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A case of sudden painless loss of vision with partial spontaneous recovery

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      Central retinal artery occlusion: visual outcome.

      To investigate systematically the natural history of visual outcome in central retinal artery occlusion (CRAO). Cohort study. At entry, 244 consecutive patients (260 eyes) with CRAO (seen consecutively from 1973 to 2000) had a detailed ocular and medical history and ocular evaluation. CRAO eyes were classified into four categories: non-arteritic (NA) CRAO (171 eyes), NA-CRAO with cilioretinal artery sparing (35), transient NA-CRAO (41), and arteritic CRAO (13). Within 7 days of onset of CRAO, initial visual acuity differed among the four CRAO types (P < .0001). In eyes with vision of counting fingers or worse, it improved in 82% of eyes with transient NA-CRAO, 67% of eyes with NA-CRAO with cilioretinal artery sparing, and 22% of eyes with NA-CRAO. Visual acuity improved primarily within the first 7 days (P < .0001). In the central 30-degree visual field, central scotoma was most common. Central visual field improved in 39% with transient NA-CRAO, 25% with NA-CRAO with cilioretinal artery sparing, and 21% with NA-CRAO. Peripheral visual field was normal in 62.9% of eyes with transient NA-CRAO and 22.1% in those with NA-CRAO. In 51.9% of eyes with NA-CRAO, the only remaining visual field was a peripheral island. Peripheral fields improved in NA-CRAO (39%) and in transient NA-CRAO (39%). Classification of CRAO is crucial for understanding differences in visual outcome. Marked improvement in visual acuity and visual field can occur without treatment and is determined by several factors. Visual field information is essential to evaluate visual disability in CRAO.
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        Fundus changes in central retinal artery occlusion.

        To investigate systematically the ophthalmoscopic fundus findings associated with central retinal artery occlusion (CRAO). The study included 240 consecutive patients (248 eyes) with CRAO. The eyes underwent detailed fundus evaluation and stereoscopic color fundus photography at initial and follow-up visits. Patients without evidence of giant cell arteritis were advised to have carotid Doppler imaging and echocardiography to determine the source of emboli. CRAO was classified into 3 types: permanent CRAO (175 eyes), permanent CRAO with cilioretinal artery sparing (35 eyes), and transient CRAO (38 eyes). In the three types of CRAO, acute-phase and late-phase changes in the retina, optic disk, and retinal vessels were evaluated. The main findings during the initial examination in our clinic for permanent CRAO were retinal opacity in the posterior pole (58%), cherry-red spot (90%), box-carring (19%), retinal arterial attenuation (32%), and optic disk edema (22%) and pallor (39%). The most frequent findings identified at the late stage, based on survivorship curves, were optic atrophy (91%), retinal arterial attenuation (58%), cilioretinal collaterals (18%), and macular retinal pigment epithelial changes (11%). Compared with permanent CRAO, permanent CRAO with cilioretinal artery sparing was associated with a lower incidence of all macular and optic disk abnormalities. For transient CRAO, the incidence of initial findings varied greatly compared with the other types. Intraarterial emboli were observed in 20% of patients. Carotid Doppler evaluation identified carotid vascular plaques in 67% of patients tested and hemodynamically significant (>50%) obstruction in 32%. Four percent of CRAOs presented with simultaneous bilateral onset. The type and incidence of fundus findings at the initial visit and in the late phase of CRAO vary by its type. This study confirms that retinal opacity is predominantly evident in the posterior retina, that optic disk findings at presentation are common, that CRAO associated with normal-appearing retinal vessels and/or optic disk is not rare, and that observation of emboli is infrequent. Clinicians should be aware of the various presentation findings during the acute and late stages of CRAO and its various types. A complete picture of CRAO is provided by combined information of our clinical and experimental studies of CRAO.
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          Branch retinal artery occlusion: natural history of visual outcome.

          To investigate systematically the natural history of visual outcome in branch retinal artery occlusion (BRAO). Cohort study. We included 199 consecutive untreated patients (212 eyes) with BRAO, first seen in our clinic from 1973 to 2000. 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. Visual acuity and visual fields. 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 or=20/40 and 1 (6%) 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. 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. The authors have no proprietary or commercial interest in any materials discussed in this article.

            Author and article information

            Department of Ophthalmology, Goa Medical College, Bambolim, Goa, India
            Author notes
            Correspondence: Dr. Pradnya Jayant Kamat, 168, 8/2, Kamat Nursing Home, Upper Bazaar, Ponda, Goa - 403 401, India. E-mail: doc.pradnyakamat@
            Oman J Ophthalmol
            Oman J Ophthalmol
            Oman Journal of Ophthalmology
            Medknow Publications & Media Pvt Ltd (India )
            Jan-Apr 2016
            : 9
            : 1
            : 66
            Copyright: © Oman Journal of Ophthalmology

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