Korean J Ophthalmol.  2018 Aug;32(4):303-311. 10.3341/kjo.2017.0093.

Optical Coherence Tomography Measurement and Visual Outcome in Acute Central Retinal Artery Occlusion

• Kim H
• Kim HK
• Yang JY
• Kim SS

• KMID: 2418151
• DOI: http://doi.org/10.3341/kjo.2017.0093

Abstract

PURPOSE
This study investigated visual acuity (VA) values and differences depending on optical coherence tomography (OCT) findings in patients with acute central retinal artery occlusion (CRAO).
METHODS
A retrospective chart review was performed on patients with acute CRAO who underwent macular and disc OCT. We evaluated changes in macular thickness and retinal nerve fiber layer (RNFL) thickness after acute CRAO onset based on OCT. We also determined the association of thickness changes with VA improvement.
RESULTS
This study involved both eyes in a total of 12 patients with acute CRAO. A significant increase was observed in foveal (1 mm) thickness (p = 0.002), parafoveal (3 mm) thickness (p = 0.002), and peripapillary RNFL thickness (p = 0.005) in affected eyes with CRAO, but not in central foveal thickness (p = 0.266). A significant small difference in both eyes (affected eye - fellow eye) was shown in foveal (1 mm) and mean parafoveal (3 mm) thickness in the improved VA group (p = 0.008 and p = 0.004, respectively), but not in central foveal or peripapillary RNFL thickness (both p = 0.283).
CONCLUSIONS
Both macular and RNFL thickness increased in patients with acute CRAO. RNFL thickness decreased over time with progression of RNFL atrophy. Less macular damage caused by acute CRAO could be predicted by a small difference in macular thickness between eyes (affected eye - fellow eye). In such cases, patients had a greater chance of VA improvement.

Keyword

Macular thickness; Optical coherence tomography; Retinal artery occlusion; Retinal nerve fiber layer thickness; Vision outcome

MeSH Terms

Atrophy
Humans
Nerve Fibers
Retinal Artery Occlusion*
Retinal Artery*
Retinaldehyde
Retrospective Studies
Tomography, Optical Coherence*
Visual Acuity
Retinaldehyde

Figure

• 

  Fig. 1 Fundus angiography and optical coherence tomography of central retinal artery occlusion patient at initial visit (patient 1). Fundus angiography and optical coherence tomography scans taken at initial visit in patient 1 with central retinal artery occlusion. (A) shows disc leakage in the affected eye (the right eye) 10 minutes after fundus angiography. (B) shows macular thickness, and (C) represents the graph of measurements, indicating an increase of macular thickness on the affected side. (D) shows scan images of peripapillary retinal nerve fiber layer thickness, and (E) represents the graph of thickness values, revealing a thick retinal nerve fiber layer thickness in the affected eye compared with the fellow eye.

• 

  Fig. 2 Changes in retinal nerve fiber layer (RNFL) thickness in the affected eye with central retinal artery occlusion (CRAO) (patient 4). Optical coherence tomography scans taken over time in Patient 4 with CRAO. (A), (B), and (C) are peripapillary cross-sectional images and (D), (E), and (F) are schematic graphs of RNFL thickness. (A) and (D) are images taken at the initial visit (1 day after CRAO attack), (B) and (E) are images taken 2 months after onset, and (C) and (F) are peripapillary RNFL optical coherence tomography images and thickness assessed 6 months after onset, revealing a reduction in RNFL thickness over time after CRAO attack.

Reference

1. Sharma S, Brown GC. Retinal artery obstruction. In : Ryan SJ, editor. Retina. St. Louis: Mosby;2001. p. 1350–1367.

2. Hollenhorst RW. Significance of bright plaques in the retinal arterioles. JAMA. 1961; 178:23–29. PMID: 13908419.

3. Rim TH, Han J, Choi YS, et al. Retinal artery occlusion and the risk of stroke development: twelve-year nationwide cohort study. Stroke. 2016; 47:376–382. PMID: 26742801.

4. Ahn SJ, Woo SJ, Park KH, et al. Retinal and choroidal changes and visual outcome in central retinal artery occlusion: an optical coherence tomography study. Am J Ophthalmol. 2015; 159:667–676. PMID: 25579642.

5. Chen H, Xia H, Qiu Z, et al. Correlation of optical intensity on optical coherence tomography and visual outcome in central retinal artery occlusion. Retina. 2016; 36:1964–1970. PMID: 26966866.

6. Chen SN, Hwang JF, Chen YT. Macular thickness measurements in central retinal artery occlusion by optical coherence tomography. Retina. 2011; 31:730–737. PMID: 21242861.

7. Yu S, Pang CE, Gong Y, et al. The spectrum of superficial and deep capillary ischemia in retinal artery occlusion. Am J Ophthalmol. 2015; 159:53–63. PMID: 25244976.

8. Shinoda K, Yamada K, Matsumoto CS, et al. Changes in retinal thickness are correlated with alterations of electroretinogram in eyes with central retinal artery occlusion. Graefes Arch Clin Exp Ophthalmol. 2008; 246:949–954. PMID: 18425524.

9. Schmidt DP, Schulte-Monting J, Schumacher M. Prognosis of central retinal artery occlusion: local intraarterial fibrinolysis versus conservative treatment. AJNR Am J Neuroradiol. 2002; 23:1301–1307. PMID: 12223369.

10. Hayreh SS, Zimmerman MB. Fundus changes in central retinal artery occlusion. Retina. 2007; 27:276–289. PMID: 17460582.

11. Hayreh SS. Acute retinal arterial occlusive disorders. Prog Retin Eye Res. 2011; 30:359–394. PMID: 21620994.

12. Rumelt S, Brown GC. Update on treatment of retinal arterial occlusions. Curr Opin Ophthalmol. 2003; 14:139–141. PMID: 12777932.

13. Cugati S, Varma DD, Chen CS, Lee AW. Treatment options for central retinal artery occlusion. Curr Treat Options Neurol. 2013; 15:63–77. PMID: 23070637.

14. Ahn SJ, Kim JM, Hong JH, et al. Efficacy and safety of intra-arterial thrombolysis in central retinal artery occlusion. Invest Ophthalmol Vis Sci. 2013; 54:7746–7755. PMID: 24176901.

15. Hattenbach LO, Kuhli-Hattenbach C, Scharrer I, Baatz H. Intravenous thrombolysis with low-dose recombinant tissue plasminogen activator in central retinal artery occlusion. Am J Ophthalmol. 2008; 146:700–706. PMID: 18718570.

16. Chen CS, Lee AW, Campbell B, et al. Efficacy of intravenous tissue-type plasminogen activator in central retinal artery occlusion: report from a randomized, controlled trial. Stroke. 2011; 42:2229–2234. PMID: 21757667.

17. Schumacher M, Schmidt D, Jurklies B, et al. Central retinal artery occlusion: local intra-arterial fibrinolysis versus conservative treatment, a multicenter randomized trial. Ophthalmology. 2010; 117:1367–1375. PMID: 20609991.

18. Schrag M, Youn T, Schindler J, et al. Intravenous fibrinolytic therapy in central retinal artery occlusion: a patient-level meta-analysis. JAMA Neurol. 2015; 72:1148–1154. PMID: 26258861.

19. Ikeda F, Kishi S. Inner neural retina loss in central retinal artery occlusion. Jpn J Ophthalmol. 2010; 54:423–429. PMID: 21052904.

20. Klein R, Klein BE, Moss SE, Meuer SM. Retinal emboli and cardiovascular disease: the Beaver Dam Eye Study. Arch Ophthalmol. 2003; 121:1446–1451. PMID: 14557181.

21. Hayreh SS. Blood supply of the optic nerve head. Ophthalmologica. 1996; 210:285–295. PMID: 8878212.