Branch retinal artery occlusion: natural history of visual outcome

Abstract

Objective: To investigate systematically the natural history of visual outcome in branch retinal artery occlusion (BRAO).

Design: Cohort study.

Participants: We included 199 consecutive untreated patients (212 eyes) with BRAO, first seen in our clinic from 1973 to 2000.

Methods: At first visit, all patients had a detailed ophthalmic and medical history, and comprehensive ophthalmic evaluation. Visual evaluation was done by recording visual acuity, using the Snellen visual acuity chart, and visual fields with a Goldmann perimeter. The same ophthalmic evaluation was performed at each follow-up visit.

Main outcome measures: Visual acuity and visual fields.

Results: We classified BRAO into permanent (133 eyes) and transient (18 eyes) and cilioretinal artery occlusion (CLRAO; 61 eyes). In eyes with permanent BRAO, of the 61 eyes seen within 7 days of onset, initial visual acuity was >or=20/40 in 74%, central scotoma in 20%, central inferior altitudinal defect in 13%, and inferior nasal and superior sector defects in 29% and 24%, respectively. Of those with follow-up, in the eyes with visual acuity <20/40, it improved in 79% (11/14), abnormal central visual field defect improved in 47%, and abnormal peripheral visual field defect improved in 52%. Of the 18 eyes with transient BRAO, initially 17 (94%) had visual acuity of >or=20/40 and 1 (6%) <20/40, which improved to 20/30 on follow-up. Of the 11 eyes with nonarteritic CLRAO alone, visual acuity was <20/40 in 3 eyes, which improved to >or=20/40 in all during follow-up. In CLRAO on follow-up of 9 eyes, the central field improved in 4. When CLRAO was associated with retinal vein occlusion (38 eyes) or giant cell arteritis (12 eyes), visual findings were influenced by the associated diseases.

Conclusions: These findings show that a visual acuity of >or=20/40 is seen initially in 74% of cases of permanent BRAO, 94% of transient BRAO, and 73% of nonarteritic CLRAO alone; and finally on follow-up, in 89%, 100%, and 100% of cases, respectively. The effectiveness of various treatment modalities for visual outcome has to be judged against this background.

Financial disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.

Figure 1

Fundus photographs of two eyes with cilioretinal artery occlusion. A: Left eye of a patient with giant cell arteritis, showing cilioretinal artery occlusion and arteritic anterior ischemic optic neuropathy. Note the presence of chalky white optic disc edema, which is diagnostic of arteritic anterior ischemic optic neuropathy. A combination of chalky white optic disc edema with cilioretinal artery occlusion is diagnostic of giant cell arteritis. B: Right eye with cilioretinal artery occlusion associated with non-ischemic central retinal vein occlusion. Note the junction between the normal (upper) and infarcted (lower) retina lies in the foveal region.

Figure 2

Fluorescein fundus angiogram of left eye, of a patient with giant cell arteritis, with cilioretinal artery occlusion and arteritic anterior ischemic optic neuropathy. Note no filling of the choroid and optic disc supplied by the medial posterior ciliary artery and of the cilioretinal artery (arrow), with normal filling of central retinal artery and lateral posterior ciliary artery. A combination of posterior ciliary artery occlusion, cilioretinal artery occlusion and arteritic anterior ischemic optic neuropathy is diagnostic of giant cell arteritis.

Figure 3

Distribution of the time interval between the onset of permanent branch retinal artery occlusion and the first clinic visit. BRAO = Branch retinal artery occlusion. mos = months.

Figure 4

Fundus photographs of two eyes with branch retinal artery occlusion. A: Left eye with inferior branch retinal artery occlusion, with an embolus (white) impacted at its origin on the optic disc. Note the junction between the normal (upper half) and infarcted (lower half) retina lies in the foveal region. B: Right eye with superior temporal branch retinal artery occlusion. Note the junction between the normal (lower) and infarcted (upper) retina lies in the foveal region.