Imaging of Dual Ophthalmic Arteries: Identification of the Central Retinal Artery

Abstract

Identification of the origin of the central retinal artery (CRA) is imperative in tailoring angiographic studies to resolve a given clinical problem. A case with dual ophthalmic arteries (OAs), characterized by different origins and distinct branching patterns, is documented for training purposes. Pre-clinical diagnosis of a 9-year-old child who presented with a sharp wire in the left-side eyeball was primarily corneal laceration. For imaging, a selected six-vessel angiographic study with the transfemoral approach was performed. Embolization was not required and the wire could be successfully removed. Right-side OA anatomy was normal, while left-side dual OAs with external carotid artery (ECA) and internal carotid artery (ICA) origins were seen. The case presented with a left-side meningo-ophthalmic artery (M-OA) anomaly via the ECA, marked by a middle meningeal artery (MMA) (origin: Maxillary artery; course: Through foramen spinosum) with normal branches (i.e. anterior and posterior branches), and an OA variant (course: Through superior orbital fissure) with a distinct orbital branching pattern. A smaller OA (origin: ICA; course: Through optic foramen) with a distinct ocular branching pattern presented with the central retinal artery (CRA). The presence of the dual OAs and the M-OA anomaly can be explained by disturbed evolutionary changes of the primitive OA and stapedial artery during development. The surgical interventionist must be aware of dual OAs and M-OA anomalies with branching pattern variations on retinal supply, because of dangerous extracranial–intracranial anastomotic connections. It is of clinical significance that the origin of the CRA from the ICA or ECA must be determined to avoid complications to the vision.

Unusual ophthalmic artery origin: Implications for intraarterial chemotherapy of retinoblastoma

“…They stated that the latter traversed through the optic foramen and branched off the CRA. 11 The embryology of the OA and its branches is a poorly understood, complex process, and there are several theories with regard to embryological development. According to Padget, adult OA develops from the ventral and dorsal primitive OAs, which arise from the levels of the future anterior choroidal artery origin and future posterior communicating artery origin, respectively.…”

“…They also have different opinions over which primitive artery branches off the CRA. 11 The CRA originates from the dorsal OA according to Padget; meanwhile, it originates from the ventral OA according to Lasjaunias and colleagues, who propose that the OA arising from the cavernous segment of the ICA entering the orbit via the SOF is termed as persistent dorsal OA. 8 They state that the anomalous origin of the OA from the ACA corresponds to the persistent ventral OA and is the result of the failure of caudal migration of the primitive ventral OA.…”

Anatomy of the Ophthalmic Artery: A Review concerning Its Modern Surgical and Clinical Applications

“…This variation corresponds to the persistence of ventral OA and its main clinical significance is aberrant course of OA above ON, instead of what is presented below. Double OA due to the persistence of both ventral and dorsal primitive OA have been reported rarely [ 27 – 30 ].…”

Central retinal artery delineation using magnetic resonance imaging

“…However, to the best of our knowledge, few studies have explored the CRAs with neuroimaging modalities [3,13]. Due to its very ne blood ow compared to the ophthalmic artery from which it arises, it is di cult to delineate the CRAs even with catheter angiography, especially under physiological conditions [2,10]. The present study aimed to explore CRAs using thin-slice contrast-enhanced magnetic resonance imaging (MRI).…”