Analysis of visual characteristics with non arteritic central retinal artery occlusion after treatment_Chinese Journal of Ocular Fundus Diseases

Authors：

Li Xiabo , Zheng Xuejing , Li Tong , Liu Hao , Xu Menghan , Yan Mei , Lu Xin , Hou Lihua ,  Wang Min

Department of Ophthalmology, First People's Hospital of Xianyang City (Xianyang Eye Hospital), The First People's Hospital of Xianyang City Affiliated to Shaanxi University of Traditional Chinese Medicine, Clinical Medical Research Center of Eye Diseases, Xianyang 712000, China;

Corresponding?author：

Wang Min, Email: angin2001@126.com

Keywords：

Non arteritic central retinal artery occlusion; Central visual acuity; Extra cenrtal visual acuity; Intravenous thrombolysis; Hyperbaric oxygen therapy

DOI：

10.3760/cma.j.cn511434-20250221-00066

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Objective To observe the changes of central visual acuity and extracentral visual acuity in eyes with non-arteritic central retinal artery occlusion (NA-CRAO). Methods A retrospective clinical study. From January 1, 2017 to December 31, 2024, 140 patients (140 eyes) diagnosed with NA-CRAO through ophthalmic examination at Department of Ophthalmology of First People's Hospital of Xianyang City were included in the study. All affected eyes underwent best corrected visual acuity (BCVA), visual field, intraocular pressure, fundus color photography, optical coherence tomography (OCT), and fluorescein angiography (FFA) examinations. After a clear diagnosis, conservative treatment such as reducing intraocular pressure, relieving spasms, and dilating blood vessels should be given immediately. Simultaneously, intravenous and/or arterial thrombolysis therapy should be administered based on the patient's overall condition. Under the same treatment conditions as other treatments, 33 eyes were treated with hyperbaric oxygen therapy within 24 hours after seeking medical attention. The changes in central visual acuity (BCVA) and peripheral visual acuity of the affected eye one month after treatment were observed. BCVA improvement of ≥ 1 line was defined as the increase of no light sensitivity to light sensitivity or above, and the increase of light sensitivity to 0.01 or above. The visual acuity outside the center was determined by the 0 ° axis in front of the eyeball at eye level, and was 10 ° outside visual acuity on the temporal side. Multivariate analysis using logistic regression analysis. Results Among the 140 cases (140 eyes), there were 84 males (84 eyes) and 56 females (56 eyes). The mean age was (63.89±10.78) years. The duration of illness from the onset of symptoms to the time of diagnosis was 48 (2-720) hours. 6, 1, 14, 47, 41, 16, and 15 eyes were diagnosed with BCVA without light perception, uncertain light perception, manual/anterior, digital/anterior, 0.01-0.10, and ≥ 0.10, respectively. FFA examination revealed delayed arm retinal circulation time and filling of the retinal artery trunk to the peak, with changes in the "arterial front" observed in 126 eyes. OCT examination showed extensive edema and unclear structure in the inner layer of the retina in all patients. Out of 140 eyes, 122 were treated with intravenous thrombolysis and 4 with arterial thrombolysis; 14 eyes did not receive thrombolytic therapy. After treatment, 38 eyes (27.1%) showed an improvement of BCVA ≥ 1; 67 eyes (47.9%) did not show an improvement in BCVA, and the affected eye had a BCVA of approximately 0.6 without light perception; 17 eyes (12.1%) showed improvement in peripheral vision, and the peripheral vision of the affected eyes ranged from 0.01 to 0.1, all of whom were patients undergoing intravenous thrombolysis, and prior to treatment, this group of patients had complete blindness in the coarse side visual field of the Amsler grid, and their out of center visual acuity could not be measured. Among the 33 eyes treated with hyperbaric oxygen therapy, 24 eyes (72.7%) showed an increase in BCVA after treatment; 9 eyes did not improve, among which 4 eyes (12.1%) showed improvement in out of center visual acuity. Among the 107 eyes that did not receive hyperbaric oxygen therapy, 49 eyes (45.8%) showed an increase in BCVA after treatment. There was no improvement in 58 eyes (54.2%), among which 13 eyes (12.1%) showed an improvement in out of center visual acuity. The results of logistic regression analysis showed that intravenous thrombolysis and hyperbaric oxygen therapy were independent predictive factors for the improvement of central and extra central visual acuity (P＜0.05). Conclusions Hyperbaric oxygen therapy within 24 hours of seeking medical attention for patients with NA-CRAO disease course ≤ 1 month has a significant effect on the recovery of central and extra central vision. Intravenous thrombolysis and hyperbaric oxygen therapy are independent predictive factors for the improvement of central and extra central vision.

Citation： Li Xiabo, Zheng Xuejing, Li Tong, Liu Hao, Xu Menghan, Yan Mei, Lu Xin, Hou Lihua, Wang Min. Analysis of visual characteristics with non arteritic central retinal artery occlusion after treatment. Chinese Journal of Ocular Fundus Diseases, 2025, 41(10): 787-792. doi: 10.3760/cma.j.cn511434-20250221-00066 Copy

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5.	呂沛霖, 王潤生, 杜善雙. 視網膜中央動脈阻塞患眼睫狀視網膜動脈存在情況及其與中心視力損害的關系[J]. 中華眼底病雜志, 2014, 30(5): 454-457. DOI: 10.3760/cma.j.issn.1005-1015.2014.05.006.Lyu PL, Wang RS, Du SS. Correlation between cilioretinal artery and central visual loss in central retinal artery occlusion[J]. Chin J Ocul Fundus Dis, 2014, 30(5): 454-457. DOI: 10.3760/cma.j.issn.1005-1015.2014.05.006.
6.	王潤生, 呂沛霖, 王賓, 等. 視網膜中央動脈阻塞患者視網膜循環時間與中心視力損害的關系[J]. 中華眼底病雜志, 2007, 23(3): 177-179. DOI: 10.3760/j.issn:1005-1015.2007.03.007.Wang RS, Lyu PL, Wang B, et al. Relationship between retinal circulation time and visual loss in patients with central retinal artery occlusion[J]. Chin J Ocul Fundus Dis, 2007, 23(3): 177-179. DOI: 10.3760/j.issn:1005-1015.2007.03.007.
7.	Shahjouei S, Bavarsad SR, Dumitrascu OM. Thrombolysis for central retinal artery occlusion: an individual participant-level meta-analysis[J]. Int J Stroke, 2024, 19(1): 29-39. DOI: 10.1177/17474930231189352.
8.	Raval V, Nayak S, Saldanha M, et al. Combined retinal vascular occlusion: demography, clinical features, visual outcome, systemic co-morbidities, and literature review[J]. Indian J Ophthalmol, 2020, 68(10): 2136-2142. DOI: 10.4103/ijo.IJO_2116_19.
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11.	Hayreh SS. Ocular vascular occlusive disorders: natural history of visual outcome[J]. Prog Retin Eye Res, 2014, 41: 1-25. DOI: 10.1016/j.preteyeres.2014.04.001.
12.	夏德昭, 張忠志. 中心絕對暗點眼的視力不是中心視力而是偏心視力—兼答商榷論文[J]. 中國實用眼科雜志, 2017, 35(3): 239-242. DOI: 10.3760/cma.j.issn.1006-4443.2017.03.004.Xia DZ, Zhang ZZ. The vision of the central absolute dark spot eye is not the central vision but the extra vision-a discussion paper[J]. Chin J Pract Ophthalmol, 2017, 35(3): 239-242. DOI: 10.3760/cma.j.issn.1006-4443.2017.03.004.
13.	Whittaker SG, Budd J, Cummings RW. Eccentric fixation with macular scotoma[J]. Invest Ophthalmol Vis Sci, 1988, 29(2): 268-278.
14.	Ergun E, Maár N, Radner W, et al. Scotoma size and reading speed in patients with subfoveal occult choroidal neovascularization in age-related macular degeneration.[J]. Ophthalmology, 2003, 110(1): 65-69. DOI: 10.1016/s0161-6420(02)01566-x.
15.	陳曉曉, 李夢瑋, 孫興懷. 低視力優選視網膜區的定位假說[J]. 國際眼科縱覽, 2016, 40(6): 409-413. DOI: 10.3760/cma.j.issn.1673-5803.2016.06.011.Chen XX, Li MW, Sun XH. Explanation for location of preferred retinal locus in low-vision patients[J]. Int Rev Ophthalmol, 2016, 40(6): 409-413. DOI: 10.3760/cma.j.issn.1673-5803.2016.06.011.
16.	Wu X, Chen S, Li S, et al. Oxygen therapy in patients with retinal artery occlusion: a meta- analysis[J/OL]. PLoS One, 2018, 13(8): e202154[2018-08-29]. https://pubmed.ncbi.nlm.nih.gov/30157206/. DOI: 10.1371/journal.pone.0202154.
17.	陳嘉寶, 李金瑛. 視網膜動脈阻塞治療現狀[J]. 國際眼科縱覽, 2019, 43(1): 68-72. DOI: 10.3760/cma.j.issn.1673-5803.2019.01.014.Chen JB, Li JY. Treatment of retinal occlusion[J]. Int Rev Ophthalmol, 2019, 43(1): 68-72. DOI: 10.3760/cma.j.issn.1673-5803.2019.01.014.

1. 逯青麗, 吳松笛. 視網膜動脈阻塞: “視網膜卒中”的認識與挑戰[J]. 中國卒中雜志, 2023, 18(6): 712-719. DOI: 10.3969/j.issn.1673-5765.2023.06.011.Lu QL, Wu SD. Retinal artery occlusion: knowledge and challenge of "retinal stroke"[J]. Chin J Stroke, 2023, 18(6): 712-719. DOI: 10.3969/j.issn.1673-5765.2023.06.011.
2. 中國研究型醫院學會神經眼科專業委員會, 陜西省研究型醫院學會神經眼科專業委員會, 魏世輝, 等. 中國視網膜中央動脈阻塞臨床診療專家共識[J]. 中國卒中雜志, 2024, 19(11): 1246-1267. DOI: 10.3969/j.issn.1673-5765.2024.11.002.Neuro-Ophthalmology Society, Chinese Research Hospital Association, Neuro-Ophthalmology Society, Shaanxi Research Hospital Association, Wei SH, et al. Expert consensus on clinical diagnosis and treatment of central retinal artery occlusion in China[J]. Chin J Stroke, 2024, 19(11): 1246-1267. DOI: 10.3969/j.issn.1673-5765.2024.11.002.
3. 夏德昭, 張忠志. 中心視力和偏心視力是不同性質的兩種視力——兼答與此相關的學術探討和爭鳴[J]. 中華眼底病雜志, 2017, 33(5): 536-538. DOI: 10.3760/cma.j.issn.1005-1015.2017.05.024.Xia DZ, Zhang ZZ. Central vision and extra vision are two different types of vision with different properties - a response to academic discussions and debates related to this[J]. Chin J Ocul Fundus Dis, 2017, 33(5): 536-538. DOI: 10.3760/cma.j.issn.1005-1015.2017.05.024.
4. 吳航, 劉大川, 張旭香, 等. 視網膜中央動脈阻塞早期眼動脈溶栓治療前后視力改變[J]. 中國實用眼科雜志, 2012, 30(2): 152-155. DOI: 10.3760/cma.j.issn.1006-4443.2012.02.016.Wu H, Liu DC, Zhang XX, et al. Visual acuity changes of the patients with recent central retinal artery occlusion after the treatment of intra-arterial thrombolysis[J]. Chin J Pract Ophthalmol, 2012, 30(2): 152-155. DOI: 10.3760/cma.j.issn.1006-4443.2012.02.016.
5. 呂沛霖, 王潤生, 杜善雙. 視網膜中央動脈阻塞患眼睫狀視網膜動脈存在情況及其與中心視力損害的關系[J]. 中華眼底病雜志, 2014, 30(5): 454-457. DOI: 10.3760/cma.j.issn.1005-1015.2014.05.006.Lyu PL, Wang RS, Du SS. Correlation between cilioretinal artery and central visual loss in central retinal artery occlusion[J]. Chin J Ocul Fundus Dis, 2014, 30(5): 454-457. DOI: 10.3760/cma.j.issn.1005-1015.2014.05.006.
6. 王潤生, 呂沛霖, 王賓, 等. 視網膜中央動脈阻塞患者視網膜循環時間與中心視力損害的關系[J]. 中華眼底病雜志, 2007, 23(3): 177-179. DOI: 10.3760/j.issn:1005-1015.2007.03.007.Wang RS, Lyu PL, Wang B, et al. Relationship between retinal circulation time and visual loss in patients with central retinal artery occlusion[J]. Chin J Ocul Fundus Dis, 2007, 23(3): 177-179. DOI: 10.3760/j.issn:1005-1015.2007.03.007.
7. Shahjouei S, Bavarsad SR, Dumitrascu OM. Thrombolysis for central retinal artery occlusion: an individual participant-level meta-analysis[J]. Int J Stroke, 2024, 19(1): 29-39. DOI: 10.1177/17474930231189352.
8. Raval V, Nayak S, Saldanha M, et al. Combined retinal vascular occlusion: demography, clinical features, visual outcome, systemic co-morbidities, and literature review[J]. Indian J Ophthalmol, 2020, 68(10): 2136-2142. DOI: 10.4103/ijo.IJO_2116_19.
9. Gong H, Song Q, Wang L. Manifestations of central retinal artery occlusion revealed by fundus fluorescein angiography are associated with the degree of visual loss[J]. Exp Ther Med, 2016, 11(6): 2420-2424. DOI: 10.3892/etm.2016.3175.
10. Mac Grory B, Schrag M, Biousse V, et al. Management of central retinal artery occlusion: a scientific statement from the American Heart Association[J/OL]. Stroke, 2021, 52(6): e282-e294[2021-03-08]. https://pubmed.ncbi.nlm.nih.gov/33677974/. DOI: 10.1161/STR.0000000000000366.
11. Hayreh SS. Ocular vascular occlusive disorders: natural history of visual outcome[J]. Prog Retin Eye Res, 2014, 41: 1-25. DOI: 10.1016/j.preteyeres.2014.04.001.
12. 夏德昭, 張忠志. 中心絕對暗點眼的視力不是中心視力而是偏心視力—兼答商榷論文[J]. 中國實用眼科雜志, 2017, 35(3): 239-242. DOI: 10.3760/cma.j.issn.1006-4443.2017.03.004.Xia DZ, Zhang ZZ. The vision of the central absolute dark spot eye is not the central vision but the extra vision-a discussion paper[J]. Chin J Pract Ophthalmol, 2017, 35(3): 239-242. DOI: 10.3760/cma.j.issn.1006-4443.2017.03.004.
13. Whittaker SG, Budd J, Cummings RW. Eccentric fixation with macular scotoma[J]. Invest Ophthalmol Vis Sci, 1988, 29(2): 268-278.
14. Ergun E, Maár N, Radner W, et al. Scotoma size and reading speed in patients with subfoveal occult choroidal neovascularization in age-related macular degeneration.[J]. Ophthalmology, 2003, 110(1): 65-69. DOI: 10.1016/s0161-6420(02)01566-x.
15. 陳曉曉, 李夢瑋, 孫興懷. 低視力優選視網膜區的定位假說[J]. 國際眼科縱覽, 2016, 40(6): 409-413. DOI: 10.3760/cma.j.issn.1673-5803.2016.06.011.Chen XX, Li MW, Sun XH. Explanation for location of preferred retinal locus in low-vision patients[J]. Int Rev Ophthalmol, 2016, 40(6): 409-413. DOI: 10.3760/cma.j.issn.1673-5803.2016.06.011.
16. Wu X, Chen S, Li S, et al. Oxygen therapy in patients with retinal artery occlusion: a meta- analysis[J/OL]. PLoS One, 2018, 13(8): e202154[2018-08-29]. https://pubmed.ncbi.nlm.nih.gov/30157206/. DOI: 10.1371/journal.pone.0202154.
17. 陳嘉寶, 李金瑛. 視網膜動脈阻塞治療現狀[J]. 國際眼科縱覽, 2019, 43(1): 68-72. DOI: 10.3760/cma.j.issn.1673-5803.2019.01.014.Chen JB, Li JY. Treatment of retinal occlusion[J]. Int Rev Ophthalmol, 2019, 43(1): 68-72. DOI: 10.3760/cma.j.issn.1673-5803.2019.01.014.

Chinese Journal of Ocular Fundus Diseases

Analysis of visual characteristics with non arteritic central retinal artery occlusion after treatment

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