Estawro Rania, Abraham Neda, Fouad Yousef, Bousquet Elodie, Sarraf David
Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, United States.
Retina Department, Al-Watany Eye Hospital, Cairo, Egypt.
Am J Ophthalmol Case Rep. 2024 Jan 20;33:101998. doi: 10.1016/j.ajoc.2024.101998. eCollection 2024 Mar.
To describe the development of cystoid macular edema (CME) as a complication of central retinal artery occlusion (CRAO) in 2 cases.
The first patient was a 51-year-old female who presented with acute loss of vision in the left eye. Multimodal retinal imaging revealed a CRAO with a perfused cilioretinal artery. CME acutely developed one week after presentation. Cystoid spaces predominantly involved the outer nuclear layer (ONL) on optical coherence tomography (OCT) and completely resolved in two weeks. The second case was a 50-year-old man who presented with acute vision loss in the right eye for 3 weeks. Multimodal retinal imaging illustrated an acute CRAO of the right eye. Four weeks later, visual acuity spontaneously improved to 20/20 and was maintained at 20/20 for more than 2 years. After 28 months, the patient returned with a recurrent drop of vision in the right eye. Cross sectional and en face OCT revealed CME in the right eye without leakage on FA. Cystoid spaces predominantly involved the inner nuclear layer (INL) and resolved with intravitreal anti-VEGF injection combined with carbonic anhydrase inhibitor (CAI) and steroid topical drop therapy.
CME can rarely complicate both the acute and chronic phase of CRAO. In the acute phase, cystoid spaces were transient and confined to the ONL on OCT. While in the chronic phase, cystoid spaces were confined to the INL on OCT and angiographically silent on FA. Further studies are needed to identify the incidence, underlying pathophysiology and visual prognosis of CME in cases of CRAO.
描述2例视网膜中央动脉阻塞（CRAO）并发症——黄斑囊样水肿（CME）的发生情况。
首例患者为一名51岁女性，左眼突发视力丧失。多模式视网膜成像显示为CRAO合并一条灌注良好的睫状视网膜动脉。就诊1周后急性发生CME。光学相干断层扫描（OCT）显示囊样间隙主要累及外核层（ONL），并在2周内完全消退。第二例是一名50岁男性，右眼急性视力丧失3周。多模式视网膜成像显示右眼急性CRAO。4周后，视力自发提高到20/20，并维持2年以上。28个月后，该患者因右眼视力再次下降前来就诊。横断面和表面OCT显示右眼CME，荧光素血管造影（FA）无渗漏。囊样间隙主要累及内核层（INL），经玻璃体腔注射抗血管内皮生长因子（anti-VEGF）联合碳酸酐酶抑制剂（CAI）及局部滴用类固醇治疗后消退。
CME很少作为CRAO急性期和慢性期的并发症出现。急性期，囊样间隙是短暂的，在OCT上局限于ONL。而在慢性期，囊样间隙在OCT上局限于INL，在FA血管造影上无显影。需要进一步研究以明确CRAO患者中CME的发生率、潜在病理生理学机制及视觉预后。
