Department of Ophthalmology, Fuyang People's Hospital of Anhui Medical University, Fuyang, Anhui, China.
Department of Ophthalmology, Affiliated Hospital of Yanbian University, Yanji, Jilin, China.
Medicine (Baltimore). 2022 Nov 11;101(45):e31204. doi: 10.1097/MD.0000000000031204.
Central retinal artery occlusion (CRAO) sparing the cilioretinal artery (CLRA) with severe subretinal fluid and non-characteristic cherry-red spot is uncommon. In the present case, the patient received an intravitreal injection of anti- vascular endothelial growth factor, which is very rare.
A 59-year-old man underwent vitrectomy of the left eye for diabetic retinopathy and vitreous hemorrhage. Six months after the operation, the patient presented with sudden painless visual-acuity decline in his left eye and was diagnosed with CRAO; his best corrected visual acuity was weak light perception. Whole retinal edema was seen on the fundus, and macular gray retinal opacification was present without a characteristic cherry-red spot. Optical coherence tomography revealed subretinal fluid (SRF) in the papillomacular bundle and inner retinal thickening. Fundus fluorescein angiography confirmed that the central retinal artery was not filled at 40 seconds and that the CLRA supplied a part of the macular area. Eight months after the second intravitreal injection of ranibizumab, Optical coherence tomography showed a significant reduction in inner retinal hyperreflectivity and the thickness of the nasal macular retina. The SRF was clearly absorbed, and the visual acuity improved to 1.1 logMAR units.
Atypical CRAO.
The patient was treated with intravitreal injection of anti-VEGF in his left eye. The thickness of the nasal macular retina decreased.
The SRF was clearly absorbed, and the patient's visual acuity significantly improved.
When CRAO occurs in patients with diabetic retinopathy sparing the CLRA, the non-characteristic cherry-red spot may be due to macular inner retinal edema, SRF and other factors. According to the patient's condition, anti-vascular endothelial growth factor can be administered as appropriate to inhibit choroidal neovascularization, reduce SRF in the macular retina, and save some vision.
伴有严重视网膜下液和非典型樱桃红斑的睫状视网膜动脉（CLRA）保留的中央视网膜动脉阻塞（CRAO）并不常见。本例患者接受了抗血管内皮生长因子的玻璃体内注射，这非常罕见。
一名 59 岁男性因糖尿病性视网膜病变和玻璃体积血接受左眼玻璃体切除术。术后 6 个月，患者左眼突发无痛性视力下降，被诊断为 CRAO；最佳矫正视力为光感。眼底可见全视网膜水肿，黄斑区呈灰色视网膜混浊，无典型樱桃红斑。光学相干断层扫描显示视乳头黄斑束存在视网膜下液（SRF）和内层视网膜增厚。眼底荧光血管造影证实中央视网膜动脉在 40 秒时未充盈，CLRA 供应部分黄斑区。第二次玻璃体内注射 ranibizumab 8 个月后，光学相干断层扫描显示内层视网膜高反射性和鼻侧黄斑视网膜厚度明显降低。SRF 明显吸收，视力提高至 1.1 logMAR 单位。
非典型 CRAO。
左眼玻璃体内注射抗 VEGF 治疗。鼻侧黄斑视网膜厚度降低。
SRF 明显吸收，患者视力明显改善。
糖尿病性视网膜病变患者发生 CRAO 时，CLRA 保留可能是由于黄斑内层视网膜水肿、SRF 等因素所致。根据患者情况，可适当给予抗血管内皮生长因子治疗，抑制脉络膜新生血管生成，减少黄斑视网膜 SRF，挽救部分视力。
