidone iodine 2.5% and tetracycline 1% in prevention of ophthalmia neonatorum.

PURPOSE: To evaluate the efficacy of povidone iodine solution 2.5% and tetracycline ointment 1% in prevention of ophthalmia neonatorum (ON). DESIGN: Prospective, randomized, controlled observational study. PARTICIPANTS: Three-hundred ninety-four full-term neonates. METHODS: A randomized comparison between 201 neonates randomly treated with povidone iodine 2.5% solution and 193 treated with tetracycline 1% ointment. MAIN OUTCOMES MEASURES: Incidence of ON. RESULTS: The incidence of ON was significantly higher after povidone iodine than tetracycline prophylaxis (15.4% and 5.2% respectively; P = 0.001). Noninfective ON developed in 10 (5%) of the 201 neonates treated with povidone iodine and in none (0%) of the neonates treated with tetracycline (P = .002). Infective ON was detected in 21 (10.4%) of the neonates treated with povidone iodine and in 10 (5.2%) after treatment with tetracycline (P = .052). Ophthalmia neonatorum appeared more commonly in the first 3 days after treatment with povidone iodine (P = .043). The spectrum of the infective isolates was similar in the 2 groups. CONCLUSIONS: Povidone iodine was associated with noninfective (sterile) conjunctivitis, probably because of its toxicity to the ocular surface in neonates. Tetracycline was marginally more effective against infective ON. For these reasons, tetracycline, rather than povidone iodine, is recommended for prevention of ON.

The influence of surgery and intraocular lens implantation timing on visual outcome in traumatic cataract.

PURPOSE: To compare the visual outcome of primary versus secondary traumatic cataract extraction and primary versus secondary intraocular lens (IOL) implantation. METHODS: The medical charts of consecutive patients who developed cataract following open and closed-globe injuries and were referred to our institute were reviewed. The best-corrected visual acuity of the patients who underwent primary and secondary cataract extraction and those with primary and secondary IOL implantation was assessed at presentation and at the end of the follow-up. PARTICIPANTS: Sixty-nine eyes of 69 patients developed cataract after being involved in ocular trauma. Forty-five eyes had open-globe injury and 24 had closed-globe injury. The right eye was involved in 26 injuries and the left in 43. RESULTS: Best-corrected visual acuity (BCVA) of 20/40 or better was not statistically associated with the type of cataract extraction (extracapsular versus phacoemulsification) (in open-globe injury p = 0.181 and in all p = 0.662) and placement of anterior or posterior IOL (in open-globe injury p = 0.196 and in all p = 0.114). The timing of surgery (as immediate surgery or later as a second surgery) and the timing of intraocular lens implantation (during the extraction of the cataract or later in a secondary procedure) were not statistically associated with BCVA of 20/40 or better (in open-globe injury p = 0.322 and 0.381 in all p = 0.460 and 0.450, respectively). Irreversible amblyopia in children was a statistically significant factor for this visual acuity both in patients with open-globe injury (p = 0.036) and in all patients (p < 0.001). CONCLUSIONS: In traumatic cataract, the visual outcome did not differ between primary and secondary cataract extraction and between primary and secondary IOL implantation in adults. In the amblyogenic age, primary surgery with IOL implantation should be preferred.

The spectrum of iatrogenic intraocular injuries caused by inadvertent cannula release during anterior segment surgery.

OBJECTIVE: To evaluate the causes of inadvertent intraocular injuries resulting from the use of cannulas during anterior segment surgery. Method Retrospective review of all cases with inadvertent release of irrigation and viscoelastic cannulas during anterior segment surgery in 15 years. RESULTS: Inadvertent release of cannulas occurred in 9 of 10 230 cases of anterior segment surgery during a 15-year period. The incidence of cannula release was 0.88 per 1000 procedures per year. Twenty percent of the surgeons who performed anterior segment surgery in this period were involved in this unfortunate event. Six cases occurred during cataract extraction and 3 during penetrating keratoplasty or replacement of corneal graft. The latter 3 cases included posterior capsule rupture and vitreous loss. Macular scar in 2 (22%) of the 9 cases was associated with poor visual outcome of counting fingers at 2.1 to 3.0 m (P = .03). In all other surgeries, the cannula caused iris or anterior chamber angle injury without consequences. CONCLUSIONS: Inadvertent release of cannulas during anterior segment surgery is a rare, memorable, and unfortunate event. The severity of the injury may be related to the type of the surgical wound. In most cases, visual outcome is not compromised unless the cannula causes retinal disruption.

Intraoperative enoxaparin minimizes inflammatory reaction after pediatric cataract surgery.

PURPOSE: To evaluate the effect of intraocular infusion of enoxaparin, a low-molecular-weight heparin, on postoperative inflammatory response in pediatric cataract surgery. DESIGN: Prospective, comparative, consecutive interventional case series. METHODS: Seventeen consecutive eyes (11 patients) underwent pediatric cataract surgery in two tertiary medical centers. During the procedure, balanced salt solution with enoxaparin (40 mg in 500 ml) was infused into the anterior chamber. Eleven consecutive eyes (eight patients) received balanced salt solution without enoxaparin in the infusion bottle. The inflammatory response in the anterior chamber was compared between the two groups by semiquantification with slit-lamp biomicroscopy. Postoperative inflammatory complications, including fibrin formation, intraocular lens precipitates, anterior and posterior synechiae, cyclitic and pupillary membrane formation, and anterior subluxation of the intraocular lens, were also compared. The follow-up period after surgery was between 3 and 36 months (average 12.3 months). RESULTS: The number of cells and the degree of flare were minimal in the group with enoxaparin in the infusion bottle (P < .001). The total number of postoperative inflammation-related complications was also lower in the enoxaparin-treated group (P = .007). All corneas remained clear, and the endothelial cell count, which was performed in two patients, did not show substantial decrease in their density or changes in shape and size. No other enoxaparin-related complications were observed. CONCLUSIONS: Infusion of enoxaparin during pediatric cataract surgery may minimize the postoperative inflammatory response and decrease the number of postoperative inflammatory related complications. Enoxaparin should also be evaluated for cataract surgery in other conditions where postoperative inflammation may be exacerbated.

Posterior capsule opacity and choroidal neovascularization in patients with age-related macular degeneration.

BACKGROUND AND OBJECTIVE: To present a series of 3 patients with the dry form of age-related macular degeneration (AMD) in whom choroidal neovascularization (CNV) was observed following neodymium: yttrium-aluminum-garnet (Nd:YAG) capsulotomy. PATIENTS AND METHODS: Three consecutive patients aged 80 to 87 years (average = 83.7 years) with hard drusen or retinal pigment epithelial changes underwent uneventful cataract extraction between 6 months and 20 years before undergoing Nd:YAG capsulotomy for posterior capsule opacity. The patients were examined for retinal changes before laser treatment and at regular intervals after treatment. RESULTS: All patients developed CNV between 12 days and 1 month after capsulotomy that caused a decrease in the visual acuity from 20/20-20/40 to 20/200--counting fingers at 4 feet. The fellow eye did not show a substantial change in AMD over a year of follow-up. Two of the fellow eyes had disciform scar due to CNV before the cataract surgery, and these patients remained legally blind. CONCLUSIONS: The development of CNV after Nd:YAG capsulotomy suggests a temporal association between the two and calls for further study. Because posterior capsule opacity may mask CNV, patients with dry AMD and posterior capsule opacity who experience decreased visual acuity or glare may undergo indocyanine green angiography before it is decided to perform Nd:YAG capsulotomy.

Potential applications of optical coherence tomography in posterior segment trauma.

BACKGROUND AND OBJECTIVE: To describe potential clinical applications of optical coherence tomography (OCT) in diagnosis and surgical timing in eyes with posterior segment trauma. PATIENTS AND METHODS: In a noncomparative study, 7 consecutive patients who had open-globe or closed-globe injury and were found to have posterior abnormality that could also be detected by OCT are described. RESULTS: All patients had documented OCT abnormalities in the posterior segment. In one patient with a penetrating injury, two metal foreign bodies were located in the posterior segment, one in the vitreous compartment coupled with inflammatory reaction and localized posterior vitreous detachment and the other embedded in the retina. In a second patient with a penetrating injury, OCT revealed the appearance of posterior vitreous detachment 5 days after injury. A closed-globe injury in one patient resulted in anterior optic neuropathy, manifested as disc edema and thickening of the circumpapillary retinal nerve fiber layer. The other patients had received blunt trauma and were found to have either full-thickness macular holes (2 patients), retinal pigment epithelium detachment at the papillomacular bundle site (1 patient), or macular edema (1 patient). CONCLUSIONS: OCT may serve as an important adjunct imaging device in evaluation of injuries to the posterior segment, qualitatively and quantitatively. It has potential in diagnosing subtle key abnormalities and in follow-up of these injuries.

Orbital hydatid cyst manifested as expanding exophthalmos following blunt orbital trauma.

A 14-year-old boy suffered right blunt orbital trauma. X-ray revealed a compressed fracture of the right ethmoidal sinuses. Three months after the trauma, progressive, painless right proptosis developed. Ocular examination revealed a severe proptosis and pronounced down displacement of the right globe without signs of orbital inflammation. A well-demarcated, extraconal right orbital cystic mass was seen on computerized tomography scan. The cyst contents were aspirated and found to contain echinococcal scolices and "hydatid sand." Hypertonic saline was injected and the cyst was excised. Progressive proptosis after blunt orbital trauma in patients from endemic areas should be suspected of being an orbital hydatid cyst.

Optic disc traction syndrome associated with central retinal vein occlusion.

OBJECTIVE: To describe the association between ischemic central retinal vein occlusion (CRVO) and the development of optic disc (vitreopapillary) traction, as verified by optical coherence tomography (OCT). METHODS: In a prospective, noncomparative, observational patient series, 3 women aged 51 to 64 years developed an ischemic type of CRVO. One patient underwent cannulation of the central retinal vein with injection of a tissue plasminogen activator. In each eye, the contour of the optic nerve head could not be accurately detected because of overlying fibrous tissue. Each patient underwent OCT examination 6 to 10 months (average, 8.3 months) after the occlusive event. RESULTS: Optic disc traction was found by OCT in the 3 patients. In each, the disc was elevated, associated with either incomplete posterior vitreous detachment (2 eyes) or vitreopapillary fibrous membrane (1 eye). Secondary peripapillary retinal traction and macular or retinal detachment developed ("optic disc traction syndrome"). These findings were less marked, or not evident, on both clinical examination and ocular ultrasonography. CONCLUSIONS: Optic disc traction and secondary localized retinal detachment can develop after ischemic CRVO and may contribute to the poor visual acuity. This syndrome should merit special attention before surgery for CRVO is planned. The use of OCT was helpful to diagnose this syndrome.

Congenital eyelid imbrication syndrome.

PURPOSE: To describe congenital eyelid imbrication syndrome and its possible pathophysiology. DESIGN: Clinical observational case report. METHODS: A full-term newborn was examined after a vaginal delivery and uneventful pregnancy. RESULTS: The upper eyelids were overlapping the lower eyelids when the eyes were closed or when the newborn was asleep. The upper eyelids resumed normal position gradually over a week without causing any symptoms or residual sequelae. CONCLUSIONS: Eyelid imbrication syndrome is a rare cause of congenital eyelid malposition. It may be caused by inborn laxity of the upper medial and lateral canthal tendons that are tightened during the postnatal period, causing resolution of this condition.

Traumatic pediatric retinal detachment: a comparison between open and closed globe injuries.

PURPOSE: To compare retinal detachment as a result of open and closed globe trauma in a pediatric age group. DESIGN: Retrospective, comparative, consecutive, interventional case series study. SETTING: Tertiary referral medical center. PATIENTS AND METHODS: One-hundred thirty-eight (5.7%) of 2,408 retinal detachments that were treated at our facility between 1980 and 2000 occurred in children aged 18 years or younger. Of these, 37 eyes (26%, n = 36) had retinal detachment following open globe injury and 23 eyes (14%, n = 20) had retinal detachment following closed globe injury. Those were compared with regard to the retinal detachment characteristics, number, types and timing of surgeries, and the anatomic and functional surgical outcome. RESULTS: Similar incidence was found in the type of retinal detachment, number of tears, extent, macular attachment type, and timing of surgery. Anatomic surgical success was achieved in 16 eyes (46%) with open globe injury and in 13 eyes (65%) with closed globe injury. The improvement in visual acuity was limited and comparable in both groups (23% to 25%), and lower than the expected according to the Ocular Trauma Score (OTS). The only predictor for favorable visual outcome of > or =20/200 was preoperative macular attachment (P =.003, Fisher exact test). CONCLUSION: The type, extent, and severity of the retinal detachment were similar in both open and closed globe injuries, suggesting that the detachment is caused by secondary indirect impact of globe deformation. The anatomic and functional surgical outcome was guarded and similar, suggesting that further surgical innovation is required to improve the visual outcome in this age group.

Detachment of subfoveal choroidal neovascularization in age-related macular degeneration.

PURPOSE: To report the entity of partial detachment and folding of subfoveal choroidal neovascularization (CNV) in age-related macular degeneration (ARMD). DESIGN: Interventional case reports. METHODS: Review of the features of CNV detachment in two patients with CNV due to ARMD by contact lens slit-lamp biomicroscopy, fluorescein angiography, optical coherence tomography, and three-dimensional confocal scanning laser indocyanine green (ICG) angiography. RESULTS: One patient out of approximately 300 (0.5%) ARMD patients treated by photodynamic therapy (PDT) developed partial CNV detachment and folding 6 weeks after the second PDT treatment. Another patient out of approximately 100 (1.0%) ARMD patients treated by transpupillary thermotherapy (TTT) developed partial CNV detachment and folding 6 weeks after the second TTT treatment. The CNVs were large (2,500 microm to 4,500 microm) and located between the retina and the retinal pigment epithelium. In each, these findings were clearly visualized by slit-lamp biomicroscopy. Fluorescein angiography demonstrated an associated retinal pigment epithelium tear in one patient. Optical coherence tomography showed distinctive features and confocal scanning laser ICG further delineated the detached folded CNV. The best-corrected visual acuity improved in one patient from 20/80 to 20/40 and in the other from counting fingers at 6 feet to 20/200 after the CNV detachment. CONCLUSIONS: Partial CNV detachment and folding represent a unique, not previously reported, and possibly favorable outcome of PDT and TTT. The low energy and selectivity of these treatments may explain this phenomenon.

Risk factors for failure of simultaneous penetrating keratoplasty and cataract extraction.

OBJECTIVE: To evaluate the indications, complications, and outcomes of simultaneous cataract extraction and penetrating keratoplasty (PKP) and the risk factors for failure of the procedure. SETTING: Tertiary referral medical center. METHODS: In a retrospective noncomparative interventional case series, the charts of 66 consecutive patients (70 eyes) who had simultaneous PKP and cataract extraction using the same surgical technique were reviewed. RESULTS: The mean follow-up was 32.4 months (range 6 to 125 months). The primary corneal graft remained clear in 48 eyes (69%) and failed in 22 eyes (31%). Sixteen eyes with a failed graft (73%) had 1 or 2 repeat keratoplasties; 8 (50%) were successful. At the end of follow-up, 56 eyes (80%) had a clear corneal graft. Nine eyes (41%) with a failed primary graft and 2 eyes (4%) with a clear primary graft had intracapsular cataract extraction (P<.001); 13 eyes (59%) and 46 eyes (96%), respectively, had extracapsular cataract extraction (P<.001). All eyes with a failed primary graft and 18 eyes (37%) with a clear primary graft had postoperative complications (P<.001). Eyes with a failed graft had more postoperative surgical interventions (P<.001). There were no statistical differences between eyes with clear grafts and eyes with failed grafts in sex, age, indications for surgery, corneal graft diameter, intraoperative vitreous loss, and intraocular lens placement. CONCLUSIONS: Intracapsular cataract extraction, postoperative complications, and postoperative surgical interventions may increase the risk for graft failure in simultaneous cataract extraction and PKP. Intraocular lens implantation did not increase the risk for graft failure.

Central retinal artery occlusion after peribulbar anesthesia.

We describe the development of central retinal artery occlusion (CRAO) in 2 patients after peribulbar (periconal) anesthesia during uneventful phacoemulsification. Although peribulbar anesthesia avoids direct optic-nerve injury, indirect injury presenting as CRAO may occur from vasospasm in response to the injection.

Secondary gelatinous-like keratopathy in corneal graft.

PURPOSE: To describe the appearance of gelatinous-like keratopathy in a corneal graft. METHODS: A 42-year-old healthy white man underwent phacoemulsification and placement of a posterior chamber intraocular lens. After the procedure, he developed pseudophakic bullous keratopathy and underwent 2 subsequent corneal transplantations because of failure of the primary corneal graft. RESULTS: Over 14 months after the second transplantation, a flower-like gelatinous keratopathy appeared in the corneal transplant. The patient underwent superficial keratectomy, removal of the continuous suture, topical application of nitomycin C, and placement of therapeutic contact lens until reepithelialization. The condition did not recur in a follow-up of 6 months. Histologically, hyperplastic epithelium, subepithelial fibrosis, and hyaline material were noted. CONCLUSION: Secondary gelatinous-like keratopathy may rarely affect corneal grafts causing a decrease in visual acuity. It may be a rare pathologic response to chronic pathophysiologic stress. Superficial keratectomy and application of topical mitomycin C with careful follow-up of the corneal graft may improve the visual outcome.

The prevalence and risk factors for donor corneal button contamination and its association with ocular infection after transplantation.

BACKGROUND: One of the most serious complications of corneal transplantation is postoperative ocular infection, which may result in loss of the eye. Contamination of the donor corneal button before transplantation may result in such complication. PURPOSE: To evaluate the prevalence of donor corneal button contamination, the spectrum of the contaminating microorganisms, and their sensitivity to antimicrobial agents. To investigate the risk factors for contamination of the donor corneal buttons and the effect of corneal button contamination on the prevalence of ocular infection in corneal transplanted patients. SETTING: Tertiary referral medical center. MATERIALS AND METHODS: Four hundred sixty-nine corneal transplantations were included in the study. Microbial cultures from the corneoscleral rims of the donor corneal buttons were obtained for isolation of bacteria and fungi and for their sensitivity to antimicrobial agents. Ocular microbial cultures were also obtained from corneal transplanted patients with clinical signs of ocular infection (ie, corneal scrapes from corneal ulcers and vitreous tap from eyes with endophthalmitis). RESULTS: Seventy-nine donor corneal buttons (16.8%) had positive bacterial cultures, and none had positive fungal culture. Staphylococci (63.7%) and streptococci (11.3%) were the most common isolated bacteria. Sensitivity to vancomycin, amikacin, and gentamicin was found in 71.3%, 28.5%, and 22.3% of all isolated bacteria, respectively. Malignancy and cardiac diseases as causes of donor death were associated with donor button contamination (P = 0.043 and P = 0.011, respectively), and septicemia was a marginally significant risk factor (P = 0.059). Age and gender of the donor, duration from death to corneal button harvesting, and time from harvesting to transplantation were not found significant risk factors for contamination. Six of the corneal transplanted patients (1.27%) had infected corneal graft ulcer, and 1 (0.22%) had endophthalmitis. The infected corneal ulcer appeared between 3 and 14 days (average 5 days), and endophthalmitis was disclosed 8 months after transplantation. Two (33%) of the 6 patients with corneal ulcer had the same species as the donor corneal rim. Postoperative ocular infection occurred in 2 (2.5%) patients out of 79 who received contaminated corneal buttons compared with 5 (1.3%) out of 390 patients who received sterile corneal buttons (P = 0.335). CONCLUSIONS: Postkeratoplasty infection of the recipient eye is infrequent despite relatively high prevalence of microbial contamination of the corneal buttons, suggesting that other risk factors for postoperative ocular infection are involved.

Preexisting and postoperative glaucoma in repeated corneal transplantation.

PURPOSE: To evaluate the incidence, risk factors, management, and visual outcome of postoperative glaucoma in comparison with preexisting glaucoma in repeated corneal transplantation. METHODS: The charts of all the patients who underwent repeated corneal transplantation between 1985 and 1998 were reviewed for the occurrence of preexisting and postoperative glaucoma. Eighty patients underwent 122 repeated corneal transplantations, of which six underwent surgery in both eyes. The mean follow-up period from the primary keratoplasty was 89.5 months and the minimal follow-up period was at least 6 months after the last transplantation. RESULTS: Postoperative glaucoma affected 29 eyes (34%) in 28 patients (35%) with repeated corneal transplantation. Herpetic scar as an indication for transplantation and a history of previous immune graft rejection were more common in patients who developed postoperative glaucoma compared with the entire regrafted group ( p= 0.016 and p< 0.001, respectively). The incidence of glaucoma usually increased with the increased number of keratoplasties. The following types of glaucoma were disclosed: closed angle (59%), corticosteroid induced (21%), open angle (11%), angle recession (3%), aqueous misdirection (3%), and unknown cause (3%). Surgical intervention was required in 62%. Glaucoma was controlled in nine eyes (31%) and resolved following regrafting or discontinuation of corticosteroids in four eyes (14%), of which five (17%) had clear regrafts. Better intraocular pressure control was achieved in those cases that did not require surgical intervention ( p= 0.019). In 15 eyes (52%), regrafts failed due to uncontrolled glaucoma and/or other causes. At the end of the follow-up period, visual acuity was 20/30 to 20/200 in 17%, counting fingers from less than 20 ft in 31%, hand movement/light perception in 35%, and no light perception in 17%. Six of the 86 eyes (7%) in six patients (7.5%) had preexisting glaucoma. Graft clarity and glaucoma control in patients with preexisting glaucoma were similar to those of postkeratoplasty glaucoma (50% had controlled glaucoma and 33% had clear regraft). CONCLUSIONS: Glaucoma, either preexisting or postoperative, is one of the most devastating complications of repeated corneal transplantation and the cause for regraft failure and visual loss even when intensively treated. Close monitoring and early targeted therapy are warranted to increase the survival of repeated corneal transplants in eyes affected by glaucoma.

Visual functions following recovery from non-arteritic central retinal artery occlusion.

BACKGROUND AND OBJECTIVE: Visual acuity and other visual functions may improve following treatment of central retinal artery occlusion (CRAO). A prospective, noncomparative case series study was conducted to investigate patients' visual functions after treatment of non-arteritic CRAO. PATIENTS AND METHODS: Eight consecutive patients whose visual acuity improved following successful systematic treatment protocol for non-arteritic CRAO of less than 48 hours (one of them with patent cilioretinal artery) were evaluated for visual functions. The visual acuity in seven patients ranged from no light perception to counting fingers at 3 feet on presentation and improved to 20/100 to 20/20 following treatment. The visual tests included: blue-yellow (Farnsworth D-15) and green-red (pseudoisochromatic Ishihara color plates) color discrimination, contrast sensitivity, and visual fields. The patients were also evaluated for subjective daily function following treatment. All tests were also performed in the fellow uninvolved eye as a control. RESULTS: The visual acuity following treatment improved from no light perception to counting fingers at 3 feet to an average of 20/65 (range, 20/20 to 20/100). Despite this improvement, six patients had dyschromatopsia to blue, green, or red whereas only two patients with a final visual acuity of 20/20 preserved their full color discrimination. All patients had decreased contrast sensitivity at mid-spatial frequency (6 cycles/min) or a more generalized decrease and visual field defects. All of the patients except one were satisfied with the visual outcome and daily function after treatment. CONCLUSION: Despite improvement in visual acuity after treatment for CRAO, all patients had residual visual function abnormalities. These abnormalities may be attributed to partial recanalization, conversion of CRAO to multiple branch retinal artery occlusions, or different retinal susceptibility for ischemia.