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Treatment of Nonarteritic Acute Central Retinal Artery Occlusion
Rahul A Sharma1, Michael Dattilo2, Nancy J Newman2,3,4
1Department of Ophthalmology, The University of Ottawa, Ottawa, ON, Canada.
Insights
Central retinal artery occlusion (CRAO) causes severe vision loss, often from emboli. Optimal treatment remains unclear, with thrombolysis showing limited evidence and uncertain risks.
Area of Science:
- Ophthalmology
- Neurology
- Cardiology
Background:
- Central retinal artery occlusion (CRAO) is a critical vascular event leading to profound vision loss.
- It typically results from emboli originating from the carotid artery, aortic arch, or heart.
- The central retinal artery (CRA) is the main blood supply to the inner neurosensory retina.
Purpose of the Study:
- To review the clinical presentation, diagnosis, and prognosis of CRAO.
- To summarize current and potential treatment options for acute CRAO.
- To emphasize risk factor identification and secondary prevention strategies.
Main Methods:
- Literature review of clinical presentations, diagnostic methods, and treatment outcomes for CRAO.
- Analysis of evidence supporting various treatment modalities, including thrombolysis.
- Discussion of risk factors associated with CRAO and cerebrovascular events.
Main Results:
- No established consensus exists for the optimal treatment of CRAO.
- Proposed treatments, including thrombolysis, have questionable efficacy and uncertain risk profiles.
- Risk factors for CRAO often overlap with those for cardiovascular and cerebrovascular events.
Conclusions:
- Management of CRAO focuses on identifying high-risk patients for stroke and implementing secondary prevention.
- Further research is needed to establish effective and safe treatment protocols for acute CRAO.
- Understanding CRAO's clinical aspects is crucial for timely diagnosis and prognosis assessment.
Abstract:
Central retinal artery occlusion (CRAO) is an event most often caused by an embolus originating in the ipsilateral carotid artery, aortic arch, or heart. CRAO may result from partial or complete occlusion of the central retinal artery (CRA), which acts as the primary blood supply to the inner neurosensory retina, and typically results in profound vision loss and permanent visual disability. No consensus has emerged regarding the optimal treatment of CRAO. All proposed treatments are of questionable efficacy and many have uncertain risk profiles. In certain circumstances, thrombolysis may be attempted as a treatment option; however, the evidence to support broad use of thrombolytics in the treatment of acute CRAO remains elusive. It is known that the risk factors that predispose to other cardiovascular and cerebrovascular events are often present in CRAO. Accordingly, identification of patients at highest risk of stroke and secondary prevention of ischemic events remains the primary focus of management. This review offers a summary of the clinical presentation, diagnosis, and prognosis of CRAO, with an emphasis on treatment options.
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