The Retrobulbar Spot Sign and Prominent Middle Limiting Membrane as Prognostic Markers in Non-Arteritic Retinal Artery Occlusion

Schnieder, Marlena; Fischer-Wedi, Charlotte V; Bemme, Sebastian; Kortleben, Mai-Linh; Feltgen, Nicolas; Liman, Jan

doi:10.3390/jcm10020338

Cited by 8 publications

(3 citation statements)

References 29 publications

(9 reference statements)

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“…All cells of the inner retinal layers suffer from acute swelling in severe acute CRAO, resulting in hyperreflectivity of the entire inner retinal layers on OCT. As a result of the higher reflectivity of the other inner retinal layers, the p-MLM sign is no longer visible on OCT. As a result, in acute CRAO, the p-MLM sign is an indicator of less severe ischemic damage and may be a factor associated with a better visual acuity outcome. Our observations on the p-MLM sign are similar to that reported by Chu et al and Schneider et al [ 18 , 19 ].…”

Section: Discussionsupporting

confidence: 92%

Retinal OCT findings in acute central retinal artery occlusion of varying severity at different disease stages – a retrospective, observational study

Mangla¹,

Venkatesh²,

Sangoram³

et al. 2023

Int J Retin Vitr

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Purpose To study the optical coherence tomography (OCT) changes in eyes with acute central retinal artery occlusion (CRAO) of different severity and at different disease stages. Methods The study included acute CRAO cases of < 7 days duration, imaged on OCT at various time points. Based on the OCT findings at presentation, cases were classified into three severity groups: mild, moderate, and severe. OCT scans were evaluated and classified into four-time intervals based on symptom duration. Results There were 39 eyes from 38 patients with acute CRAO who underwent 96 OCT scans. At presentation, the study had 11, 16, and 12 cases of mild, moderate, and severe CRAO, respectively. Middle retinal layer opacification was more common in mild CRAO cases, which caused inner retinal layer thinning over time. Moderate CRAO cases had total inner retinal layer opacification, which resulted in retinal thinning over time. Prominent middle limiting membrane (p-MLM) sign was seen in mild and moderate CRAO eyes while were not visualised in severe CRAO. This sign gradually faded out over time. Other OCT findings in higher grades of CRAO included inner retinal fluid, neurosensory detachment, internal limiting membrane detachment, hyperreflective foci, and posterior vitreous opacities. Regardless of the CRAO grade, the final end-point seen was inner retinal layer thinning over time. Conclusion OCT in CRAO is a useful for determining the severity of retinal ischemia, disease stage, tissue damage mechanism, and final visual outcome. More prospective studies analysing a larger number of cases at fixed time points will be required in the future. Trial Registration Trial Registration Number: Not applicable.

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Section: Discussionsupporting

confidence: 92%

Retinal OCT findings in acute central retinal artery occlusion of varying severity at different disease stages – a retrospective, observational study

Mangla¹,

Venkatesh²,

Sangoram³

et al. 2023

Int J Retin Vitr

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“…Additional imaging modalities could potentially enhance the diagnostic workflow. There is evidence that a positive retrobulbar spot sign visualized by ultrasound could be associated with a poor response to IVT and could therefore be a contraindication ( 15 , 22 , 23 ). Retinal diffusion restriction visualized by diffusion-weighted magnetic resonance imaging (DWI-MRI) may provide additional information ( 24 ).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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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.

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“…2,3 Approximately 38%-50% of CRAOs have no identified embolic source, which is more than twice the reported proportion of embolic stroke of unknown source. [4][5][6] Ischemic monocular visual loss with an uncertain embolic source has been reported to be less frequently associated with concurrent cerebral ischemic lesions. 4,5 These findings suggest that the pathomechanism of CRAO with and without embolic sources may differ.…”

Section: Introductionmentioning

confidence: 99%

Presence of Embolic Source and Outcome in Central Retinal Artery Occlusion

et al. 2023

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Objectives:The etiology of central retinal artery occlusion (CRAO) is unclear in about 50% of patients, suggesting pathomechanical heterogeneity; moreover, little is known about outcomes according to etiology. This study investigated whether the presence of an embolic source affects outcome in CRAO.Methods:CRAO patients within 7 days of symptom onset were retrospectively enrolled. Clinical parameters, including initial and 1-month visual acuity, CRAO subtype, and brain images, were reviewed. CRAO etiology was categorized as CRAO with or without an embolic source (CRAO-E+and CRAO-E-). Visual improvement was defined as a decrease in logarithm of the minimum angle of resolution ≥0.3 at 1 month.Results:A total of 114 patients with CRAO were included. Visual improvement was noted in 40.4% of patients. Embolic sources were identified in 55.3% of patients, and visual improvement group rather than no improvement group was more commonly associated with the presence of an embolic source. In multivariable logistic regression analysis, CRAO-E+independently predicted visual improvement (OR 3.00, 95% CI 1.15–7.81,P= 0.025).Discussion:CRAO-E+was found to be associated with a better outcome. CRAO-E+may be more prone to recanalization than that CRAO-E-.

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The Retrobulbar Spot Sign and Prominent Middle Limiting Membrane as Prognostic Markers in Non-Arteritic Retinal Artery Occlusion

Cited by 8 publications

References 29 publications

Retinal OCT findings in acute central retinal artery occlusion of varying severity at different disease stages – a retrospective, observational study

Retinal OCT findings in acute central retinal artery occlusion of varying severity at different disease stages – a retrospective, observational study

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

Presence of Embolic Source and Outcome in Central Retinal Artery Occlusion

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