Ischemic Injury of the Papillomacular Bundle Is a Predictive Marker of Poor Vision in Eyes With Branch Retinal Artery Occlusion

Abstract

Purpose: To propose a novel prognostic feature of spectral-domain optical coherence tomography (SDOCT) in macula-involving branch retinal artery occlusion (BRAO).

Design: Retrospective comparative case study.

Methods: We analyzed 66 eyes diagnosed with acute BRAO involving the macula from our hospital RAO registry. At presentation, a detailed ophthalmic and medical history was obtained from all patients, and all underwent a comprehensive ophthalmic evaluation, which included visual acuity examination, fundus photography, fluorescein angiography, and SDOCT. This evaluation was performed at each follow-up visit.

Results: The 66 eyes diagnosed with acute BRAO involving the macula were divided into 2 groups according to initial vision: Good Vision (≥20/40, 29 eyes, 44%) and Poor Vision (<20/40, 37 eyes, 56%). The Poor Vision group was further divided into Improvement (18 eyes, 27%) and Nonimprovement (19 eyes, 28%) groups, according to visual recovery at the final examination. Among multiple OCT parameters, the involvement of papillomacular bundle, but not that of the central fovea, was consistently observed in the Poor Vision group (P < .001) and more significantly in the Nonimprovement group (P < .001). Papillomacular bundle involvement features included signs of inner retinal ischemia, including inner retinal thickening, inner retinal hyperreflectivity, and loss of layer-by-layer integrity. Loss of layer-by-layer integrity was seen consistently in the Nonimprovement group. Quantitative analysis of inner retinal thickness also supported this association.

Conclusion: In eyes with macula-involving BRAO, ischemic injury of the papillomacular bundle at the acute stage, as seen on OCT, correlates closely with poor vision and can explain the poor visual prognosis.