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      High correlation of scotopic and photopic electroretinogram components with severity of central retinal artery occlusion

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          Abstract

          Purpose

          The aim of this study was to determine whether a significant correlation exists between the scotopic and photopic components of electroretinograms (ERGs) and the degree of circulation disturbances caused by a central retinal artery occlusion (CRAO).

          Design

          Observational clinical study.

          Participants

          Sixteen patients with a CRAO (16 eyes).

          Methods

          The circulatory disturbance in eyes with CRAO was graded as mild (group 1) when the arm-to-retina transmission time was <30 sec and severe (group 2) when the arm-to-retina transmission time was ≥30 sec. Scotopic and photopic ERG components in eyes with CRAO were compared with those in healthy fellow eyes with respect to the degree of circulation disturbance.

          Results

          The scotopic and photopic b-waves were significantly reduced only in group 2, whereas the amplitudes of the photopic negative response (PhNR) of the photopic cone ERGs were significantly reduced in both groups. The amplitudes of each ERG component, except for the a-wave of the mixed rod-cone ERG, were significantly smaller in group 2 than in group 1.

          Conclusions

          The PhNR was reduced even in group 1 with minimal circulatory disturbance and thus may be a good functional indicator.

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          Most cited references26

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          Central retinal artery occlusion: visual outcome.

          Shawn M. Zimmerman, Sohan Hayreh (2005)
          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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            Central retinal artery occlusion: local intra-arterial fibrinolysis versus conservative treatment, a multicenter randomized trial.

            Martin Schumacher, Dieter Schmidt, Bernhard Jurklies … (2010)
            The reported outcomes of central retinal artery occlusion (CRAO) with or without treatment vary considerably. Although local intra-arterial fibrinolysis (LIF) using recombinant tissue plasminogen activator (rtPA) is a promising treatment, outcomes have not been compared in randomized trials. Prospective randomized multicenter clinical trial (the European Assessment Group for Lysis in the Eye Study) to compare treatment outcome after conservative standard treatment (CST) and LIF for acute nonarteritic CRAO. Between 2002 and 2007, 9 centers in Austria and Germany recruited 84 patients (40 received CST, 44 received LIF), and data for 82 patients were analyzed. Patients (age 18-75 years) with CRAO, symptoms for 20 hours or less, and best-corrected visual acuity (BCVA) or = 0.3 logMAR) was noted in 60.0% (CST) and 57.1% (LIF) of patients. Two patients in the CST group (4.3%) and 13 patients in the LIF group (37.1%) had adverse reactions. Because of apparently similar efficacy and the higher rate of adverse reactions in the LIF group, the study was stopped after the first interim analysis at the recommendation of the data and safety monitoring committee. In light of these 2 therapies' similar outcomes and the higher rate of adverse reactions associated with LIF, we cannot recommend LIF for the management of acute CRAO. The author(s) have no proprietary or commercial interest in any materials discussed in this article. Copyright 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
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              Central retinal artery occlusion. Retinal survival time.

              Shawn M. Zimmerman, Ashish Sanon, A Kimura … (2004)
              To investigate the retinal survival time following central retinal artery occlusion (CRAO). In 38 elderly, atherosclerotic and hypertensive rhesus monkeys, transient CRAO (varying from 97 to 240 min) was produced by temporarily clamping the CRA at its site of entry into the optic nerve. Stereoscopic color fundus photography, fluorescein fundus angiography, electroretinography (ERG), and visual evoked potential (VEP) recording were performed before and during CRA clamping, after unclamping, and serially thereafter. After unclamping of the CRA, the animals were followed for variable lengths of time (median duration 8.14 weeks). Finally, the eyes and optic nerves were examined histologically. The data on ERG changes were analyzed in the following four time frames: (1) baseline before CRA clamping, (2) during CRA clamping, (3) immediately after unclamping, and (4) at the end of follow-up. Duration of CRAO was divided into four groups: 97, 105-120, 150-165, and > or = 180 min. A 'negative ERG' appeared during CRA clamping. With removal of the CRA clamp, there was b-wave recovery, with differential rates of recovery of ERG-eyes with shorter CRAO recovered sooner than those with longer occlusion. On removal of clamp, recovery was seen in scotopic 24 dB b-wave, photopic 0 dB single flash b-wave and 30 Hz flicker, with the b/a ratio of the combined rod and cone response and selective rod response showing statistically significant differences amongst the shorter and longer periods of CRAO. A delayed normalization of the depressed b/a ratio immediately after CRA reperfusion may indicate high-grade ischemic damage. At the final follow-up test session, no clear-cut derangement of any ERG parameter was seen for any group, with subtotal b-wave amplitude recovery for all groups. Longer CRAO produced incomplete VEP recovery. On histology, in the macular retina, eyes with CRAO for 97 min showed practically no damage, but duration of CRAO was found to be significantly associated with the amount of damage in the ganglion cell layer (p = 0.009) and inner nuclear layer (p = 0.017). Outer nuclear and plexiform layers and photoreceptors showed no damage at all with CRAO. There was no significant association of the ERG measures and histologic changes with any of the residual retinal circulation variables. Our electrophysiologic, histopathologic and morphometric studies showed that the retina of old, atherosclerotic, hypertensive rhesus monkeys suffers no detectable damage with CRAO of 97 min but above that level, the longer the CRAO, the more extensive the irreversible damage. The study suggests that CRAO lasting for about 240 min results in massive irreversible retinal damage.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Ophthalmol
                Journal ID (publisher-id): Clinical Ophthalmology
                Title: Clinical Ophthalmology (Auckland, N.Z.)
                Publisher: Dove Medical Press
                ISSN (Print): 1177-5467
                ISSN (Electronic): 1177-5483
                Publication date Collection: 2011
                Publication date (Print): 2011
                Publication date (Electronic): 20 January 2011
                Volume: 5
                Pages: 115-121
                Affiliations
                [1 ] Department of Ophthalmology, Teikyo University School of Medicine, Tokyo, Japan
                [2 ] Department of Ophthalmology, Faculty of Medicine, Oita University, Oita, Japan
                Author notes
                Correspondence: Kei Shinoda, Department of Ophthalmology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8606, Japan, Tel +81 3 3964 1225, Fax +81 3 3964 1402, Email shinodak@ 123456med.teikyo-u.ac.jp
                Article
                Publisher ID: opth-5-115
                DOI: 10.2147/OPTH.S16053
                PMC ID: 3037039
                PubMed ID: 21339804
                SO-VID: 7e32a1ce-73a4-44e0-99aa-e410c5e91758
                Copyright © © 2011 Matsumoto et al, publisher and licensee Dove Medical Press Ltd.
                License:

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

                History
                Categories
                Subject: Original Research

                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: scotopic electroretinogram,photopic electroretinogram,photopic negative response,central retinal artery occlusion,fluorescein angiography
                Data availability:
                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: scotopic electroretinogram, photopic electroretinogram, photopic negative response, central retinal artery occlusion, fluorescein angiography

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