Aggressive systematic treatment for central retinal artery occlusion
Section snippets
Patients and methods
Central retinal artery occlusion was diagnosed based on abrupt visual loss accompanied by one or more of the following signs as observed by slit-lamp biomicroscopy with a +90 diopter or +78 diopter lens: (1) sluggish, thinned retinal artery flow; (2) fragmentation of the blood column in retinal arterioles; (3) retinal opacification combined with sluggish retinal blood flow; and (4) the presence of a cherry-red spot. These findings were compared with the fellow noncompromised eye. Visual acuity
Results
Improvement of the retinal blood flow observed by three-mirror contact lens at completion of treatment was invariably associated with improvement of visual acuity in our patients. After treatment, retinal circulation and visual acuity improved in eight (73%) of the 11 patients in the systematic treatment group. In only one of the eight patients in this group (Case 1), retinal circulation improved after ocular massage, sublingual isosorbide dinitrate, oral acetazolamide, and intravenous
Discussion
The incidence of CRAO in the population is unknown. Only one report estimated CRAO to occur in one per 10,000 outpatient visits.5 Because our facility is the only tertiary referral facility for a population of 200,000 and our outpatient clinic has approximately 15,000 visits per year, our estimate for acute CRAO (duration of fewer than 48 hours) is 0.85 per 100,000 per year or 1.13 per 10,000 outpatient visits.
Central retinal artery occlusion is an ocular emergency. Prolonged retinal ischemia
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