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Management of acute central retinal artery occlusion

Nature Clinical Practice Neurology volume 4, pages 376–383 (2008)Cite this article

Abstract

Central retinal artery occlusion (CRAO) is considered to be an acute stroke of the eye that results in profound visual loss. Spontaneous recovery rates are poor. Most CRAOs are caused by thromboembolism in the central retinal artery. Current standard therapies for CRAO that aim to restore perfusion to the retina and optic nerve head have not been shown to alter the natural course of the disease. Thrombolytic therapy for acute management of CRAO has shown promise in nonrandomized studies with regard to improving visual outcomes. A randomized controlled trial will be required to confirm the efficacy of thrombolytic therapy before it can be recommended for use in CRAO in daily clinical practice.

Key Points

  • Central retinal artery occlusion (CRAO) is considered to be an acute stroke of the eye that involves hypoperfusion to the retina and optic nerve head and leads to a reduction in visual function

  • CRAO has a poor spontaneous recovery rate

  • Current standard therapies for CRAO have not conclusively been shown to change the natural course of the disease

  • Local intra-arterial fibrinolysis shows promise in nonrandomized studies for the treatment of CRAO, but a randomized controlled trial will be required to demonstrate efficacy before this treatment can be considered for use in standard clinical practice

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Figure 1: Color fundus photographs in a patient with acute central retinal artery occlusion.
Figure 2: Fundus fluorescein angiography of an eye with acute central retinal artery occlusion.
Figure 3: Central retinal artery occlusion with cilioretinal artery sparing.

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Acknowledgements

The authors would like to thank Drs Neil Miller, Eric Aldrich, Kieran Murphy, Phillip Gailloud and Rebecca Gottesman for contributing information about the study on superselective intra-arterial thrombolysis at the Johns Hopkins Hospital, Baltimore, MD, USA. Dr Chen was supported by the American Australian Association Education Fellowship Program and the Donegan Fund for AION Research at the Wilmer Eye Institute during her fellowship at Johns Hopkins Hospital.

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  1. CS Chen is a Consultant Neuro-ophthalmologist in the Department of Ophthalmology and AW Lee is a Consultant Cerebrovascular Neurologist in the Department of Neurology, Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia.,

    Celia S Chen & Andrew W Lee

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Correspondence to Andrew W Lee.

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Chen, C., Lee, A. Management of acute central retinal artery occlusion. Nat Rev Neurol 4, 376–383 (2008). https://doi.org/10.1038/ncpneuro0811

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