Clinical Characteristics and Natural History of Branch Retinal Artery Ischemia

To describe the clinical features and natural history of branch retinal artery ischemia (BRAI)-an uncommon condition where chronic, partial branch retinal artery obstruction (also known as partial BRAO) by a nonocclusive arterial plaque causes sectoral retinal ischemia and hemorrhages.

A retrospective, multicenter cohort study.

Thirteen patients diagnosed with BRAI between January 1, 2013, and December 31, 2023.

We identified patients with BRAI based on the presence of (1) a retinal arterial plaque, (2) sectoral round hemorrhages in the distribution of the affected artery, and (3) delayed arterial flow on fluorescein angiography (FA). We reviewed longitudinal medical records, color fundus images, FA, OCT, and OCT angiography images where available. We also systematically reviewed images of patients diagnosed with Hollenhorst plaque, BRAO or central retinal artery occlusion, or ocular ischemic syndrome to estimate BRAI prevalence.

Clinical features, visual acuity (VA), and central subfield thickness.

We identified 13 patients with BRAI with a median follow-up of 1.7 years (range 0.1-6.3 years). The mean age was 74.2 ± 9.4 years, with 61.5% men. Most patients had a history of hypertension (76.9%), hyperlipidemia (84.6%), carotid artery disease (69.2%), or type 2 diabetes mellitus (69.2%). Most patients (53.9%) maintained good VA (20/25 or better) over the years, and none developed macular edema or neovascularization during follow-up. The retinal hemorrhages fluctuated in severity over time but did not correlate with VA or central subfield thickness.

Branch retinal artery ischemia is defined by a triad of features: retinal arterial plaque, sectoral retinal hemorrhages, and delayed arterial flow. Most patients with BRAI have systemic vascular risk factors but maintain good vision without complications over years.

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