Sir,
I read with interest the correspondence on central retinal artery occlusion (CRAO) and cerebral stroke regarding Varma et al’s article ‘A review of central retinal artery occlusion: clinical presentation and management.’1 In a paper published in this journal in 1992 we looked at the relationship between central retinal artery and ocular neovascularisation in eight patients.2
We agree with McLeod3 that penumbral retinal tissue viability can persist as half of our patients did not fall into the carotid occlusive disease group. This concurs with Kottow and Hendrickson,4 who found anterior segment neovascularisation following CRAO, as well as Brown,5 who reported a case of neovascularisation following CRAO due to presumed single mitral valve embolus in the absence of carotid disease.
Varma et al also refer to preventing ocular neovascularisation following CRAO. The relationship between these two events is more complex than this paper implies, as we described in a table which I reproduce here for the sake of clarity (Table 1). As well as considering CRAO alone, it considers the concept of double embolism as reported by Wolter6 as well as CRAO in a setting of chronic ocular ischaemia due to carotid occlusive disease.7, 8
We do, however, strongly agree with Varma et al that such patients should be reviewed at regular intervals for at least 3 months following the diagnosis of CRAO.
References
Varma DD, Cugati S, Lee AW, Chen CS . A review of central retinal artery occlusion: clinical presentation and management. Eye 2013; 27: 688–697.
Jacobs NA, Trew DR . Occlusion of the central retinal artery and ocular neovascularization: an indirect association? Eye 1992; 6: 599–602.
McLeod D . Letter to the editor: partial central retinal artery occlusion offers a unique insight into the ischemic penumbra. Clin Ophthalmol 2012; 6: 9–22.
Kottow M, Hendrickson P . Iris angiographic findings in retinal arterial occlusions. Can J Ophthalmol 1974; 9: 435–443.
Brown GC . Isolated central retinal artery obstruction in association with ocular neovascularization. Am J Ophthalmol 1983; 96: 10–11.
Wolter JR . Double embolism of the central retinal artery followed by secondary haemorrhagic glaucoma. Am J Ophthalmol 1972; 73: 652–657.
Sturrock GD, Mueller HR . Chronic ocular ischaemia. Br J Ophthalmol 1984; 68: 716–723.
Jacobs NA, Ridgway AEA . Syndrome of ischaemic ocular inflammation; six cases and review. Br J Ophthalmol 1985; 69: 681–687.
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Jacobs, N. Concerning central retinal artery occlusion (CRAO) and cerebral stroke. Eye 28, 1269–1270 (2014). https://doi.org/10.1038/eye.2014.118
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DOI: https://doi.org/10.1038/eye.2014.118