Search Results (9)

Purpose: To systematically review the evidence regarding the characteristics of Optical Coherence Tomography Angiography (OCTA) in acute retinal arterial occlusion (RAO), with a particular focus on vascular alterations across the superficial and deep capillary plexuses, choroid, and peripapillary regions. Methods: A comprehensive literature search was performed across PubMed, Web of Science, Scopus, EMBASE, Google Scholar, and the Cochrane Database up to April 2025. The search terms included “Optical coherence tomography angiography,” “OCTA,” “Retinal arterial occlusion,” “Central retinal artery occlusion,” and “Branch retinal artery occlusion.” Studies were included if they evaluated the role of OCTA in diagnosing or assessing acute RAO. Case reports, conference abstracts, and non-English articles were excluded. Two reviewers independently conducted the study selection and data extraction. The methodological quality of the included studies was assessed using the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool. Results: The initial search yielded 457 articles, from which 10 studies were ultimately included in the final analysis after a rigorous screening process excluding duplicates, non-English publications, and ineligible articles based on title, abstract, or full-text review. The included studies consistently demonstrated that OCTA is a valuable, noninvasive modality for evaluating microvascular changes in RAO. Key OCTA findings in acute RAO include significant perfusion deficits and reduced vessel density in both the superficial capillary plexus (SCP) and deep capillary plexus (DCP). Several studies noted more pronounced involvement of the SCP compared to the DCP. OCTA parameters, such as vessel density in the macular region, have been found to correlate with visual acuity, suggesting a prognostic value. While findings regarding the foveal avascular zone (FAZ) were mixed, the peripapillary area frequently showed reduced vessel density. Conclusion: Acute RAO is an ocular emergency that causes microvascular ischemic changes detectable by OCTA. This review establishes OCTA as a significant noninvasive tool for diagnosing, monitoring, and prognosticating RAO. It effectively visualizes perfusion deficits that correlate with clinical outcomes. However, limitations such as susceptibility to motion artifacts, segmentation errors, and the lack of standardized normative data must be considered. Future standardization of OCTA protocols and analysis is essential to enhance its clinical application in managing RAO. Full article

Background: Central and branch retinal artery occlusion (CRAO and BRAO) are critical causes of acute vision loss, predominantly affecting older adults with systemic vascular pathology. These occlusions typically result from embolic events, leading to partial or complete retinal ischemia. Methods: This retrospective case series report details of our 10-year experience using the 1064 nm Nd:YAG laser for Transluminal Nd:YAG Embolysis (TYE) in order to lyse visible emboli within the retinal arteries. Results: We conducted a retrospective case series involving 18 patients treated by TYE for different retinal arteries occlusions between 2014 and 2024. TYE effectively restored blood flow in the occluded arteries, with variable but generally favorable visual outcomes. Our article highlights significant clinical and interventional aspects of three treated patients: a BRAO case with multiple transluminal emboli, a case of double BRAO and a CRAO case. We also report the successful use of TYE for intraluminal lysing of an embolus located outside the optic disc. The procedures were well-tolerated, with minor complications such as preretinal or vitreous hemorrhages resolving spontaneously. Conclusions: TYE is a minimally invasive therapeutic option for retinal artery occlusion with visible emboli, particularly when intervention occurs shortly after the onset of symptoms. Compared to observation, TYE can improve visual outcomes and reduce the risk of permanent vision loss, presenting a significant advancement in the management of this ophthalmic emergency. The worldwide experience with TYE is continuously increasing. Further research with larger cohorts is recommended to validate these results and refine the treatment protocol. Full article

Arterial occlusions of the retina are potentially sight-threatening diseases which often result in profound visual loss. The aim of this narrative review is to provide an overview of the aetiology, discuss major risk factors, describe the management and systemic assessments and evaluate existing therapies. For this review, an extensive literature search in PubMed was performed. Emboli from the heart or the carotid arteries can cause ophthalmic artery occlusion (OAO), central retinal artery occlusion (CRAO) and branch retinal artery occlusion (BRAO). Most patients with arterial occlusions have vascular risk factors such as arterial hypertension, hyperhomocysteinaemia, carotid stenosis and atrial fibrillation, which also increase the risk of cerebral stroke and myocardial infarction. Therapies such as ocular massage, thrombolysis and anterior chamber paracentesis have been suggested but are still equivocal. However, it is evident that retinal artery occlusion should be immediately treated and accompanied by interdisciplinary collaboration, since early diagnosis and the proper treatment of possible risk factors are important to reduce the risk of further damage, recurrences, other vascular diseases and mortality. Full article

Purpose: to assess the tomographic retinal layers’ thickness in eyes affected by branch retinal artery occlusion (BRAO) and to compare it to those of patients affected by primary open angle glaucoma (POAG). Methods: retrospective review of 27 patients; 16 with BRAO (16 eyes) and 11 with POAG (20 eyes) were identified among those who received SD-OCT scans, including analysis of macular retinal nerve fiber layer (mRNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), neuroretinal rim (NRR), circumpapillary RNFL at 3.5 mm and hemisphere asymmetry (HA). Results: the total IPL and INL thinning difference between the two groups was statistically significant (p = 0.0067 and p < 0.0001, respectively). The HA difference for the total macular thinning, mRNFL, GCL, IPL and INL (p < 0.0001) was also statistically significant. The analysis of the average total retinal thinning, total mRNFL and GCL thinning showed no statistically significant difference between the two groups. Conclusions: unilateral inner retinal thinning may represent a sign of temporal BRAO, particularly for INL thinning and HA difference over 17µm in total retinal layer thinning. This information is particularly useful in the diagnosis of previous, undiagnosed BRAO and may help prevent further retinal arterial occlusion and possible cerebrovascular incidents. Full article

A rarely described condition known as branch retinal artery occlusion (BRAO) with concurrent obstruction of the central retinal vein (CRVO) is characterized by diffuse retinal hemorrhages, dilated and tortuous retinal veins, macular and disc edema, cotton wool spots, and a generalized delay in arteriovenous transit on fluorescein angiography, together with a retinal whitening in the area of the affected retinal arterial branch. Although BRAO and CRVO may share underlying systemic risk factors, the pathogenesis of combined BRAO + CRVO is still unknown. We present a BRAO + CRVO case report concerning a 63-year-old white male who came to our observation complaining of sudden vision loss in his right eye. An increased risk for thrombotic event was revealed in this case, and the patient improved only with systemic anticoagulant therapy and in the absence of ocular therapy. We also explain all the clinical findings that are detectable using different diagnostic devices and analyze the scientific literature for other, similar clinical cases. Full article

We performed a systematic review and analyzed the current available data on branch retinal artery occlusion (BRAO) with simultaneous central retinal vein obstruction (CRVO), a rarely described occurrence. MEDLINE/PubMed and ISI Web of Sciences searches were performed according to MOOSE guidelines. Studies were considered eligible if they (1) described patients with simultaneous BRAO + CRVO and (2) had been published in peer-reviewed journals. We initially identified 239 records from databases. Ultimately, only 19 reports met the selection criteria. Twenty-nine patients (15 men, 14 women; mean age 43 ± 15 years) were analyzed. Seventeen (59%) patients presented vascular risk factors. Mean visual acuity at onset and final visual outcome were 20/83 and 20/45, respectively, an insignificant improvement. Vision improved in 48% of cases. A marked heterogeneity in treatment approach was found. Eight (28%) patients received no therapy, whereas for 21 (72%) a large variety of topical and/or systemic drugs was given. In the treated group, mean visual acuity at onset and final visual outcome were 20/90 and 20/44, respectively, a not statistically significant improvement. Results suggest that combined BRAO + CRVO occurs at a younger age than isolated BRAO or CRVO. At present, there is insufficient evidence to support any specific management to improve vision in simultaneous BRAO + CRVO. Full article

Background: To investigate whether vaccination against SARS-CoV-2 is associated with the onset of retinal vascular occlusive disease (RVOD). Methods: In this multicentre study, data from patients with central and branch retinal vein occlusion (CRVO and BRVO), central and branch retinal artery occlusion (CRAO and BRAO), and anterior ischaemic optic neuropathy (AION) were retrospectively collected during a 2-month index period (1 June–31 July 2021) according to a defined protocol. The relation to any previous vaccination was documented for the consecutive case series. Numbers of RVOD and COVID-19 vaccination were investigated in a case-by-case analysis. A case–control study using age- and sex-matched controls from the general population (study participants from the Gutenberg Health Study) and an adjusted conditional logistic regression analysis was conducted. Results: Four hundred and twenty-one subjects presenting during the index period (61 days) were enrolled: one hundred and twenty-one patients with CRVO, seventy-five with BRVO, fifty-six with CRAO, sixty-five with BRAO, and one hundred and four with AION. Three hundred and thirty-two (78.9%) patients had been vaccinated before the onset of RVOD. The vaccines given were BNT162b2/BioNTech/Pfizer (n = 221), followed by ChadOx1/AstraZeneca (n = 57), mRNA-1273/Moderna (n = 21), and Ad26.COV2.S/Johnson & Johnson (n = 11; unknown n = 22). Our case–control analysis integrating population-based data from the GHS yielded no evidence of an increased risk after COVID-19 vaccination (OR = 0.93; 95% CI: 0.60–1.45, p = 0.75) in connection with a vaccination within a 4-week window. Conclusions: To date, there has been no evidence of any association between SARS-CoV-2 vaccination and a higher RVOD risk. Full article

Background and Objectives: To document, through multimodal imaging, the post-procedural clinical course and visual outcome of a patient who received intra-arterial tissue plasminogen activator (tPA) for acute iatrogenic branch retinal artery occlusion (BRAO), and to review the literature and guidelines regarding the use of tPA for retinal arterial occlusions. Methods: A 28-year-old female patient who sustained an iatrogenic BRAO and subsequently received intra-arterial tPA was followed through her post-interventional course of 3 months with serial exams and multimodal imaging, including color fundus photography, visual field testing, spectral domain optical coherence tomography (SD-OCT), and OCT angiography (OCT-A). Results: A patient with history of left internal cerebral artery (ICA) aneurysm and baseline visual acuity (VA) of 20/20 developed an acutely symptomatic BRAO after undergoing a neuroendovascular procedure and was acutely treated with tPA through the left ophthalmic artery. At two weeks follow-up, a central posterior pole hemorrhage was noted although VA was preserved. A superior altitudinal defect was shown on automated perimetry. VA dropped to 20/50 at 7 weeks follow-up and hyperreflective material deep to the attachment between the posterior hyaloid and the internal limiting membrane (ILM) consistent with hemorrhage was noted on SD-OCT. At 11 weeks follow-up, VA returned to 20/20, SD-OCT revealed a membrane bridging the foveal depression, OCT-A showed decreased vascularity in the inferior macula, and the visual field defect was stable by automated perimetry. Conclusions: Intraocular hemorrhage is a possible complication of intra-arterial tPA administration for BRAO, and a careful analysis of risks, benefits, and goals of this procedure must be considered by both provider and patient before such intervention. Full article

Purpose: Retinal artery occlusion (RAO) is associated with an increased risk of cardiovascular events such as ischemic stroke and myocardial infarction, but whether different RAO subtypes such as central retinal artery occlusion (CRAO) or branch retinal artery occlusion (BRAO) carry similar risk of these events is unclear. Our aim was to determine whether the risk of cardiovascular events differs between CRAO and BRAO. Methods: This single-center, retrospective study included 131 patients hospitalized in our clinic in 2010–2020 with CRAO or BRAO confirmed by ophthalmic examination. Data on demographics, previous ischemic stroke and myocardial infarction, comorbidities, the results of echocardiographic and ultrasound carotid artery examinations and laboratory tests were assessed. Data on ischemic stroke, myocardial infarction, and all-cause mortality occurring after RAO were obtained from the Polish National Health Service, which collects data on all publicly funded hospitalizations. Using these data, Kaplan-Meier analyses and Cox proportional hazard regression were performed. Results: Ischemic stroke occurred in 9.9% of patients after RAO: 10.6% in the CRAO group and 8.1% in the BRAO group (p = 0.662). Myocardial infarction occurred in 2.3% of patients after RAO: 2.1% in the CRAO group and 2.7% in the BRAO group (p = 0.843). All-cause mortality occurred in 22.9% of patients after RAO: 25.5% in the CRAO group and 16.2% in the BRAO group (p = 0.253). The composite endpoint of ischemic stroke, myocardial infarction, and all-cause mortality after RAO occurred in 28.2% of patients: 30.9% in the CRAO group and 21.6% in the BRAO group (p = 0.338). There was no difference between CRAO and BRAO in median time to ischemic stroke (32 vs. 76.4 months; p = 0.352), all-cause mortality (35.9 vs. 36.3 months; p = 0.876) or composite endpoint (37.5 vs. 41.5 months; p = 0.912) after RAO. The Kaplan-Meier analysis showed no differences between CRAO and BRAO in ischemic stroke, myocardial infarction, all-cause mortality, or the composite endpoint; similar results were obtained in analyses of patients with and without cardiovascular events before RAO. Conclusions: The prognosis for ischemic stroke, myocardial infarction, and all-cause mortality is similar in patients with CRAO and BRAO. Ischemic strokes occur with a similar frequency before and after RAO. Myocardial infarctions are observed significantly more frequently before an episode of RAO than after. The results of our study indicate that both CRAO and BRAO require expanded diagnostics to assess the risk of recurrent cardiovascular events, especially ischemic strokes, to implement appropriate prophylaxis and reduce mortality. Full article