Progress in central retinal artery occlusion: a narrative review

Abstract

Central retinal artery occlusion (CRAO) is a catastrophic ophthalmic emergency that severely impairs a patient’s visual function, often reducing visual acuity to counting fingers or worse. Progress in CRAO research has provided new information regarding its epidemiological characteristics and led to useful assessments through various ophthalmic examinations. Additional insights about CRAO have been gained through studies of its pathophysiological mechanisms, improving intervention timing and enhancing patient prognosis. Treatment for CRAO has evolved, particularly with assistance from surgical instruments and surgical robots. Although surgical treatment is now possible, this option is not widely recognized by ophthalmologists. Conservative therapies have limited benefits compared with the natural course of disease. Recently, pars plana vitrectomy plus endovascular surgery has received considerable interest among ophthalmologists because of its potential efficacy in the treatment of CRAO. Considering the inconsistencies in rationale and efficacy of CRAO treatment modalities, it is important to distinguish between treatment effects and the natural courses of various CRAO subclasses. This narrative review explores progress in CRAO epidemiology, pathophysiology, ophthalmic examination, and treatment.

From Heart to Eye

“…Despite this limitation, prompt identification of the underlying cause is critical given the potentially life-threatening sequelae of infectious endocarditis as an underlying etiology. 8 This absence of standardized treatment could be attributable to the disease's obscure pathophysiology and its rarity in the population. In 2022, Jayashinge et al 9 published a systematic review in which they compare the new treatments for CRAO in urgency, reporting that treatments other than intra-arterial and intravenous thrombolysis have shown some improvement in the management of CRAO when provided as combination therapy.…”

From Heart to Eye

“…Despite this limitation, prompt identification of the underlying cause is critical given the potentially life-threatening sequelae of infectious endocarditis as an underlying etiology. 8 This absence of standardized treatment could be attributable to the disease's obscure pathophysiology and its rarity in the population. In 2022, Jayashinge et al 9 published a systematic review in which they compare the new treatments for CRAO in urgency, reporting that treatments other than intra-arterial and intravenous thrombolysis have shown some improvement in the management of CRAO when provided as combination therapy.…”

Efficacy study of hyperbaric oxygen therapy for the treatment of central retinal artery occlusion: a systematic review

“…17 No gold standard VA-boosting therapy has been shown after CRAO. 18 Acute therapy within three hours of injury may prevent irreparable retinal ischemia. Extension to 61-2 hours is possible, however treatment after 12 hours is unsuccessful.…”

Orbital and sinus rhabdomyosarcoma with concurrent central retinal artery occlusion: A case report

“…CRAO is defined by abrupt blockage of the central retinal artery, resulting in inadequate retinal perfusion, swift and progressive cellular deterioration, and subsequent visual impairment[ 2 ]. The predominant cause of CRAO is platelet-fibrin thrombi and emboli originating from atherosclerotic disease, which account for more than two-thirds of all cases.…”

“…Upon ophthalmoscopic examination, the retina manifests as diffusely pale with centrally located cherry red spots. Prompt diagnosis and expeditious intervention aimed at eliminating or dissolving the obstructive embolus or thrombus are imperative to prevent irreversible retinal injury and mitigate the risk of blindness[ 2 ].…”

From Heart to Eye

“…Despite this limitation, prompt identification of the underlying cause is critical given the potentially life-threatening sequelae of infectious endocarditis as an underlying etiology. 8 This absence of standardized treatment could be attributable to the disease's obscure pathophysiology and its rarity in the population. In 2022, Jayashinge et al 9 published a systematic review in which they compare the new treatments for CRAO in urgency, reporting that treatments other than intra-arterial and intravenous thrombolysis have shown some improvement in the management of CRAO when provided as combination therapy.…”

Efficacy study of hyperbaric oxygen therapy for the treatment of central retinal artery occlusion: a systematic review

“…17 No gold standard VA-boosting therapy has been shown after CRAO. 18 Acute therapy within three hours of injury may prevent irreparable retinal ischemia. Extension to 61-2 hours is possible, however treatment after 12 hours is unsuccessful.…”

Orbital and sinus rhabdomyosarcoma with concurrent central retinal artery occlusion: A case report

“…CRAO is defined by abrupt blockage of the central retinal artery, resulting in inadequate retinal perfusion, swift and progressive cellular deterioration, and subsequent visual impairment[ 2 ]. The predominant cause of CRAO is platelet-fibrin thrombi and emboli originating from atherosclerotic disease, which account for more than two-thirds of all cases.…”

“…Upon ophthalmoscopic examination, the retina manifests as diffusely pale with centrally located cherry red spots. Prompt diagnosis and expeditious intervention aimed at eliminating or dissolving the obstructive embolus or thrombus are imperative to prevent irreversible retinal injury and mitigate the risk of blindness[ 2 ].…”

From Heart to Eye

“…Despite this limitation, prompt identification of the underlying cause is critical given the potentially life-threatening sequelae of infectious endocarditis as an underlying etiology. 8 This absence of standardized treatment could be attributable to the disease's obscure pathophysiology and its rarity in the population. In 2022, Jayashinge et al 9 published a systematic review in which they compare the new treatments for CRAO in urgency, reporting that treatments other than intra-arterial and intravenous thrombolysis have shown some improvement in the management of CRAO when provided as combination therapy.…”

Efficacy study of hyperbaric oxygen therapy for the treatment of central retinal artery occlusion: a systematic review

“…17 No gold standard VA-boosting therapy has been shown after CRAO. 18 Acute therapy within three hours of injury may prevent irreparable retinal ischemia. Extension to 61-2 hours is possible, however treatment after 12 hours is unsuccessful.…”

Orbital and sinus rhabdomyosarcoma with concurrent central retinal artery occlusion: A case report

“…CRAO is defined by abrupt blockage of the central retinal artery, resulting in inadequate retinal perfusion, swift and progressive cellular deterioration, and subsequent visual impairment[ 2 ]. The predominant cause of CRAO is platelet-fibrin thrombi and emboli originating from atherosclerotic disease, which account for more than two-thirds of all cases.…”

“…Upon ophthalmoscopic examination, the retina manifests as diffusely pale with centrally located cherry red spots. Prompt diagnosis and expeditious intervention aimed at eliminating or dissolving the obstructive embolus or thrombus are imperative to prevent irreversible retinal injury and mitigate the risk of blindness[ 2 ].…”