Cerebral Small Vessel Disease in Branch Retinal Artery Occlusion

We investigated the pathophysiology of branch retinal artery occlusion (BRAO) by evaluating the retina, brain, and carotid artery in patients with BRAO.

This study was a retrospective registry study. We used 46 eyes from 46 patients with acute BRAO and evaluated the medical history, including previous cardiovascular disease, and compared brain magnetic resonance images (MRI) and carotid artery stenosis state between the embolic BRAO group and nonembolic BRAO group. We measured differences in cerebrovascular characteristics, including brain MRI, according to the existence of retinal emboli.

The embolic BRAO group tended to have a significantly higher likelihood of cardiovascular disease history, including ischemic heart disease and smoking history (P = 0.018 and P < 0.001, respectively). In addition, the embolic group had a higher frequency of acute cerebral infarctions and stenotic carotid arteries (P = 0.017 and P = 0.028, respectively). Although the overall frequency of cerebral small vessel disease (SVD) did not differ between embolic and nonembolic groups, the nonembolic BRAO group showed a significantly higher prevalence of cerebral SVD without large vessel pathology (P = 0.008).

Patients with BRAO showed different cerebrovascular characteristics following retinal emboli, including brain MRI findings. The results suggest that we must consider SVD etiology as well as large vessel disease mechanisms in the pathophysiology of BRAO.