Kim Yong Hoon, Park Kyu Hyung, Woo Se Joon
Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Korean J Ophthalmol. 2020 Feb;34(1):27-34. doi: 10.3341/kjo.2019.0099.
To investigate the clinical manifestations and prognosis of eyes with cilioretinal artery sparing central retinal artery occlusion (CRAO).
A retrospective study was conducted on 90 eyes diagnosed with complete CRAO, including 16 cases of cilioretinal artery sparing CRAO. Clinical features, visual outcome, papillomacular bundle involvement, and remnant visual field were analyzed according to cilioretinal artery sparing.
Among eyes with complete CRAO, the proportion of cilioretinal artery sparing CRAO was 17.8% (16 / 90). Mean initial best-corrected visual acuities (BCVAs) (2.04 ± 0.69 vs. 2.34 ± 0.47, = 0.039) and final BCVAs (1.65 ± 0.87 vs. 2.22 ± 0.84, = 0.001) were significantly better in eyes of the cilioretinal artery sparing group than the non-sparing group. The proportion with poor visual outcome (final BCVA <20 / 200) was 81.3% in the cilioretinal artery sparing group and 97.3% in the non-sparing group ( = 0.01). In sub-group analysis within cilioretinal artery sparing CRAO eyes, ischemic involvement of the papillomacular bundle at disease onset was significantly more frequent in the poor vision group (BCVA <20 / 200, 12 / 13 [92.3%]) than in the good vision group (BCVA ≥20 / 200, 1 / 3 [33.3%], = 0.016) and it was associated with preserved central visual field.
Although cilioretinal artery sparing is common in CRAO and has a better prognosis than complete CRAO, the visual outcome is generally poor and only a small proportion of eyes has preserved small central visual field. Ischemic injury of the papillomacular bundle at the acute stage of CRAO correlates with poor visual outcome and could be a prognostic sign.
探讨保留睫状视网膜动脉的视网膜中央动脉阻塞（CRAO）患眼的临床表现及预后。
对90例诊断为完全性CRAO的患眼进行回顾性研究，其中16例为保留睫状视网膜动脉的CRAO。根据是否保留睫状视网膜动脉分析临床特征、视力预后、黄斑束受累情况及残余视野。
在完全性CRAO患眼中，保留睫状视网膜动脉的CRAO比例为17.8%（16/90）。保留睫状视网膜动脉组患眼的平均初始最佳矫正视力（BCVA）（2.04±0.69对2.34±0.47，P = 0.039）和最终BCVA（1.65±0.87对2.22±0.84，P = 0.001）均显著优于未保留组。保留睫状视网膜动脉组视力预后差（最终BCVA<20/200）的比例为81.3%，未保留组为97.3%（P = 0.01）。在保留睫状视网膜动脉的CRAO患眼亚组分析中，视力差组（BCVA<20/200，12/13[92.3%]）发病时黄斑束的缺血性受累明显比视力好组（BCVA≥20/200，1/3[33.3%]）更常见（P = 0.016），且与保留的中心视野相关。
虽然保留睫状视网膜动脉在CRAO中较为常见，且预后优于完全性CRAO，但视力预后总体较差，只有一小部分患眼保留了小的中心视野。CRAO急性期黄斑束的缺血性损伤与视力预后差相关，可能是一个预后指标。
