Multimodal Imaging of Acute Central Retinal Artery Occlusion

Abstract The aim of this study was to describe fluorescein angiography (FA), ocular coherence tomography (OCT) and ocular coherence tomography angiography (OCTA) in the diagnosis of acute central retinal artery occlusion (CRAO). This is an observational case series study performed at Sohag Ophthalmic Investigation Center. Fifteen patients presented by a sudden marked unilateral diminution of vision were included. Corrected Distance Visual acuity (CDVA), color fundus photos, FA, OCT and OCTA, imaging obtained in the first week of presentation and imaging of the other normal eye as a control were assessed. Central macular thickness (CMT), parafoveal inner retinal layers thickness and parafoveal outer retinal thickness in diseased and contralateral normal eyes were compared. Fifteen patients (mean age ۵۲.۶۷ years, ۱۱-۷۴ years old) including ۶۶.۷% male entered the study. CDVA ranged from no perception of light to ۰.۰۵ (۲۰/۴۰۰). Fundus examination showed a cherry red spot in ۱۰ cases (۶۶.۷ %) and retinal whitening in ۹ cases (۶۰%), arteriolar narrowing in ۷ (۴۶.۶۷%), optic disc edema in ۴ (۲۶.۶۷%), optic disc pallor in ۵ (۳۳.۳%) and cattle trucking in ۵ (۳۳.۳%). Fluorescein angiography showed delayed arteriovenous transit time > ۲۳ seconds in ۸ cases (۵۳.۳۳ %) and normal FA in ۴ cases (۲۶.۶۷ %). OCT revealed increased hyperreflective of the inner retinal layers in comparison to hyporeflective inner retinal layers in all cases (۱۰۰%) and significant increase in CMT in ۱۰ cases (۶۶.۶۷%). The mean ± standard deviation (SD) of CMT (CRAO) was ۳۰۶.۵ ± ۲۷.۹ (P < ۰.۰۰۱), the parafoveal inner retinal thickness (CRAO) ۳۴۵ ± ۵۱.۸ µm (P < ۰.۰۰۱) and the parafoveal outer retinal thickness (CRAO) ۱۲۰.۹ ± ۱۳.۶ µm (P < ۰.۰۰۱). OCTA was performed and clear images obtained in ۱۱ cases (۷۳.۳۳%). Disruption of superficial and deep capillary plexus was found in all cases. We concluded that the OCT is the most confirmative imaging method in the diagnosis of acute CRAO even in the absence of fundus signs. OCTA confirms the diagnosis, but it cannot be performed in some cases. Epub: October ۱, ۲۰۱۹.