Department of Ophthalmology and Visual Sciences, College of Medicine, University of Iowa, Iowa City, Iowa, USA.
Indian J Ophthalmol. 2018 Dec;66(12):1684-1694. doi: 10.4103/ijo.IJO_1446_18.
The pathogeneses, clinical features, and management of central retinal artery occlusion (CRAO) are discussed. CRAO consists of the following four distinct clinical entities: non-arteritic CRAO (NA-CRAO), transient NA-CRAO, NA-CRAO with cilioretinal artery sparing, and arteritic CRAO. Clinical characteristics, visual outcome, and management very much depend upon the type of CRAO. Contrary to the prevalent belief, spontaneous improvement in both visual acuity and visual fields does occur, mainly during the first 7 days. The incidence of spontaneous visual acuity improvement during the first 7 days differs significantly (P < 0.001) among the four types of CRAO; among them, in eyes with initial visual acuity of counting finger or worse, visual acuity improved, remained stable, or deteriorated in NA-CRAO in 22%, 66%, and 12%, respectively; in NA-CRAO with cilioretinal artery sparing in 67%, 33%, and none, respectively; and in transient NA-CRAO in 82%, 18%, and none, respectively. Arteritic CRAO shows no change. Recent studies have shown that administration of local intra-arterial thrombolytic agent not only has no beneficial effect but also can be harmful. Investigations to find the cause and to prevent or reduce the risk of any further visual problems are discussed. Prevalent multiple misconceptions on CRAO are discussed.
讨论了中央视网膜动脉阻塞（CRAO）的发病机制、临床特征和治疗方法。CRAO 包括以下四种不同的临床实体：非动脉炎性 CRAO（NA-CRAO）、短暂性 NA-CRAO、伴有睫状视网膜动脉保留的 NA-CRAO 和动脉炎性 CRAO。临床特征、视力预后和治疗方法在很大程度上取决于 CRAO 的类型。与普遍的观点相反，视力和视野都确实会自发改善，主要发生在第 7 天内。在第 7 天内自发视力改善的发生率在四种类型的 CRAO 中差异显著（P < 0.001）；其中，在初始视力为指数或更差的眼睛中，NA-CRAO 中视力分别改善、稳定或恶化的比例为 22%、66%和 12%；在伴有睫状视网膜动脉保留的 NA-CRAO 中分别为 67%、33%和无；在短暂性 NA-CRAO 中分别为 82%、18%和无。动脉炎性 CRAO 没有变化。最近的研究表明，局部动脉内溶栓剂的给药不仅没有有益效果，反而可能有害。探讨了寻找病因以及预防或减少任何进一步视力问题风险的调查。讨论了关于 CRAO 的普遍存在的多种误解。
