Abstract
Central retinal artery occlusion (CRAO) is a form of acute ischemic stroke which affects
the retina. Intravenous thrombolysis is emerging as a compelling therapeutic approach.
However, it is not known which patients may benefit from this therapy because there
are no imaging modalities that adequately distinguish viable retina from irreversibly
infarcted retina. The inner retina receives arterial supply from the central retinal
artery and there is robust collateralization between this circulation and the outer
retinal circulation, provided by the posterior ciliary circulation. Fundus photography
can show canonical changes associated with CRAO including a cherry-red spot, arteriolar
boxcarring and retinal pallor. Fluorescein angiography provides 2-dimensional imaging
of the retinal circulation and can distinguish a complete from a partial CRAO as well
as central versus peripheral retinal non-perfusion. Transorbital ultrasonography may
assay flow through the central retinal artery and is useful in the exclusion of other
orbital pathology that can mimic CRAO. Optical coherence tomography provides structural
information on the different layers of the retina and exploratory work has described
its utility in determining the time since onset of ischemia. Two experimental techniques
are discussed. 1) Retinal functional imaging permits generation of capillary perfusion
maps and can assay retinal oxygenation and blood flow velocity. 2) Photoacoustic imaging
combines the principles of optical excitation and ultrasonic detection and - in animal
studies - has been used to determine the retinal oxygen metabolic rate. Future techniques
to determine retinal viability in clinical practice will require rapid, easily used,
and reproducible methods that can be deployed in the emergency setting.
Key Words
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Article info
Publication history
Published online: May 17, 2021
Accepted:
April 8,
2021
Received in revised form:
April 6,
2021
Received:
March 1,
2021
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.105828
Copyright
© 2021 Elsevier Inc. All rights reserved.
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- Response by Mac Grory et al. to Letter regarding “Structural and Functional Imaging of the Retina in Central Retinal Artery Occlusion – Current Approaches and Future Directions”Journal of Stroke and Cerebrovascular DiseasesVol. 30Issue 10
- PreviewWe wish to thank Drs. Tuuminen, Achiron and Kanclerz for the interest in our paper and for the opportunity to address several entrenched misconceptions about the treatment of central retinal artery occlusion (CRAO). In 2015, Schrag et al.1 published a subject level meta-analysis concerning visual outcomes in patients with CRAO who were untreated, treated with thrombolysis or treated with a variety of conservative therapies (anterior chamber paracentesis, ocular massage and/or hemodilution). An important innovation in this work was the use of a simple, reproducible definition of visual recovery as the attainment of a final visual acuity of ≥20/100 in the affected eye.
- Full-Text
- Preview
- Controversies on the Recommended Treatment for Central Retinal Artery OcclusionJournal of Stroke and Cerebrovascular DiseasesVol. 30Issue 10
- PreviewIn a recent article, Mac Grory et al.1 described the structural and functional retinal imaging modalities in central retinal artery occlusion (CRAO). They have also suggested that thrombolysis is emerging as a compelling therapeutic approach for CRAO treatment, and should be administered shortly after the onset of visual loss to induce recanalisation of the occluded retinal arteries and reperfusion of the ischemic retina before retinal cell death. Importantly, there is considerable variability in CRAO management patterns among practitioners, institutions, and subspecialty groups.
- Full-Text
- Preview
