Atheromatous and atheroma-like lesions of the central retinal artery: histopathological correlations

Arteriosclerosis is very rare in the distal central retinal artery (CRA) of aged eyes devoid of significant ocular pathology. Nevertheless, atheromatous and atheroma-like lesions are occasionally observed in routine ophthalmic pathology. We investigated the histopathologic correlations of the eyes and vessels involved. Twenty-eight globes presenting atheromatous and atheroma-like lesions (defined as accumulations of foamy macrophages in the tunica intima) in the CRA or its first-order branches were obtained from our files and studied under light microscopy. Vessels were examined for 7 histological characteristics related to atherogenesis, and the histopathological features of the involved eyes were analysed. Deposits of foamy macrophages were observed most frequently in the postlaminar CRA, followed by the intraneural and the intralaminar segment. There was a conspicuous association with glaucoma (78.6%), especially neovascular glaucoma (71.4%). The most frequently associated ocular pathologic features were optic atrophy (96.4%), atrophy of the inner retina (85.7%), cataract (64.3%), and inflammatory conditions (50%). Atheromatous and atheroma-like lesions of the CRA appear to be more common than generally reported. It is unlikely that they represent an age-related degenerative type of arteriosclerosis. They are more likely to be primarily or secondarily related to the severe ocular disease conditions with which they are found.