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Review
. 2022 Aug 18;12(3):273-281.
doi: 10.4103/2211-5056.353126. eCollection 2022 Jul-Sep.

A review of the management of central retinal artery occlusion

Reema Madike  1 , Sudha Cugati  2 , Celia Chen  3
Affiliations
Review

A review of the management of central retinal artery occlusion

Reema Madike et al. Taiwan J Ophthalmol. .

Abstract

Central retinal artery occlusion (CRAO), the ocular analog of a cerebral stroke, is an ophthalmic emergency. The visual prognosis for overall spontaneous visual recovery in CRAO is low. Furthermore, the risk of future ischemic heart disease and cerebral stroke is increased due to the underlying atherosclerotic risk factors. There is currently no guideline-endorsed treatment for CRAO. This review will describe the anatomy, pathophysiology, epidemiology, and clinical features of CRAO, and investigate the current and future management strategies.

Keywords: Central retinal artery; Ischemia; occlusion; prevention; reperfusion; thrombolysis.

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Conflict of interest statement

Prof. Celia Chen, an editorial board member at Taiwan Journal of Ophthalmology, had no role in the peer review process of or decision to publish this article. The other authors decalared no conflicts of interest in writing this paper.

Figures

Figure 1
Figure 1
Vascular supply to the eye. (a) The central retinal artery is a branch of the ophthalmic artery. In central retinal artery occlusion (Green cross marks site of occlusion), the blood supply to the retina is interrupted. (b) Patients with a cilioretinal artery have supplied to the macula stemming from the short posterior ciliary artery. Therefore, in CRAO (green cross), the macula is supplied, and central vision is preserved. CRAO: Central retinal artery occlusion
Figure 2
Figure 2
Fundus photograph showing a left acute CRAO. The color on the left is paler compared to the right retina due to retinal edema. There is disc edema (O) with peripapillary hemorrhage (H). The macula appeared erythematous called cherry-red spot (C) due to preserved choroidal circulation underlying the fovea. The retinal vessels are thin and attenuated with a boxcarring appearance (B). CRAO: Central retinal artery occlusion
Figure 3
Figure 3
(a) Color fundus photograph of a left eye with nonarteritic CRAO with cilioretinal sparing. The maculopapular bundle is perfused by the cilioretinal artery (C) and imparts the orange retinal appearance compared to the surrounding retina that appears pale. (b) Fundus fluorescein angiography showing the cilioretinal artery (black arrow). CRAO: Central retinal artery occlusion
Figure 4
Figure 4
Cilioretinal artery occlusion. Color fundus photograph (right) and red-free fundus photograph (left) showing edema surrounding the macula (M) but preserved superior and inferior retinal arcade (blue arrows)
Figure 5
Figure 5
Color fundus photograph (a) of a patient with right arteritic CRAO. (b-d) FFA at 28 s, 45 s, and 1 min 28 s showing choroidal filling defect (P). CRAO: Central retinal artery occlusion
Figure 6
Figure 6
Color fundus photograph in a patient presenting with acute loss of vision due to a right CRAO. The left eye is asymptomatic but has a cotton wool spot (arrow) in the absence of other microangiopathies suggesting there is retinal nerve fiber layer ischemia. CRAO: Central retinal artery occlusion
Figure 7
Figure 7
A patient with chronic CRAO showing band-like hyperreflective focal or diffuse lesions visible at the level of the INL corresponding to superficial INL ischemia on OCT angiography. There is epiretinal membrane formation (arrow). CRAO: Central retinal artery occlusion, INL: Inner nuclear layer
Figure 8
Figure 8
Paracentral acute middle maculopathy in a case of CRAO. CRAO: Central retinal artery occlusion
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