Inner Neural Retina Loss in Central Retinal Artery Occlusion

Purpose: To report morphologic retinal changes and visual outcomes in acute and chronic central retinal artery occlusion (CRAO). Methods: We reviewed ten eyes of ten patients with CRAO (age, 65.3 +/- 10.2 years) and measured retinal thicknesses at the central fovea and the perifovea using optical coherence tomography (OCT) over 8 +/- 4 months. Results: During the acute phase (within 10 days), the mean inner retinal thicknesses were 148% and 139% of normal values at 1 mm nasal and temporal to the fovea. They decreased to 22% and 11% of normal inner retinal thickness during the chronic phase (3 months or later). The retinal thickness at the perifovea decreased linearly until 3 months but was stable during the chronic phase. In contrast, the foveal thickness increased slightly in the acute phase but was equivalent to the normal level during the chronic phase. As a result of inner retinal atrophy, the foveal pit was shallow during the chronic phase. The final visual acuity was correlated positively with retinal thickness at the perifovea during the chronic CRAO phase. Conclusion: OCT showed that inner retinal necrosis with early swelling and late atrophy occurred in CRAO. The fovea and outer retina appeared to be excluded from ischemic change. The residual inner retina at the perifovea determined the final visual outcomes. Jpn J Ophthalmol 2010;54:423-429 (C) Japanese Ophthalmological Society 2010