The Association Between Fundus Changes and Visual Prognosis in Central Retinal Artery Occlusion

To study the association between fundus changes and visual prognosis in central retinal artery occlusion (CRAO).

A total of 222 CRAO cases hospitalized at Hebei Eye Hospital between January 2013 and December 2016 were included in this study. Fundus photographs on admission were evaluated via dual independent image review. Retinal ischemic edema and cilioretinal arteries were graded. Logistic regression analysis was performed to explore the association between fundus findings and visual prognosis in CRAO.

The main fundus changes in CRAO patients on admission included retinal ischemic edema (95.0%), cherry-red spot (89.6%), retinal arterial narrowing (65.3%) and venous narrowing (53.6%), cotton-wool spots (53.6%), optic disc margin blurring (36.0%) and pallor (35.1%), retinal venous dilation (21.2%), and retinal hemorrhages (12.6%). Upon admission, retinal edema grades were grade 0 in 11 eyes (5.0%), grade 1 in 23 (10.4%), grade 2 in 80 (36.0%); and grade 3 in 108 (48.6%). Forty-seven eyes (21.1%) showed fissure-like edema, while 164 eyes (73.9%) exhibited a diffuse pattern. Chi square test showed the grade and pattern of retinal ischemic edema, the border and size of the cherry-red spot, the presence of retinal hemorrhage and cotton wool spots, macular folds and retinal arterial narrowing were all significantly associated with the time from symptom onset to presentation. Multivariate logistic regression analysis identified visual acuity at presentation, retinal ischemic grade, optic disc margin clarity, cherry-red spot size, and the presence of a cilioretinal artery supplying the macula as predictive factors for visual prognosis in CRAO.

The fundus changes in acute CRAO were correlated with the visual prognosis. Visual acuity at presentation, grade of retinal ischemic edema, clarity of the optic disc margin, size of the cherry-red spot, and the presence of a cilioretinal artery supplying the macula could be predictive factors for visual prognosis in CRAO.