Branch Retinal Artery Occlusion

Hayreh, Sohan Singh; Podhajsky, Patricia; Zimmerman, M. Bridget

doi:10.1016/j.ophtha.2009.01.015

Cited by 104 publications

(63 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Following were the findings in various types of BRAO reported in a recent study (Hayreh et al , 2009a), based on 199 consecutive untreated patients (212 eyes).…”

Section: Branch Retinal Arteriolar Occlusionmentioning

confidence: 95%

See 1 more Smart Citation

Acute retinal arterial occlusive disorders

Hayreh

2011

Progress in Retinal and Eye Research

Self Cite

311

309

View full text Add to dashboard Cite

The initial section deals with basic sciences; among the various topics briefly discussed are the anatomical features of ophthalmic, central retinal and cilioretinal arteries which may play a role in acute retinal arterial ischemic disorders. Crucial information required in the management of central retinal artery occlusion (CRAO) is the length of time the retina can survive following that. An experimental study shows that CRAO for 97 minutes produces no detectable permanent retinal damage but there is a progressive ischemic damage thereafter, and by 4 hours the retina has suffered irreversible damage. In the clinical section, I discuss at length various controversies on acute retinal arterial ischemic disorders. Classification of acute retinal arterial ischemic disorders These are of 4 types: CRAO, branch retinal artery occlusion (BRAO), cotton wools spots and amaurosis fugax. Both CRAO and BRAO further comprise multiple clinical entities. Contrary to the universal belief, pathogenetically, clinically and for management, CRAO is not one clinical entity but 4 distinct clinical entities – non-arteritic CRAO, non-arteritic CRAO with cilioretinal artery sparing, arteritic CRAO associated with giant cell arteritis (GCA) and transient non-arteritic CRAO. Similarly, BRAO comprises permanent BRAO, transient BRAO and cilioretinal artery occlusion (CLRAO), and the latter further consists of 3 distinct clinical entities - non-arteritic CLRAO alone, non-arteritic CLRAO associated with central retinal vein occlusion and arteritic CLRAO associated with GCA. Understanding these classifications is essential to comprehend fully various aspects of these disorders. Central retinal artery occlusion The pathogeneses, clinical features and management of the various types of CRAO are discussed in detail. Contrary to the prevalent belief, spontaneous improvement in both visual acuity and visual fields does occur, mainly during the first 7 days. The incidence of spontaneous visual acuity improvement during the first 7 days differs significantly (p<0.001) among the 4 types of CRAO; among them, in eyes with initial visual acuity of counting finger or worse, visual acuity improved, remained stable or deteriorated in nonarteritic CRAO in 22%, 66% and 12% respectively; in nonarteritic CRAO with cilioretinal artery sparing in 67%, 33% and none respectively; and in transient nonarteritic CRAO in 82%, 18% and none respectively. Arteritic CRAO shows no change. Recent studies have shown that administration of local intra-arterial thrombolytic agent not only has no beneficial effect but also can be harmful. Prevalent multiple misconceptions on CRAO are discussed. Branch retinal artery occlusion Pathogeneses, clinical features and management of various types of BRAO are discussed at length. The natural history of visual acuity outcome shows a final visual acuity of 20/40 or better in 89% of permanent BRAO cases, 100% of transient BRAO and 100% of nonarteritic CLRAO alone. Cotton wools spots These are common, non-specific acute focal retinal...

show abstract

“…Following were the findings in various types of BRAO reported in a recent study (Hayreh et al , 2009a), based on 199 consecutive untreated patients (212 eyes).…”

Section: Branch Retinal Arteriolar Occlusionmentioning

confidence: 95%

“…In the recent study on 199 patients with BRAO, there was non-arteritic CLRAO alone in 6%, non-arteritic CLRAO associated with CRVO/hemi-CRVO in 19% and CLRAO associated with GCA in 6% (Hayreh et al , 2009a). …”

Section: Branch Retinal Arteriolar Occlusionmentioning

confidence: 99%

Acute retinal arterial occlusive disorders

Hayreh

2011

Progress in Retinal and Eye Research

Self Cite

311

309

View full text Add to dashboard Cite

show abstract

“…Hayreh et al (2009) prospectively evaluated the visual outcome (both VA and visual fields) in a cohort of 199 consecutive patients (212 eyes) with various types of BRAO. The following is a brief account of those findings (Hayreh et al, 2009).…”

Section: Natural History Of Visual Outcome In Branch Retinal Artementioning

confidence: 99%

“…In the study of Hayreh et al (2009), there were 11 eyes with non-arteritic CLRAO, 12 with arteritic CLRAO and 38 with CRVO/hemi-CRVO.…”

Section: Natural History Of Visual Outcome In Cilioretinal Arterymentioning

confidence: 99%

Ocular vascular occlusive disorders: Natural history of visual outcome

Hayreh

2014

Progress in Retinal and Eye Research

Self Cite

262

197

View full text Add to dashboard Cite

Ocular vascular occlusive disorders collectively constitute the most common cause of visual disability. Before a disease can be managed, it is essential to understand its natural history, so as to be able to assess the likely effectiveness of any intervention. I investigated natural history of visual outcome in prospective studies of 386 eyes with non-arteritic anterior ischemic optic neuropathy (NA-AION), 16 eyes with non-arteritic posterior ischemic optic neuropathy, 697 eyes with central retinal vein occlusion (CRVO), 67 eyes with hemi-CRVO (HCRVO), 216 eyes with branch retinal vein occlusion (BRVO), 260 eyes with central retinal artery occlusion (CRAO), 151 eyes with branch retinal artery occlusion (BRAO) and 61 eyes with cilioretinal artery occlusion (CLRAO). My studies have shown that every one of these disorders consists of multiple distinct clinical sub-categories with different visual findings. When an ocular vascular occlusive disorder is caused by giant cell arteritis, which is an ophthalmic emergency, it would be unethical to do a natural history study of visual outcome in them, because in this case early diagnosis and immediate, intensive high-dose steroid therapy is essential to prevent any further visual loss, not only in the involved eye but also in the fellow, normal eye. In NA-AION in eyes seen ≤2 weeks after the onset, visual acuity (VA) improved in 41% of those with VA 20/70 or worse, and visual field (VF) improved in 26% of those with moderate to severe VF defect. In non-ischemic CRVO eyes with VA 20/70 or worse, VA improved in 47% and in ischemic CRVO in 23%; moderate to severe VF defect improved in 79% in non-ischemic CRVO and in 27% in ischemic CRVO. In HCRVO, overall findings demonstrated that initial VA and VF defect and the final visual outcome were different in non-ischemic from ischemic HCRVO – much better in the former than the latter. In major BRVO, in eyes with initial VA of 20/70 or worse, VA improved in 69%, and moderate to severe VF defect improved in 52%. In macular BRVO with 20/70 or worse initial VA, it improved in 53%, and initial minimal-mild VF defect was stable or improved in 85%. In various types of CRAO there are significant differences in both initial and final VA and VF defects. In CRAO eyes seen within 7 days of onset and initial VA of counting fingers or worse, VA improved in 82% with transient non-arteritic CRAO, 67% with non-arteritic CRAO with cilioretinal artery sparing, 22% with non-arteritic CRAO. Central VF improved in 39% of transient non-arteritic CRAO, 25% of non-arteritic CRAO with cilioretinal artery sparing and 21% of non-arteritic CRAO. Peripheral VF improved in non-arteritic CRAO in 39% and in transient non-arteritic CRAO in 39%. In transient CRAO, finally peripheral VFs were normal in 93%. In non-arteritic CRAO eyes initially 22% had normal peripheral VF and in the rest it improved in 39%. Final VA of 20/40 or better was seen in 89% of permanent BRAO, and in 100% of transient BRAO and non-arteritic CLRAO. In permanent BRAO eyes, among those seen wit...

show abstract

“…In contrast, a BRAO leads to visual field defects corresponding to the ischemic retinal areas, and if the BRAO does not involve the fovea, the patient has relatively good vision. Hayreh et al reported that even if a case had a visual acuity <20/40 at the initial examination, 79% of these cases can have an improvement of their visual acuity 1. However, the decrease in the visual functions of both types is permanent unless the treatment starts soon after the occlusion.…”

Section: Introductionmentioning

confidence: 99%

Transcorneal electrical stimulation improves visual function in eyes with branch retinal artery occlusion

Oono

Kurimoto²,

Kashimoto³

et al. 2011

OPTH

View full text Add to dashboard Cite

Purpose:To investigate the effects of transcorneal electrical stimulation (TES) on eyes that have a branch retinal artery occlusion (BRAO).Subjects and method:We studied two eyes having a BRAO, with an interval between the onset of symptoms and the beginning of treatment of >16 weeks (longstanding cases), and in three eyes with an interval of <16 weeks (fresh cases). The visual functions of the eyes were assessed by the best-corrected visual acuity (BCVA), multifocal electroretinograms (mfERGs), and automated static perimetry with the Humphrey field analyzer (HFA). The mfERGs were recorded before and 1 month after the TES, and perimetry with the HFA was done before and at 1 and 3 months after the TES. The amplitudes and implicit times of the N1, P1, and N2 components of the mfERGs were analyzed.Results:TES did not alter the BCVA significantly in all eyes, but it led to a significant increase in the amplitude of the N2 wave of the mfERGs (P < 0.01). The amplitude of the N1–P1 was also increased but not significantly. The implicit times of N1 (P < 0.01) and P1 (P < 0.05) were significantly shorter than that before the TES. The mean deviation of the HFA was increased after the TES but only in the longstanding cases.Conclusion:Our results indicate that TES improves the visual function in eyes with BRAO, mainly in longstanding cases.

show abstract

Branch Retinal Artery Occlusion

Cited by 104 publications

References 25 publications

Acute retinal arterial occlusive disorders

Acute retinal arterial occlusive disorders

Ocular vascular occlusive disorders: Natural history of visual outcome

Transcorneal electrical stimulation improves visual function in eyes with branch retinal artery occlusion

Contact Info

Product

Resources

About