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The following is a summary of “Multimodal imaging characteristics and correlation to outcomes in patients with CRAO presenting to a large academic center,” published in the October 2024 issue of Ophthalmology by Hoyek et al. 

Researchers conducted a retrospective study to characterize the patients with central retinal artery occlusion (CRAO) by describing presenting features and outcomes relating to manually segmented optical coherence tomography (OCT) features, angiographic reperfusion, and visual recovery.  

They examined patients with CRAO (ICD-10: H34.1) initially presenting to a tertiary referral center between January 2017 and December 2021. Demographics, eye exam findings, fundus photographs, OCT, and fluorescein angiography (FA) were analyzed. The main outcome measures were total and inner retinal thickness on macular OCT, reperfusion, visual outcomes, and development of neovascularization.  

The results showed 145 eyes of 144 patients, with a mean age of 69.4 ± 13.6 years, the mean time to presentation was 1.6 ± 4.2 days, with 19% examined within 4.5 hours and 26% within 6 hours after vision loss. Among the patients, 19% had cilioretinal artery (CLRA) sparing. The mean initial visual acuity (VA) was 1.68 ± 1.10 LogMAR for the CLRA sparing group compared to 2.53 ± 0.58 LogMAR for the non-CLRA sparing group (P < 0.001), 32% of the patients had an elevated inflammatory marker, of the 47 eyes assessed with final FA, one-third exhibited some reperfusion. The final vision was 1.40 ± 1.16 LogMAR in the CLRA sparing group vs 2.46 ± 0.81 in the non-CLRA sparing group (P < 0.001). One-third of patients showed improvement in VA across both groups, with 27% of the CLRA-sparing group and 36% of the non-CLRA-sparing group gaining more than 2 lines of vision. Furthermore, 17% of the CLRA sparing group improved to better than 20/200, while 4% achieved this in the non-CLRA sparing group, and 11% of patients had neovascularization, all of whom were in the non-CLRA sparing group. A multiple linear regression analysis indicated that VA at presentation was linked to regaining 2 lines or more of vision (OR = 2.603, P = 0.007); OCT demonstrated progressive thinning over time, reaching the lowest measurements at 6 months before stabilizing.  

They concluded the early presentation and better initial VA were linked to improved visual outcomes in patients with acute CRAO, while systemic inflammatory markers and baseline OCT had limited predictive value. 

Source: ajo.com/article/S0002-9394(24)00470-7/abstract