Prevalence and Distribution of Macular Fluid with Central Retinal Artery Occlusion and Anterior Ischemic Optic Neuropathy

Abstract

Purpose To examine the prevalence and distribution of fluid within a cohort of eyes with acute central retinal artery occlusion (CRAO) and non-arteritic anterior ischemic optic neuropathy (AION) using optical coherence tomography (OCT). Methods A retrospective analysis of patient records and OCT imaging. Patients presenting with acute CRAO or AION who had available macular OCT imaging and no co-morbidities known to cause macular fluid were included in the analysis. Baseline characteristics, visual acuity (VA), and fluid presence and distribution among the retinal layers were recorded. Results In the 16 eyes with acute CRAO, fluid was noted in 5 eyes (31%), which was mainly subretinal (3 eyes) or intraretinal located within the outer retinal layers (3 eyes). Only one eye had inner retinal cysts. Of the 11 eyes with acute AION, fluid was present in 8 eyes (73%). Subretinal fluid was noted in 4 eyes and extended to the foveal area in 3 of them, and outer retinal versus inner retinal cysts were noted in 6 versus 3 eyes, respectively. None of the eyes showed hard exudate deposition. In the small subset of eyes with CRAO and macular fluid that were followed-up, VA improved, while in eyes with AION, VA remained stable. Conclusion Macular fluid on OCT is not an uncommon feature of acute CRAO and AION and is mainly distributed within the outer retinal layers or subretinal space. Fluid is an understudied feature of retinal and optic nerve head infarction and may have a role in predicting neuronal damage extent and visual outcome.

Prevalence and Distribution of Macular Fluid with Central Retinal Artery Occlusion and Anterior Ischemic Optic Neuropathy [Letter]

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We read with interest the article by Fouad et al regarding macular fluid in CRAO and AION. 1 The results obtained in 11 cases of AION are generally in agreement with the acute phase findings in our own study, 2 emphasizing that early OCT imaging is crucial to detect retinal fluid accumulation and tissue oedema in AION. However, we disagree with the comment that in our article we reported that the finding in the inner nuclear layer (INL) of microcystic macular oedema (MME) "constitutes inner retinal cysts presumably associated with impaired axonal transport".

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Prevalence and Distribution of Macular Fluid with Central Retinal Artery Occlusion and Anterior Ischaemic Optic Neuropathy [Response to Letter]

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We thank Plant et al for their interest in our article "Prevalence and Distribution of Macular Fluid with Central Retinal Artery Occlusion and Anterior Ischemic Optic Neuropathy". 1 In our study, 6 out of 11 eyes with acute non-arteritic anterior ischemic optic neuropathy (AION) had intraretinal fluid on optical coherence tomography (OCT). All 6 eyes had fluid involving the outer nuclear layer, 4 eyes had fluid within the inner nuclear layer (INL), and 3 eyes had fluid within the ganglion cell layer (GCL).We agree with the authors of the letter on the importance of distinguishing the acutely developing microcystic macular edema from the later developing cystic degeneration of the INL (referred to as "retrograde maculopathy").

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