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PHOTO ESSAY
Year : 2021  |  Volume : 1  |  Issue : 3  |  Page : 425-426

Spectral domain optical coherence tomography imaging findings in a case of acute central retinal artery occlusion sparing the cilioretinal artery


1 Department of Vitreo-Retina, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India
2 Department of Vitreo-Retina, BB Eye Foundation, Kolkata, West Bengal, India

Date of Submission11-Oct-2020
Date of Acceptance19-Jan-2021
Date of Web Publication02-Jul-2021

Correspondence Address:
Dr. Debmalya Das
Aditya Birla Sankara Nethralaya, 147 Mukundapur, E.M Bypass, Kolkata - 700 099, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_3242_20

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  Abstract 


Keywords: Central retinal artery occlusion, cilioretinal artery, retinal ischemia


How to cite this article:
Das D, Herekar S, Roy R, Saurabh K. Spectral domain optical coherence tomography imaging findings in a case of acute central retinal artery occlusion sparing the cilioretinal artery. Indian J Ophthalmol Case Rep 2021;1:425-6

How to cite this URL:
Das D, Herekar S, Roy R, Saurabh K. Spectral domain optical coherence tomography imaging findings in a case of acute central retinal artery occlusion sparing the cilioretinal artery. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Jul 26];1:425-6. Available from: https://www.ijoreports.in/text.asp?2021/1/3/425/320091



A 58-year-old man complained of sudden loss of vision in his right eye. Best-corrected visual acuity was 6/60, N36 in right eye and 6/6, N6 in the left eye. Anterior segment was unremarkable in both eyes. Color fundus photo (CFP) and Multicolor imaging (MCI) showed retinal whitening at posterior pole except over an area temporal to the temporal margin of optic nerve head (ONH) [Figure 1]a and [Figure 1]b. SD-OCT line scan showed hyperreflectivity of inner retinal layers up to inner nuclear layer in the affected areas. A sharp demarcation line separated the area of affected retina from the area which retained perfusion on the SD-OCT scan. The integrity of the retinal layers was normal in the area of uninvolved retina [Figure 1]c. A diagnosis of central retinal artery occlusion (CRAO) sparing cilioretinal artery was made. Blue and green reflectance images showed hyperreflectivity at the posterior pole and isoreflectivity in the area supplied by cilioretinal artery [Figure 2]a and [Figure 2]b. Blue autofluorescence image showed hypoautofluorescence in the area of retinal pallor owing to retinal edema and normal autofluorescence in the area supplied by the cilioretinal artery. [Figure 2]c
Figure 1: (a) Color fundus photo (CFP) of right eye shows retinal pallor with sparing of retina at temporal margin of optic nerve head and at fovea. Cilioretinal artery is shown by blank yellow arrow head. (b) Multicolor imaging (MCI ) corroborated the findings on CFP. Cilioretinal artery is shown by blank yellow arrow head. (c) SD.OCT through fovea showed homogenous hyperreflectivity of inner retinal layers suggestive of ischemia. The hyperreflectivity abruptly ended at the junction of area supplied by cilioretinal artery (blank yellow arrow head)

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Figure 2: (a) Blue reflectance image of right eye showed hyperreflectivity of retina except at the area supplied by cilioretinal artery. (b) Green reflectance image of right eye showed more hyperreflectivity of retina compared to blue reflectance as it mainly images inner retinal layers whereas blue channel mainly images retinal surface. (c) Blue autofluorescence image showed hypoautofluorescence at the area of retinal pallor caused by blockage of normal autofluorescence signals by retinal thickening. The area supplied by cilioretinal artery showed normal autofluorescence

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  Discussion Top


Cilioretinal artery sparing in the setting of CRAO has been associated with a better visual prognosis.[1],[2] However, the final visual prognosis remains guarded because it depends upon size of the cilioretinal artery and the extent of retina supplied by it.[3] Abdellah et al. have demonstrated that the SD-OCT findings of hyperreflective inner retinal layers and hyporeflective outer retinal layers in affected areas of retina were a consistent finding in all cases of CRAO noted in their study. They state that even in cases of apparently normal looking fundus, SD-OCT findings are the most confirmatory imaging method in cases with acute CRAO for detecting retinal ischemia.[4]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hayreh SS, Zimmerman MB. Central retinal artery occlusion: Visual outcome. Am J Ophthalmol 2005;140:376-91.  Back to cited text no. 1
    
2.
Justice J Jr, Lehmann RP. Cilioretinal arteries. A study based on review of stereo fundus photographs and fluorescein angiographic findings. Arch Ophthalmol 1976;94:1355-8.  Back to cited text no. 2
    
3.
Varma DD, Cugati S, Lee AW, Chen CS. A review of central retinal artery occlusion: Clinical presentation and management. Eye (Lond) 2013;27:688-97.  Back to cited text no. 3
    
4.
Abdellah MM. Multimodal imaging of acute central retinal artery occlusion. Med Hypothesis Discov Innov Ophthalmol 2019;8:283-90.  Back to cited text no. 4
    


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  [Figure 1], [Figure 2]



 

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