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Updated: Jun 1, 2026

Retinal Vascular Reactivity as Assessed by Optical Coherence Tomography Angiography
07:23

Retinal Vascular Reactivity as Assessed by Optical Coherence Tomography Angiography

Published on: March 26, 2020

Acute retinal arterial occlusive disorders.

Sohan Singh Hayreh1

  • 1Department of Ophthalmology and Visual Sciences, College of Medicine, University Hospitals and Clinics, 200 Hawkins Drive, University of Iowa, Iowa City, IA 52242-1091, USA. sohan-hayreh@uiowa.edu

Progress in Retinal and Eye Research
|May 31, 2011
PubMed
Summary

Acute retinal arterial ischemic disorders, including central retinal artery occlusion (CRAO) and branch retinal artery occlusion (BRAO), have distinct subtypes impacting prognosis. Understanding these classifications is key for effective management and predicting visual outcomes.

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Published on: November 12, 2020

Area of Science:

  • Ophthalmology
  • Vascular Neurology
  • Retinal Vascular Diseases

Background:

  • Acute retinal arterial ischemic disorders encompass central retinal artery occlusion (CRAO), branch retinal artery occlusion (BRAO), cotton wool spots, and amaurosis fugax.
  • Understanding the anatomical features of ophthalmic, central retinal, and cilioretinal arteries is crucial for diagnosing and managing these conditions.
  • The duration of retinal ischemia significantly impacts the potential for permanent damage, with irreversible injury occurring by 4 hours of CRAO.

Purpose of the Study:

  • To clarify the distinct clinical entities within CRAO and BRAO, challenging the notion of them being single conditions.
  • To discuss the pathogenesis, clinical features, and management strategies for various types of CRAO and BRAO.
  • To address controversies and misconceptions surrounding acute retinal arterial ischemic disorders, particularly CRAO.

Main Methods:

  • Review and synthesis of existing literature on the classification, pathophysiology, and clinical presentation of retinal arterial occlusive events.
  • Analysis of experimental data on retinal survival times following CRAO.
  • Discussion of clinical observations regarding spontaneous visual improvement in different CRAO subtypes.

Main Results:

  • CRAO is reclassified into four distinct entities: non-arteritic CRAO, non-arteritic CRAO with cilioretinal artery sparing, arteritic CRAO (associated with giant cell arteritis), and transient non-arteritic CRAO.
  • BRAO is similarly categorized into permanent BRAO, transient BRAO, and cilioretinal artery occlusion (CLRAO), with CLRAO further divided into three subtypes.
  • Spontaneous visual improvement occurs in CRAO subtypes within 7 days, with varying incidences (e.g., 82% in transient non-arteritic CRAO vs. 22% in non-arteritic CRAO). Intra-arterial thrombolysis may be harmful.

Conclusions:

  • Accurate classification of CRAO and BRAO subtypes is essential for understanding their distinct pathogeneses, clinical courses, and prognoses.
  • The potential for spontaneous visual recovery differs significantly among CRAO subtypes, influencing management decisions.
  • Current evidence suggests caution regarding the use of intra-arterial thrombolytic agents in CRAO due to potential harm.