Central retinal artery occlusion resembling Purtscher-like retinopathy

Abstract

This paper reports three cases of central retinal artery occlusion (CRAO) with Purtscher-like retinopathy and good recovery of visual function. The three cases of CRAO had similar fundus changes, ie, cotton wool patches surrounding the optic disc and whitening of the retina surrounding the fovea with a cherry red spot. Fluorescein angiography showed a delay of arm-to-retina circulation time and a partial defect of choroid circulation. Although the three cases were treated by different regimens of steroid pulse therapy and antiplatelet therapy, visual function recovered well and all disturbances of the retinal and choroid circulations resolved. Although eyes with a CRAO normally have a poor visual prognosis, our three cases responded well to the treatments and recovered good visual function. Thus, cases showing fundus changes similar to our three cases may have a pathogenesis different from that of a complete CRAO.

Letter to the editor: partial central retinal artery occlusion offers a unique insight into the ischemic penumbra

“…Although not reported as such, periarterial sparing is readily discernible in the fundus photographs of two of Kurimoto et al’s patients (cases 1 and 2) 1. Similar sparing is also a potential feature of panretinal hypoperfusion in eyes with so-called nonischemic central retinal vein occlusion (CRVO).…”

“…Kurimoto and colleagues recently reported three cases of unilateral visual loss associated with striking ischemic changes in the posterior retina and impressive visual recovery following treatment 1. The presenting signs included an indistinct foveal cherry-red spot and a circle of cotton-wool spots (CWSs) surrounding the optic disc.…”

Evidence for an enduring ischaemic penumbra following central retinal artery occlusion, with implications for fibrinolytic therapy

“…In such eyes, the inner retina typically reperfuses after several days whereupon visual function will often improve markedly, sometimes to "normal" visual acuity and a "full" visual field albeit usually with a persistent RAPD and subsequent development of some degree of optic atrophy (Wise et al, 1971;Oji and McLeod, 1978;Kurimoto et al, 2011). The functional improvement achieved following recanalisation of the CRA is accompanied by resumption of normal retinal venous sO 2 levels (i.e.…”

“…After restoration of the CRA circulation, the OEF reverts to normal (i.e. it decreases to 40e50%) and visual acuity and fields often show remarkable recovery, presumably through expansion of the volume of functioning cells and restoration of their connectivity with the higher visual pathways Kurimoto et al, 2011). The likelihood is that a similar visual recovery process obtains after retinal reperfusion in patients with the "classic" CRAO picture and a residual circulation on FFA, albeit a much lesser degree of functional revival is to be anticipated.…”

“…A proportion of RGC axons are permanently damaged in eyes with "partial" CRAO, witness the persistent RAPD and the partial optic atrophy and nerve-fibre bundle defects that become evident by ophthalmoscopy after some weeks of follow-up (Hoyt et al, 1972;Oji and McLeod, 1978;Kurimoto et al, 2011;McLeod, 2012). The "grooves" that develop in the NFL as the larger CWSs are absorbed suggest that the formation of "penumbral sentinels" (i.e.…”