Retinal Artery Occlusion
Common risk factors include:
The whitening of the retina generally lasts 4 to 6 weeks before fading. Fluorescein angiography (FA) shows a delay in filling of the retinal arteries. (Figure 3) Optical coherence tomography (OCT) provides detailed images of the central retina, and shows swelling in the inner layers of the retina in the affected area, which over time atrophy, becoming much thinner than normal.
Treatment and Prognosis
Thrombolytic therapy (“clot-busting” drugs), delivered either intravenously or directly through the ophthalmic artery, has also been tried but clinical trials have not shown this treatment to be effective.
An important aspect of managing retinal artery occlusion is for your doctor to identify and manage risk factors that may lead to other vascular conditions. The risk factors for CRAO are the same atherosclerotic risk factors as for stroke and heart disease; tests are important to try to identify the source of a clot from another part of the body. These tests include:
Vision loss with CRAO is usually severe. However, CRAOs in patients who have a cilioretinal artery have better visual prognosis, usually recovering to 20/50 vision or better in over 80% of eyes. Visual field loss in BRAO is usually permanent, but central visual acuity may recover to 20/40 or better in 80% of eyes.
Formation of new blood vessels of the retina or iris that are prone to bleed is a rare complication seen after a CRAO or BRAO. Growth of these vessels can further decrease vision by causing vitreous hemorrhage and glaucoma. If this happens, laser photocoagulation therapy is used to create burns in the area of the blocked artery to try to lower the oxygen demand of the retina and thus stop the abnormal blood vessels from growing.
Intravitreal injections of anti-VEGF medications such as Avastin® (bevacizumab), Lucentis® (ranibizumab) or Eylea® (aflibercept) may also be used in such cases.
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