Analysis of visual characteristics with non arteritic central retinal artery occlusion after treatment_Chinese Journal of Ocular Fundus Diseases

Authors：

Li Xiabo , Zheng Xuejing , Li Tong , Liu Hao , Xu Menghan , Yan Mei , Lu Xin , Hou Lihua ,  Wang Min

Department of Ophthalmology, First People's Hospital of Xianyang City (Xianyang Eye Hospital), The First People's Hospital of Xianyang City Affiliated to Shaanxi University of Traditional Chinese Medicine, Clinical Medical Research Center of Eye Diseases, Xianyang 712000, China;

Corresponding author：

Wang Min, Email: angin2001@126.com

Keywords：

Non arteritic central retinal artery occlusion; Central visual acuity; Extra cenrtal visual acuity; Intravenous thrombolysis; Hyperbaric oxygen therapy

DOI：

10.3760/cam.j.cn511434-20250221-00066

Video：

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Objective To observe the changes of central visual acuity and extracentral visual acuity in eyes with non-arteritic central retinal artery occlusion (NA-CRAO). Methods A retrospective clinical study. From January 1, 2017 to December 31, 2024, 140 patients (140 eyes) diagnosed with NA-CRAO through ophthalmic examination at Department of Ophthalmology of First People's Hospital of Xianyang City were included in the study. All affected eyes underwent best corrected visual acuity (BCVA), visual field, intraocular pressure, fundus color photography, optical coherence tomography (OCT), and fluorescein angiography (FFA) examinations. After a clear diagnosis, conservative treatment such as reducing intraocular pressure, relieving spasms, and dilating blood vessels should be given immediately. Simultaneously, intravenous and/or arterial thrombolysis therapy should be administered based on the patient's overall condition. Under the same treatment conditions as other treatments, 33 eyes were treated with hyperbaric oxygen therapy within 24 hours after seeking medical attention. The changes in central visual acuity (BCVA) and peripheral visual acuity of the affected eye one month after treatment were observed. BCVA improvement of ≥ 1 line was defined as the increase of no light sensitivity to light sensitivity or above, and the increase of light sensitivity to 0.01 or above. The visual acuity outside the center was determined by the 0 ° axis in front of the eyeball at eye level, and was 10 ° outside visual acuity on the temporal side. Multivariate analysis using logistic regression analysis. Results Among the 140 cases (140 eyes), there were 84 males (84 eyes) and 56 females (56 eyes). The mean age was (63.89±10.78) years. The duration of illness from the onset of symptoms to the time of diagnosis was 48 (2-720) hours. 6, 1, 14, 47, 41, 16, and 15 eyes were diagnosed with BCVA without light perception, uncertain light perception, manual/anterior, digital/anterior, 0.01-0.10, and ≥ 0.10, respectively. FFA examination revealed delayed arm retinal circulation time and filling of the retinal artery trunk to the peak, with changes in the "arterial front" observed in 126 eyes. OCT examination showed extensive edema and unclear structure in the inner layer of the retina in all patients. Out of 140 eyes, 122 were treated with intravenous thrombolysis and 4 with arterial thrombolysis; 14 eyes did not receive thrombolytic therapy. After treatment, 38 eyes (27.1%) showed an improvement of BCVA ≥ 1; 67 eyes (47.9%) did not show an improvement in BCVA, and the affected eye had a BCVA of approximately 0.6 without light perception; 17 eyes (12.1%) showed improvement in peripheral vision, and the peripheral vision of the affected eyes ranged from 0.01 to 0.1, all of whom were patients undergoing intravenous thrombolysis, and prior to treatment, this group of patients had complete blindness in the coarse side visual field of the Amsler grid, and their out of center visual acuity could not be measured. Among the 33 eyes treated with hyperbaric oxygen therapy, 24 eyes (72.7%) showed an increase in BCVA after treatment; 9 eyes did not improve, among which 4 eyes (12.1%) showed improvement in out of center visual acuity. Among the 107 eyes that did not receive hyperbaric oxygen therapy, 49 eyes (45.8%) showed an increase in BCVA after treatment. There was no improvement in 58 eyes (54.2%), among which 13 eyes (12.1%) showed an improvement in out of center visual acuity. The results of logistic regression analysis showed that intravenous thrombolysis and hyperbaric oxygen therapy were independent predictive factors for the improvement of central and extra central visual acuity (P＜0.05). Conclusions Hyperbaric oxygen therapy within 24 hours of seeking medical attention for patients with NA-CRAO disease course ≤ 1 month has a significant effect on the recovery of central and extra central vision. Intravenous thrombolysis and hyperbaric oxygen therapy are independent predictive factors for the improvement of central and extra central vision.

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3.	夏德昭, 张忠志. 中心视力和偏心视力是不同性质的两种视力——兼答与此相关的学术探讨和争鸣[J]. 中华眼底病杂志, 2017, 33(5): 536-538. DOI: 10.3760/cma.j.issn.1005-1015.2017.05.024.Xia DZ, Zhang ZZ. Central vision and extra vision are two different types of vision with different properties - a response to academic discussions and debates related to this[J]. Chin J Ocul Fundus Dis, 2017, 33(5): 536-538. DOI: 10.3760/cma.j.issn.1005-1015.2017.05.024.
4.	吴航, 刘大川, 张旭香, 等. 视网膜中央动脉阻塞早期眼动脉溶栓治疗前后视力改变[J]. 中国实用眼科杂志, 2012, 30(2): 152-155. DOI: 10.3760/cma.j.issn.1006-4443.2012.02.016.Wu H, Liu DC, Zhang XX, et al. Visual acuity changes of the patients with recent central retinal artery occlusion after the treatment of intra-arterial thrombolysis[J]. Chin J Pract Ophthalmol, 2012, 30(2): 152-155. DOI: 10.3760/cma.j.issn.1006-4443.2012.02.016.
5.	吕沛霖, 王润生, 杜善双. 视网膜中央动脉阻塞患眼睫状视网膜动脉存在情况及其与中心视力损害的关系[J]. 中华眼底病杂志, 2014, 30(5): 454-457. DOI: 10.3760/cma.j.issn.1005-1015.2014.05.006.Lyu PL, Wang RS, Du SS. Correlation between cilioretinal artery and central visual loss in central retinal artery occlusion[J]. Chin J Ocul Fundus Dis, 2014, 30(5): 454-457. DOI: 10.3760/cma.j.issn.1005-1015.2014.05.006.
6.	王润生, 吕沛霖, 王宾, 等. 视网膜中央动脉阻塞患者视网膜循环时间与中心视力损害的关系[J]. 中华眼底病杂志, 2007, 23(3): 177-179. DOI: 10.3760/j.issn:1005-1015.2007.03.007.Wang RS, Lyu PL, Wang B, et al. Relationship between retinal circulation time and visual loss in patients with central retinal artery occlusion[J]. Chin J Ocul Fundus Dis, 2007, 23(3): 177-179. DOI: 10.3760/j.issn:1005-1015.2007.03.007.
7.	Shahjouei S, Bavarsad SR, Dumitrascu OM. Thrombolysis for central retinal artery occlusion: an individual participant-level meta-analysis[J]. Int J Stroke, 2024, 19(1): 29-39. DOI: 10.1177/17474930231189352.
8.	Raval V, Nayak S, Saldanha M, et al. Combined retinal vascular occlusion: demography, clinical features, visual outcome, systemic co-morbidities, and literature review[J]. Indian J Ophthalmol, 2020, 68(10): 2136-2142. DOI: 10.4103/ijo.IJO_2116_19.
9.	Gong H, Song Q, Wang L. Manifestations of central retinal artery occlusion revealed by fundus fluorescein angiography are associated with the degree of visual loss[J]. Exp Ther Med, 2016, 11(6): 2420-2424. DOI: 10.3892/etm.2016.3175.
10.	Mac Grory B, Schrag M, Biousse V, et al. Management of central retinal artery occlusion: a scientific statement from the American Heart Association[J/OL]. Stroke, 2021, 52(6): e282-e294[2021-03-08]. https://pubmed.ncbi.nlm.nih.gov/33677974/. DOI: 10.1161/STR.0000000000000366.
11.	Hayreh SS. Ocular vascular occlusive disorders: natural history of visual outcome[J]. Prog Retin Eye Res, 2014, 41: 1-25. DOI: 10.1016/j.preteyeres.2014.04.001.
12.	夏德昭, 张忠志. 中心绝对暗点眼的视力不是中心视力而是偏心视力—兼答商榷论文[J]. 中国实用眼科杂志, 2017, 35(3): 239-242. DOI: 10.3760/cma.j.issn.1006-4443.2017.03.004.Xia DZ, Zhang ZZ. The vision of the central absolute dark spot eye is not the central vision but the extra vision-a discussion paper[J]. Chin J Pract Ophthalmol, 2017, 35(3): 239-242. DOI: 10.3760/cma.j.issn.1006-4443.2017.03.004.
13.	Whittaker SG, Budd J, Cummings RW. Eccentric fixation with macular scotoma[J]. Invest Ophthalmol Vis Sci, 1988, 29(2): 268-278.
14.	Ergun E, Maár N, Radner W, et al. Scotoma size and reading speed in patients with subfoveal occult choroidal neovascularization in age-related macular degeneration.[J]. Ophthalmology, 2003, 110(1): 65-69. DOI: 10.1016/s0161-6420(02)01566-x.
15.	陈晓晓, 李梦玮, 孙兴怀. 低视力优选视网膜区的定位假说[J]. 国际眼科纵览, 2016, 40(6): 409-413. DOI: 10.3760/cma.j.issn.1673-5803.2016.06.011.Chen XX, Li MW, Sun XH. Explanation for location of preferred retinal locus in low-vision patients[J]. Int Rev Ophthalmol, 2016, 40(6): 409-413. DOI: 10.3760/cma.j.issn.1673-5803.2016.06.011.
16.	Wu X, Chen S, Li S, et al. Oxygen therapy in patients with retinal artery occlusion: a meta- analysis[J/OL]. PLoS One, 2018, 13(8): e202154[2018-08-29]. https://pubmed.ncbi.nlm.nih.gov/30157206/. DOI: 10.1371/journal.pone.0202154.
17.	陈嘉宝, 李金瑛. 视网膜动脉阻塞治疗现状[J]. 国际眼科纵览, 2019, 43(1): 68-72. DOI: 10.3760/cma.j.issn.1673-5803.2019.01.014.Chen JB, Li JY. Treatment of retinal occlusion[J]. Int Rev Ophthalmol, 2019, 43(1): 68-72. DOI: 10.3760/cma.j.issn.1673-5803.2019.01.014.

1. 逯青丽, 吴松笛. 视网膜动脉阻塞: “视网膜卒中”的认识与挑战[J]. 中国卒中杂志, 2023, 18(6): 712-719. DOI: 10.3969/j.issn.1673-5765.2023.06.011.Lu QL, Wu SD. Retinal artery occlusion: knowledge and challenge of "retinal stroke"[J]. Chin J Stroke, 2023, 18(6): 712-719. DOI: 10.3969/j.issn.1673-5765.2023.06.011.
2. 中国研究型医院学会神经眼科专业委员会, 陕西省研究型医院学会神经眼科专业委员会, 魏世辉, 等. 中国视网膜中央动脉阻塞临床诊疗专家共识[J]. 中国卒中杂志, 2024, 19(11): 1246-1267. DOI: 10.3969/j.issn.1673-5765.2024.11.002.Neuro-Ophthalmology Society, Chinese Research Hospital Association, Neuro-Ophthalmology Society, Shaanxi Research Hospital Association, Wei SH, et al. Expert consensus on clinical diagnosis and treatment of central retinal artery occlusion in China[J]. Chin J Stroke, 2024, 19(11): 1246-1267. DOI: 10.3969/j.issn.1673-5765.2024.11.002.
3. 夏德昭, 张忠志. 中心视力和偏心视力是不同性质的两种视力——兼答与此相关的学术探讨和争鸣[J]. 中华眼底病杂志, 2017, 33(5): 536-538. DOI: 10.3760/cma.j.issn.1005-1015.2017.05.024.Xia DZ, Zhang ZZ. Central vision and extra vision are two different types of vision with different properties - a response to academic discussions and debates related to this[J]. Chin J Ocul Fundus Dis, 2017, 33(5): 536-538. DOI: 10.3760/cma.j.issn.1005-1015.2017.05.024.
4. 吴航, 刘大川, 张旭香, 等. 视网膜中央动脉阻塞早期眼动脉溶栓治疗前后视力改变[J]. 中国实用眼科杂志, 2012, 30(2): 152-155. DOI: 10.3760/cma.j.issn.1006-4443.2012.02.016.Wu H, Liu DC, Zhang XX, et al. Visual acuity changes of the patients with recent central retinal artery occlusion after the treatment of intra-arterial thrombolysis[J]. Chin J Pract Ophthalmol, 2012, 30(2): 152-155. DOI: 10.3760/cma.j.issn.1006-4443.2012.02.016.
5. 吕沛霖, 王润生, 杜善双. 视网膜中央动脉阻塞患眼睫状视网膜动脉存在情况及其与中心视力损害的关系[J]. 中华眼底病杂志, 2014, 30(5): 454-457. DOI: 10.3760/cma.j.issn.1005-1015.2014.05.006.Lyu PL, Wang RS, Du SS. Correlation between cilioretinal artery and central visual loss in central retinal artery occlusion[J]. Chin J Ocul Fundus Dis, 2014, 30(5): 454-457. DOI: 10.3760/cma.j.issn.1005-1015.2014.05.006.
6. 王润生, 吕沛霖, 王宾, 等. 视网膜中央动脉阻塞患者视网膜循环时间与中心视力损害的关系[J]. 中华眼底病杂志, 2007, 23(3): 177-179. DOI: 10.3760/j.issn:1005-1015.2007.03.007.Wang RS, Lyu PL, Wang B, et al. Relationship between retinal circulation time and visual loss in patients with central retinal artery occlusion[J]. Chin J Ocul Fundus Dis, 2007, 23(3): 177-179. DOI: 10.3760/j.issn:1005-1015.2007.03.007.
7. Shahjouei S, Bavarsad SR, Dumitrascu OM. Thrombolysis for central retinal artery occlusion: an individual participant-level meta-analysis[J]. Int J Stroke, 2024, 19(1): 29-39. DOI: 10.1177/17474930231189352.
8. Raval V, Nayak S, Saldanha M, et al. Combined retinal vascular occlusion: demography, clinical features, visual outcome, systemic co-morbidities, and literature review[J]. Indian J Ophthalmol, 2020, 68(10): 2136-2142. DOI: 10.4103/ijo.IJO_2116_19.
9. Gong H, Song Q, Wang L. Manifestations of central retinal artery occlusion revealed by fundus fluorescein angiography are associated with the degree of visual loss[J]. Exp Ther Med, 2016, 11(6): 2420-2424. DOI: 10.3892/etm.2016.3175.
10. Mac Grory B, Schrag M, Biousse V, et al. Management of central retinal artery occlusion: a scientific statement from the American Heart Association[J/OL]. Stroke, 2021, 52(6): e282-e294[2021-03-08]. https://pubmed.ncbi.nlm.nih.gov/33677974/. DOI: 10.1161/STR.0000000000000366.
11. Hayreh SS. Ocular vascular occlusive disorders: natural history of visual outcome[J]. Prog Retin Eye Res, 2014, 41: 1-25. DOI: 10.1016/j.preteyeres.2014.04.001.
12. 夏德昭, 张忠志. 中心绝对暗点眼的视力不是中心视力而是偏心视力—兼答商榷论文[J]. 中国实用眼科杂志, 2017, 35(3): 239-242. DOI: 10.3760/cma.j.issn.1006-4443.2017.03.004.Xia DZ, Zhang ZZ. The vision of the central absolute dark spot eye is not the central vision but the extra vision-a discussion paper[J]. Chin J Pract Ophthalmol, 2017, 35(3): 239-242. DOI: 10.3760/cma.j.issn.1006-4443.2017.03.004.
13. Whittaker SG, Budd J, Cummings RW. Eccentric fixation with macular scotoma[J]. Invest Ophthalmol Vis Sci, 1988, 29(2): 268-278.
14. Ergun E, Maár N, Radner W, et al. Scotoma size and reading speed in patients with subfoveal occult choroidal neovascularization in age-related macular degeneration.[J]. Ophthalmology, 2003, 110(1): 65-69. DOI: 10.1016/s0161-6420(02)01566-x.
15. 陈晓晓, 李梦玮, 孙兴怀. 低视力优选视网膜区的定位假说[J]. 国际眼科纵览, 2016, 40(6): 409-413. DOI: 10.3760/cma.j.issn.1673-5803.2016.06.011.Chen XX, Li MW, Sun XH. Explanation for location of preferred retinal locus in low-vision patients[J]. Int Rev Ophthalmol, 2016, 40(6): 409-413. DOI: 10.3760/cma.j.issn.1673-5803.2016.06.011.
16. Wu X, Chen S, Li S, et al. Oxygen therapy in patients with retinal artery occlusion: a meta- analysis[J/OL]. PLoS One, 2018, 13(8): e202154[2018-08-29]. https://pubmed.ncbi.nlm.nih.gov/30157206/. DOI: 10.1371/journal.pone.0202154.
17. 陈嘉宝, 李金瑛. 视网膜动脉阻塞治疗现状[J]. 国际眼科纵览, 2019, 43(1): 68-72. DOI: 10.3760/cma.j.issn.1673-5803.2019.01.014.Chen JB, Li JY. Treatment of retinal occlusion[J]. Int Rev Ophthalmol, 2019, 43(1): 68-72. DOI: 10.3760/cma.j.issn.1673-5803.2019.01.014.

Chinese Journal of Ocular Fundus Diseases

Latest ArticlesAnalysis of visual characteristics with non arteritic central retinal artery occlusion after treatment

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