Retinal oedema in central retinal artery occlusion develops as a function of time

Ochakovski, G. Alex; Wenzel, Daniel A.; Spitzer, Martin S.; Poli, Sven; Härtig, Florian; Fischer, Manuel; Dimopoulos, Spyridon; Schultheiß, Maximilian

doi:10.1111/aos.14375

Cited by 24 publications

(15 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Typically, CRAO is a clinical diagnosis, but as unfortunately clinical signs such as retinal edema and a cherry red spot may have not evolved in the very early phase, pathognomonic signs on OCT scans can provide valuable information about CRAO. An increase in retinal thickness for example is a characteristic feature, for which a temporal correlation has been shown recently ( 16 , 17 ). Similarly, a rise in optical intensity in the affected eye can be observed ( 9 , 11 , 12 , 19 ), but the temporal dynamics have yet been unknown.…”

Section: Discussionmentioning

confidence: 79%

Inner Retinal Layer Hyperreflectivity Is an Early Biomarker for Acute Central Retinal Artery Occlusion

et al. 2022

View full text Add to dashboard Cite

PurposeTo investigate inner retinal hyperreflectivity on optical coherence tomography (OCT) as a potential biomarker indicating acute central retinal artery occlusion (CRAO).MethodsA total of 56 patients at two university hospitals with acute CRAO (symptom onset ≤48 h) were included in this retrospective study. The optical intensity of the inner retinal layers was determined in both eyes and the relationship between symptom onset and inner retinal layer optical intensity in OCT scans compared to the unaffected fellow eye was analyzed. Several differential diagnoses [central retinal vein occlusion, anterior ischemic optic neuropathy, diabetic macular edema, and subretinal fibrosis/disciform scar (Junius-Kuhnt)] served as controls to validate optical intensity-based diagnosis of CRAO.ResultsCRAO strongly correlated with an increased inner retinal layer hyperreflectivity in this cohort with acute CRAO with a time since symptom onset ranging from 1.1 to 48.0 h. Receiver operating characteristic (ROC) analysis showed an area under the curve of 0.99 to confirm CRAO with a true positive rate of 0.93 and a false positive rate of 0.02. No correlation between optical intensity and time since symptom onset was noticeable. None of the differential diagnoses did show an elevated optical intensity of the inner retinal layers as it was detectable in CRAO.ConclusionOCT-based determination of inner retinal layer hyperreflectivity is a very promising biomarker for a prompt diagnosis of CRAO in an emergency setting. This may be of major interest to speed up the administration of a possible thrombolytic treatment.

show abstract

Section: Discussionmentioning

confidence: 79%

Inner Retinal Layer Hyperreflectivity Is an Early Biomarker for Acute Central Retinal Artery Occlusion

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Although it is well known that acute CRAO induces a retinal oedema, data dealing with the exact temporal dynamics of the retinal thickness increase, however, is scarce (Falkenberry et al 2006; Shinoda, Yamada & Matsumoto 2008; Chen, Hwang & Chen 2011; Cornut et al 2012). Our recent publication found near‐linear retinal thickness increase as a function of time in the very acute phase (first 9 hr) of CRAO, which gave reason to us to investigate this possible biomarker's behaviour over the first 48 hr after ischaemia onset in the present study (Ochakovski et al 2020). We hypothesized that RRTI might be useful to be used as surrogate marker to determine whether a patient is within the therapeutic window of 4.5 hr – the period of time where a reperfusion therapy might be beneficial (Schrag et al 2015; Schultheiss et al 2018).…”

Section: Discussionmentioning

confidence: 86%

“…Nonetheless, the exact temporal dynamics of the natural course of retinal thickness changes in the acute phase of CRAO are not well described and, so far, remain inconclusive. Recently, we have shown that the retinal thickness increase shows a near‐linear progression rate within the first 9 hr after ischaemia onset measured by optical coherence tomography (OCT) (Ochakovski et al 2020). In this context, the objective of this study was to quantitatively assess the temporal changes in retinal thickness within the first 48 hr and to determine the ability of OCT‐based retinal thickness analysis to specify the time of ischaemia onset in acute CRAO (≤ 8 hr) patients, which in the future may imply important consequences for possible reperfusion concepts, such as intravenous thrombolysis.…”

Section: Introductionmentioning

confidence: 99%

Optical coherence tomography‐based determination of ischaemia onset – the temporal dynamics of retinal thickness increase in acute central retinal artery occlusion

Wenzel

Kromer

Poli

et al. 2020

Acta Ophthalmologica

Self Cite

View full text Add to dashboard Cite

Purpose Acute central retinal artery occlusion (CRAO) induces ischaemic retinal oedema. The purpose of this study was to define sensitivity and specificity of optical coherence tomography (OCT) based retinal thickness analysis in determining ischaemia onset in CRAO. Methods The relative retinal thickness increase (RRTI) in comparison with the fellow eye was analysed retrospectively in OCT scans of 66 patients diagnosed with CRAO between January 2010 and December 2019 within 48 hr of ischaemia onset. The natural course of RRTI and the sensitivity and specificity of OCT‐based determination of ischaemia onset in identifying CRAO within 4.5 hr using the RRTI were evaluated. Results Relative retinal thickness increase (RRTI) in acute CRAO follows a hyperbolic curve with a steep incline within the early phase after which it reaches a plateau. Optical coherence tomography (OCT)‐based retinal thickness analysis in CRAO allows to differentiate patients with ischaemia onset within the past 4.5 hr or thereafter with a sensitivity of 100% and a specificity of 94.3%. Conclusion Relative retinal thickness increase (RRTI) allows to identify CRAO patients that are eligible for a potentially beneficial reperfusion therapy within a therapeutic window of 4.5 hr with a high accuracy. Especially in patients with unknown ischaemia onset, this diagnostic tool could be of major importance in the future clinical management.

show abstract

“…In previous studies, we presented the temporal changes of retinal thickness in acute CRAO patients [ 5 , 16 ]. We showed with a sensitivity of 100% and a specificity of 94.3% that RRTI is a valuable surrogate parameter to determine if ischemia onset was within the last 4.5 hours [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Determination of Ischemia Onset Based on Automatically Generated Spectralis SD-OCT Values in Acute Central Retinal Artery Occlusion

Casagrande

Kromer

Wenzel

et al. 2021

Journal of Ophthalmology

Self Cite

View full text Add to dashboard Cite

Acute central retinal artery occlusion (CRAO) induces a time-dependent increase in retinal thickness. By manually measuring the relative retinal thickness increase (RRTI) in comparison to the contralateral eye based on optical coherence tomography (OCT), ischemia onset within the past 4.5 hours could be determined with 100% sensitivity and 94.3% specificity. To enable examiner-independent and quicker diagnostics, we analyzed the RRTI using the automatic retinal thickness measurement. In this retrospective study, 28 eyes were evaluated with an acute CRAO (<46 hours). All patients received a Spectralis SD-OCT image of both eyes. The RRTI was calculated for the ETDRS sectors using the Segmentation Module for Single Retinal Layer Analysis. Receiver operating characteristic (ROC) analysis was performed to determine patients ≤4.5 hours by RRTI. In all sectors, time to OCT (TTO) and RRTI correlated positively. The optimal cutoff point to detect CRAOs ≤4.5 hours was between 18.7% nasally and 22.9% RRTI temporally. Sensitivity and specificity varied between the sectors with 90–95% sensitivity and 89–100% specificity. In conclusion, the automatic measurement of RRTI also allows the differentiation of CRAOs within a possible therapeutic time window ≤4.5 hours and CRAOs ≥4.5 hours with a high sensitivity and specificity. Additionally, it offers quicker, easier, and a user-independent assessment of ischemia onset, helping to set a base for establishing automatic indices generated by the OCT machines.

show abstract

Retinal oedema in central retinal artery occlusion develops as a function of time

Cited by 24 publications

References 18 publications

Inner Retinal Layer Hyperreflectivity Is an Early Biomarker for Acute Central Retinal Artery Occlusion

Inner Retinal Layer Hyperreflectivity Is an Early Biomarker for Acute Central Retinal Artery Occlusion

Optical coherence tomography‐based determination of ischaemia onset – the temporal dynamics of retinal thickness increase in acute central retinal artery occlusion

Determination of Ischemia Onset Based on Automatically Generated Spectralis SD-OCT Values in Acute Central Retinal Artery Occlusion

Contact Info

Product

Resources

About