OCTA characteristics in non-arteritic central retinal artery occlusion and correlation with visual acuity

AIM:To observe the retinal and choroidal circulations in patients with non-arteritic permanent central retinal artery occlusion(NA-CRAO)via optical coherence tomography angiography(OCTA)and analyze their correlation with visual acuity.METHODS:Sixty-two eyes with clinically confirmed acute NA-CRAO were included in the study and divided into:A type(mild n=29),B type(moderate n=27)and C type(severe n=6)based on the degree of visual loss,retinal edema,and arterial blood flow delay in fundus fluorescence angiography(FFA).Contralateral healthy eyes were used as the control group.Best-corrected visual acuity(BCVA),slit lamp microscopy,indirect ophthalmoscopy,fundus color photography,OCTA,and FFA were performed.Spearman’s correlation analysis was used to determine the correlations between retinal and choroidal vessels and visual acuity.RESULTS:There were no statistically significant differences in age,gender,and intraocular pressure among the three types and the control group(P>0.05).Vessel density in deep capillary plexus(VD-DCP)significantly decreased(P<0.05)in all three types of NA-CRAO patients compared to the control group.Vessel density in superficial vascular plexus(VD-SVP)significantly decreased(P<0.05)in type A patients and choriocapillaris flow area significantly decreased(P<0.05)in type B and type C patients compared to the control group;while outer retinal flow areas significantly increased in the type A(P<0.05)and decreased in type C patients(P<0.05).The retinal thickness significantly increased in type C group(P<0.05).The VD-SVP at fovea in the type A was significantly lower than both of type B and C.The VD-SVP at nasal parafovea in type A and B was significantly lower than type C(P<0.05).The logMAR BCVA of type A was significantly better than that of type B and C groups(P<0.05).Spearman’s correlation analysis showed that the logMAR BCVA was positively correlated with VD-SVP at fovea(r=0.679,P=0.031)and nasal parafovea(r=0.826,P=0.013).CONCLUSION:OCTA is valuable for assessing retinal ischemia,and evaluating visual impairment.Deep retinal vasculature is commonly affected in all NA-CRAO types.VDSVPs at fovea and nasal parafovea can serve as reliable markers of visual impairment in NA-CRAO.

Risk factors of non-arteritic anterior ischaemic optic neuropathy and central retinal artery occlusion

AIM:To investigate the difference in risk factors between non-arteritic anterior ischaemic optic neuropathy(NAION)and central retinal artery occlusion(CRAO)and develop a predictive diagnostic nomogram.METHODS:The study included 37 patients with monocular NAION,20 with monocular CRAO,and 24 with hypertension.Gender,age,and systemic diseases were recorded.Blood routine,lipids,hemorheology,carotid and brachial artery doppler ultrasound,and echocardiography were collected.The optic disc area,cup area,and cup-to-disc ratio(C/D)of the unaffected eye in the NAION and CRAO group and the right eye in the hypertension group were measured.RESULTS:The carotid artery intimal medial thickness(C-IMT)of the affected side of the CRAO group was thicker(P=0.039)and its flow-mediated dilation(FMD)was lower(P=0.049)than the NAION group.Compared with hypertension patients,NAION patients had higher whole blood reduced viscosity low-shear(WBRV-L)and erythrocyte aggregation index(EAI;P=0.045,0.037),and CRAO patients had higher index of rigidity of erythrocyte(IR)and erythrocyte deformation index(EDI;P=0.004,0.001).The optic cup and the C/D of the NAION group were smaller than the other two groups(P<0.0001).The diagnostic prediction model showed high diagnostic specificity(83.7%)and sensitivity(85.6%),which was highly related to hypertension,the C-IMT of the affected side,FMD,platelet(PLT),EAI,and C/D.CONCLUSION:CRAO patients show thicker C-IMT and worse endothelial function than NAION.NAION and CRAO may be related to abnormal hemorheology.A small cup and small C/D may be involved in NAION.The diagnostic nomogram can be used to preliminarily identify NAION and CRAO.

Orbital and sinus rhabdomyosarcoma with concurrent central retinal artery occlusion:A case report

BACKGROUND Both rhabdomyosarcoma(RMS)and central retinal artery occlusion(CRAO)are rare medical diseases,and their simultaneous occurrence in the same patient is extraordinarily uncommon.This study presents a comprehensive overview of the clinical manifestations,diagnostic imaging results,and therapeutic interventions of a patient with both conditions.CASE SUMMARY In this report,we present a 30-year-old male who presented with significant protrusion,pain and vision loss and was diagnosed with RMS in the orbit and sinus with CRAO.Following resection of the sinus and orbital mass and enucleation of the right eye,the patient experienced symptom improvement.CONCLUSION This article provides an in-depth analysis of the patient’s clinical manifestations,the tumor’s anatomical origin,and the etiology of CRAO.The concurrent manifestation of both RMS and CRAO is exceedingly uncommon in clinical practice.

Giant cavernous aneurysms occluded by aneurysmal thrombosis,calcification,parent artery occlusion:A case report and review of literature

BACKGROUND Patients with giant intracranial aneurysms(GIAs)are at a high risk of rupture,morbidity,and mortality even after surgical or endovascular treatment.We described a case of a spontaneously occluded GIA secondary to gradual growth of the GIA,continuously progressed aneurysmal thrombosis,complete aneurysmal calcification and complete occlusion of the parent artery-the right internal carotid artery(RICA).CASE SUMMARY A 72-year-old female patient complained of sudden pain in her right eye upon admission to our hospital.She had been diagnosed with a GIA[30 mm(axial)×38 mm(coronal)×28 mm(sagittal)]containing an aneurysmal thrombus located in the cavernous sinus segment of RICA diagnosed by magnetic resonance imaging(MRI),enhanced MRI,and magnetic resonance angiography more than 14 years ago.Later,with slow growth of the cavernous carotid GIA,aneurysmal thrombosis progressed continuously,spontaneous occlusion of the RICA,complete aneurysmal calcification,and occlusion of the GIA occurred gradually.She had no history of subarachnoid hemorrhage but missed the chance for endovascular therapy at an early stage.As a result,she was left with severe permanent sequelae from the injuries to the right cranial nerves Ⅱ,Ⅲ,Ⅳ,V1/V2,and Ⅴ.CONCLUSION The risk of rupture of the cavernous carotid GIAs was relatively low and possibly further be reduced by the stasis flow and spontaneous occlusion of the parent artery internal carotid artery(ICA)induced by the mass effect of the cavernous carotid GIAs and the extremely rare aneurysmal calcification.However,nowadays,it is advisable to recommend early endovascular treatment for the cavernous carotid GIAs to prevent injuries to the surrounding intracranial nerves and occlusion of the ICA,mainly caused by the mass effect of the cavernous carotid GIAs.

Disorganization of the retinal inner layers as a prognostic factor in eyes with central retinal artery occlusion

AIM: To evaluate baseline foveal disorganisation of retinal inner layers(DRIL) as a prognostic factor in eyes with central retinal artery occlusion(CRAO). METHODS: Twenty-eight CRAO patients who were followed-up between 2010 and 2016 were retrospectively investigated. Demographic characteristics and detailed ophthalmological examination findings of all patients were recorded. Macular thicknesses(MTs) from 5 separate spots and DRIL were measured with spectral-domain optic coherence tomography(SD-OCT). Correlations between DRIL score and logMAR converted visual acuity(VA), change in VA, patient reference time(RT), number of hyperbaric oxygen therapy(HBOT) sessions, MT and MT change were investigated.RESULTS: There was a positive correlation between the DRIL score and the final VA(r=0.787) and a negative correlation with the change in VA(r=-0.763). The RT and MT were closely related to the DRIL score. A negative correlation was found between the number of HBOT sessions and the DRIL score(r=-0.341).CONCLUSION: The DRIL score is a parameter assessed by SD-OCT, which can provide us reliable information regarding the prognosis of visual functions and response to the treatment for CRAO patients at acute phase.

Central retinal artery occlusion and traumatic optic neuropathy following blunt ocular trauma

Dear Editor,We are writing to present a case report of central retinal artery occlusion（CRAO）and traumatic optic neuropathy（TON）with immediate visual loss caused by blunt facial trauma with a soccer ball.CRAO is an ophthalmic emergency with an estimated incidence of 10 in 1 million.

Correlation of the history of stroke and the retinal artery occlusion: a nested case-control study

AIM:To analyze the systemic factors including stroke history related to the retinal artery occlusion(RAO).METHODS:Patients with an exact diagnosis of RAO in the medical database of the Kailuan Corporation were identified as the case group.Five patients without RAO were added for each case from the Kailuan Study and matched for sex and age(age±2)as the control group.The Kailuan Study is a general population-based cohort study in northern China,in which a total of 101510 individuals(81110 men)aged 18-98 y were recruited to participate in the study.And the participants were bi-annually reexamined.The database of both groups was from Kailuan study of 2010 cohort.All the information,including the demographic characteristics,lifestyle behaviors,medical comorbidities,medical history,family medical history,drug usage,anthropometric measurements,blood pressure measurement,blood sample laboratory assessment,urine tests,and other physical examinations were all collected.A retrospective nested case-control method was used for this study.Conditional multivariate logistic regression was used to analyze the risk factors with SPSS 13.0 software and SAS 9.3 software.RESULTS:A total of 45 patients were included as the case group,and the control group included 225 patients.In the case group,28 patients(62.2%)had a central retinal artery occlusion(CRAO),and 17 patients(37.8%)had a branch retinal artery occlusion(BRAO).A total of 18 patients(40.0%)had a stroke before the RAO(mean 4.04±3.88 y before the RAO),and 31 patients(81.6%)had infarctions or malacia identified by the cranial computed tomography(CT)scans.The basal ganglia and centrum semiovale were the most frequently involved regions.Plaques in the common carotid artery were present in 32 patients(88.9%).Conditional multivariate logistic regression analysis showed that the RAO was found to be associated with the history of stroke(P=0.0023,OR=28.794;95%CI:3.322-249.586).CONCLUSION:A history of stroke can significantly increase the incidence of RAO.Exists of plaque in the carotid artery is mean more than its severe stenosis for RAO.

Central retinal artery occlusion after endovascular coil embolization for internal carotid artery aneurysm

Dear Editor,We are writing this letter to report an unexpected rare caseofcentralretinalarteryocclusion(CRAO)happened after stent-assisted coiling for internal carotid artery(ICA)aneurysm in a female patient.CRAO is a devastating ocular emergency with poor visual prognosis and no universal acceptedtreatmentatpresent.CRAOisusuallyassociated witharterialhypertension,diabetesmellitus,renaldisease.

Prevalence of SARS-CoV-2 among central retinal artery occlusion patients:A case series-HORA study report No.3

Introduction:COVID-19 patients are susceptible to hypercoagulability,thromboembolic,and vasculitis state;central retinal artery occlusion(CRAO)could be caused by hyperviscosity syndrome,thromboembolic accidents,and vasculitis.Evolving case reports are correlating CRAO with COVID-19 patients.Our case series aims to reveal the prevalence of SARS-CoV-2 among CRAO patients under the COVID-19 pandemic.Methods:Medical records of all CRAO patients who attended our tertiary referral hospital,during COVID-19 local outbreak(March to November 2020),were reviewed.Respiratory tract samples were tested for SARS-CoV-2 by the validated Xpert Xpress SARS-CoV-2 assay.If patients were able to cooperate,oropharyngeal saliva samples were obtained.Otherwise,nasopharyngeal and deep throat swabs were taken by registered nurses.Results:A total of 15 CRAO patients(7 males,8 females)were identified during the 9-month study period.The mean age was 72.1-years(range 45-88 year).None of the patients were infected by SARS-CoV-2 before their CRAO disease episodes.Three patients had a history of CRAO over the contralateral eye.No patient was diagnosed with COVID-19 up to their last follow-up(mean 255.4 days,range 152-341 days).Without any COVID-19 positive case,correlation statistical tests on SARS-CoV-2 infection and CRAO were not established.Conclusions:Some of the presumed COVID-19 related CRAO cases may be just coincident with at-risk patients,as COVID-19 is prevalent across the world.More in-depth research,with adjustment to known confounding risk factors,is needed to establish a genuine correlation.

Anomalous retinal artery associated with branch retinal artery occlusion and neovascular glaucoma: A case report

BACKGROUND Congenital anomalous retinal artery is rare and does not typically affect visual acuity.However,an abnormal artery that passes through and supplies blood to the macular area complicated with branch retinal artery occlusion may negatively impact visual acuity.This study reports an unusual case of anomalous retinal artery combined with retinal artery occlusion.CASE SUMMARY A 52-year-old male presented with severely reduced vision in the right eye.The fundus examination revealed an anomalous artery,extending from the superior temporal arcade and crossing the macula into the inferior temporal quadrant.The anomalous artery was partially occluded,with a narrowed lumen.A cherry-red spot was observed with whitening of the macular area,suggesting macular edema.Fundus fluorescein angiography revealed disc leakage and a delayed filling time.Optical coherence tomography revealed increased thickness of the neuroretina and underlying layers.The patient was treated with vessel dilation,hyperbaric oxygen,ocular massage,and thrombolytics.Visual acuity of the right eye subsequently improved to 20/200 from hand motion at 4 cm.This improvement in visual acuity persisted when the patient was examined at the 1-mo follow-up visit.The patient was subsequently followed via telephone interview.The information provided via interview indicated that visual acuity in the affected eye was stable up to 6 years from the time of the initial presentation.However,after 3 additional years,the patient was diagnosed with neovascular glaucoma in the right eye,which was subsequently enucleated.CONCLUSION Although congenital retinal vascular anomaly,including anomalous retinal artery,rarely affects vision,when complicated with branch retinal artery occlusion,the abnormal artery that supplies the macula may severely reduce visual acuity.

Bilateral Central Retinal Vein Occlusions Combined with Artery Occlusions in A Patient with Acquired Immune Deficiency Syndrome

Purpose: This is the first report of a bilateral nonischemic central retinal vein occlusionscombined with artery occlusions in a patient with acquired immune deficiency syndrome(AIDS). Methods: Case report. Results: A 22-year-old Chinese(male) with a positive human immunodeficiency virus(HIV) infection developed bilateral nonischemic central retinal vein occlusions combinedwith artery occlusions and severe vision loss. The manifestations of the fundus andfluorescein angiography were similar in both eyes.Conclusion: This case report provides the evidences that central retinal vein and arteryocclusions are probably part of the spectrum of AIDS vascular diseases.

Characteristics of retinal vein occlusion with final vision better than 78 letters after sequential therapy with ranibizumab and triamcinolone acetate

AIM： To analyze the reasons that may lead to the different vision result by combining the ranibizumab and triamcinolone acetate（TA） in sequence to treat macular edema in retinal vein occlusion（RVO）.METHODS： Ranibizumab and TA were combined in sequence to treat 43 patients with macular edema secondary to RVO.Six months after the treatment,patients with central fovea thickness（CFT） less than 300 μm in optical coherence tomography（OCT） were collected into Groups I and II,based on vision acuity（VA） better than 78 letters or less than 60 letters.The age,baseline VA,duration from onset to treatment,CFT at the baseline,sub-retinal fluid（SRF）,sub-foveal exudates and injection times of TA and ranibizumab were taken into comparison.RESULTS： The mean age of the subjects was 46.4y in Group I but 57.5y in Group II.The difference of age was significant between groups（P〈0.01）.The mean baseline VA was 51.4 letters in Group I and 43.9 letters in Group II（P〈0.05）.The baseline CFT were 670.9 μm in Group I with SRF in 54.3% patients and 678.1 μm in Group II with SRF in 52.9%（P〉0.05）.The mean number of injections of TA was 0.9 and the mean number of injections of ranibizumab was 2.3 in Group I but 1.7 and 2.9 respectively in Group II.The treatment times of ranibizumab had no difference between the 2 groups（P〉0.05） but the difference of TA injection times was significant（P〈0.05）.Subfoveal exudates at final stage happened in no subjects in Group I but in 45.83% subjects in Group II.CONCLUSION： This combined treatment is safer than TA injection and cheaper than ranibizumab injection alone.Younger patients and earlier treatment will help to get better vision outcome.Subfoveal exudates at the final stage have significant relationship with vision outcome.No relationship existed between the baseline CFT,SRF and the vision outcome.

Real-world outcomes of anti-vascular endothelial growth factor therapy for retinal vascular vein occlusion in Tibet,China

AIM: To evaluate the outcomes of intravitreal antivascular endothelial growth factor(anti-VEGF) agents for patients with retinal vein occlusion(RVO) related-macular edema(ME) in Tibetan.METHODS: A retrospective, observational, single-center study. The demographic and clinical data of 90 RVO Tibetan patients(93 eyes) treated with either ranibizumab or conbercept in Tibet Autonomous Region People’s Hospital from Jan 2018 to December 2019 were collected.RESULTS: The mean patient age was 56.8±10.6y, 45(50%) of them were female. The mean living altitude was 3867.8±567.9 m. At the last visit, the best-corrected visual acuity(BCVA) significantly increased(52.2±21.8 letters) in comparison with the baseline(38.2±24.1 letters, P<0.001);while the central retinal thickness(CRT) significantly reduced(245.5±147.6 μm) in comparison with the baseline(504.1±165.2 μm, P<0.001). The 43.0% of the eyes gained≥15 letters, 60.2% of the eyes gained ≥10 letters, and 78.5% of the eyes gained ≥5 letters. No vision loss was noted in 92.5% of the eyes, 4 eyes lost more than 10 letters during follow-up period. The mean number of injections was 2.4±1.8. No severe ocular or systemic adverse events related to either the drug or injection were noted.CONCLUSION: Anti-VEGF therapy is effective and safe in Tibetan patients for the treatment of RVO related ME.

Treatment controversies in a rare case of a simultaneous branch retinal artery and vein occlusion secondary to hyperhomocysteinemia and hypertension

Dear Editor,Combined vascular occlusions involving retinal arteries and veins have been reported in the past. Combined occlusion of the central retinal vein （CRVO） and artery （CRAO）is well described;. Cilioretinal artery occlusion along with CRVO is frequently reported and is well characterized;.

Long-Term Evaluation of Retinal Artery Occlusion Patients Who Applied Hyperbaric Oxygen Treatment

Introduction： Hyperbaric oxygen treatment （HBOT） is one of the treatment modalities for retinal artery occlusion （RAO）. HBOT may be beneficial if initiated within 2-12 hours of onset of symptoms. The objective of this study was to evaluate the usefulness of HBOT on the patients who had applied to our center for HBOT with an RAO diagnose. Methods： Sixteen patients were included in this study for a three-year period those were applied HBOT with RAO diagnosis. HBOT sessions of these patients had been started as quick as possible soon after they have arrived. Also, all patients had been started medication by ophthalmologists who sent them. To evaluate the outcome of the treatment the patients were called with telephone and ophthalmology clinic control examinations were obtained. Patients were asked survey questions about their visual ameliorations before and after HBOT. Results： Mean initiation duration of patients to get HBOT was about 28 hours. Only one patient has initiated treatment after 13 days from the event and no visual improvement was recorded. Within this patient, no visual amelioration was recorded for two more patients. Among the other 13 patients, three had 80% and more, three had 50-79% and seven had below 50% visual amelioration. Eleven of 13 patients had peripheral visual field amelioration. Discussion： With the medical treatment, an immediate intervention of HBOT was considered a useful treatment modality for RAO. The visual improvement of the visual fields was considered especially in the peripheral vision rather than central vision.

Localized Administration of Tissue Plasminogen Activator through the Ophthalmic Artery in the Setting of Central Retinal Artery Occlusion

Treatment of central retinal artery occlusion (CRAO) has been an ambiguous entity in the medical community. Many interventions have been explored;however, a standard of care has yet to be defined. Recent studies have suggested localized intra-arterial fibrinolysis as a promising method;however, a timeframe for optimal treatment initiation continues to be investigated. This case demonstrates an instance of CRAO treated with local fibrinolysis, however, what could be due to delayed time-to-treat, final visual outcomes were unfavorable. In conjunction with supporting literature, we believe optimization of thrombolytic protocols should be sought after to facilitate successful treatment outcomes. In addition, we encourage community awareness of the signs and symptoms of CRAO in hopes that earlier patient presentations will lead to swifter interventions and overall preservation of ocular function.

Modified constraint-induced movement therapy alters synaptic plasticity of rat contralateral hippocampus following middle cerebral artery occlusion

Modified constraint-induced movement therapy is an effective treatment for neurological and motor impairments in patients with stroke by increasing the use of their affected limb and limiting the contralateral limb.However,the molecular mechanism underlying its efficacy remains unclear.In this study,a middle cerebral artery occlusion(MCAO)rat model was produced by the suture method.Rats received modified constraint-induced movement therapy 1 hour a day for 14 consecutive days,starting from the 7^th day after middle cerebral artery occlusion.Day 1 of treatment lasted for 10 minutes at 2r/min,day 2 for 20 minutes at 2 r/min,and from day 3 onward for 20 minutes at 4 r/min.CatWalk gait analysis,adhesive removal test,and Y-maze test were used to investigate motor function,sensory function as well as cognitive function in rodent animals from the 1st day before MCAO to the 21^st day after MCAO.On the 21^st day after MCAO,the neurotransmitter receptor-related genes from both contralateral and ipsilateral hippocampi were tested by micro-array and then verified by western blot assay.The glutamate related receptor was shown by transmission electron microscopy and the glutamate content was determined by high-performance liquid chromatography.The results of behavior tests showed that modified constraint-induced movement therapy promoted motor and sensory functional recovery in the middle cerebral artery-occluded rats,but had no effect on cognitive function.The modified constraint-induced movement therapy upregulated the expression of glutamate ionotropic receptor AMPA type subunit 3(Gria3)in the hippocampus and downregulated the expression of the beta3-adrenergic receptor gene Adrb3 and arginine vasopressin receptor 1 A,Avprla in the middle cerebral artery-occluded rats.In the ipsilateral hippocampus,only Adra2 a was downregulated,and there was no significant change in Gria3.Transmission electron microscopy revealed a denser distribution the more distribution of postsynaptic glutamate receptor 2/3,which is an a-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid receptor,within 240 nm of the postsynaptic density in the contralateral cornu ammonis 3 region.The size and distribution of the synaptic vesicles within 100 nm of the presynaptic active zone were unchanged.Western blot analysis showed that modified constraint-induced movement therapy also increased the expression of glutamate receptor 2/3 and brain-derived neurotrophic factor in the hippocampus of rats with middle cerebral artery occlusion,but had no effect on Synapsin I levels.Besides,we also found modified constraint-induced movement therapy effectively reduced glutamate content in the contralateral hippocampus.This study demonstrated that modified constraint-induced movement therapy is an effective rehabilitation therapy in middle cerebral artery-occluded rats,and suggests that these positive effects occur via the upregulation of the postsynaptic membrane a-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid receptor expression.This study was approved by the Institutional Animal Care and Use Committee of Fudan University,China(approval No.201802173 S)on March 3,2018.

Comparison of one and three initial monthly intravitreal ranibizumab injection in patients with macular edema secondary to branch retinal vein occlusion

AIM： To compare three initial monthly intravitreal ranibizumab（IVR） injections followed by pro re nata（PRN） dosing with one initial monthly IVR injections followed by PRN dosing for macular edema（ME） secondary to branch retinal vein occlusion（BRVO）.METHODS： Forty-two eyes of 42 patients who had IVR injections for BRVO were retrospectively studied. Eighteen eyes received 1 initial IVR injection（1＋PRN group） and 24 eyes received 3 monthly IVR injections（3＋PRN）. At 1, 3, 6 and 12mo; spectral-domain optical coherence tomography（SD-OCT） was performed. Central macular thickness（CMT）, the integrity of the external limiting membrane（ELM）, the presence of subretinal fluid, cyst size, the presence of inner segment/outer segment（IS/OS） defect were determined.RESULTS： At baseline the mean CMT was 521.3±153.2 μm in the 3＋PRN group while it was 438.1±162.4 μm in 1＋PRN group. At the final visit, mean CMT was 278.3±87.8 μm in the 3＋PRN group and 285.2±74.2 μm in the 1＋PRN group（P=0.079）. The changes in CMT over the entire study period were also comparable in both groups（243±160 μm in the 3＋PRN group, and 152.9±175.3 μm in the 1＋PRN group; P=0.090）. At baseline, best-corrected visual acuity（BCVA） was 0.92±0.60 logarithm of the minimal angle of resolution（logMAR） in the 3＋PRN group, while it was 0.72±0.46 logMAR in the 1＋PRN group. Final BCVA was 0.42±0.55 logMAR in the 3＋PRN group and 0.38±0.50 logMAR in the 1＋PRN group（P=0.979）. Additionally, the BCVA changes from baseline to final visit were not significantly different（-0.50±0.45 logMAR in the 3＋PRN group, and-0.33±0.39 logMAR in the 1＋PRN group; P=0.255）.CONCLUSION： No significant differences in the anatomical or functional results are found between 3＋PRN and 1＋PRN regimens in the patients receiving ranibizumab for ME secondary to BRVO. Intact IS/OS and baseline BCVA are good predictor of the visual gain, while baseline CMT is a good predictor of the anatomical gain.

Acute retinal arterial ischemia

Acute retinal arterial ischemia,which includes transient monocular vision loss(TMVL),branch retinal artery occlusion(BRAO),central retinal artery occlusion(CRAO)and ophthalmic artery occlusion(OAO),is most commonly the consequence of an embolic phenomenon from the ipsilateral carotid artery,heart or aortic arch,leading to partial or complete occlusion of the central retinal artery(CRA)or its branches.Acute retinal arterial ischemia is the ocular equivalent of acute cerebral ischemia and is an ophthalmic and medical emergency.Patients with acute retinal arterial ischemia are at a high risk of having further vascular events,such as subsequent strokes and myocardial infarctions(MIs).Therefore,prompt diagnosis and urgent referral to appropriate specialists and centers is necessary for further work-up(such as brain magnetic resonance imaging with diffusion weighted imaging,vascular imaging,and cardiac monitoring and imaging)and potential treatment of an urgent etiology(e.g.,carotid dissection or critical carotid artery stenosis).Since there are no proven,effective treatments to improve visual outcome following permanent retinal arterial ischemia(central or branch retinal artery occlusion),treatment must focus on secondary prevention measures to decrease the likelihood of subsequent ischemic events.

腔内和血管旁路手术治疗锁骨下动脉闭塞的疗效分析

目的 探讨腔内手术和血管旁路手术治疗锁骨下动脉闭塞的疗效。方法 回顾性分析2020年1月至2022年12月我科收治的69例锁骨下动脉闭塞患者的临床资料,其中左侧病变56例,右侧病变13例;病变位于起始部65例,中段4例。结果 59例患者成功接受手术治疗,术中均无并发症及死亡发生。行旁路手术19例(颈总动脉-锁骨下动脉旁路9例,腋-腋动脉旁路10例),术后出现淋巴瘘及消化道出血各1例。腔内治疗40例(经股动脉穿刺顺行开通20例,联合肱动脉穿刺逆向开通20例),术后出现急性脑梗死及急性心肌梗死各1例,均经保守治疗后好转,左侧肱动脉血栓形成1例,急诊行肱动脉切开取栓术。其余患者术后30 d内均无并发症及死亡发生。随访3~32个月,中位随访时间14.8个月,腔内治疗和旁路手术患者间累积通畅率比较无统计学差异。结论 腔内手术和血管旁路手术均可有效治疗锁骨下动脉闭塞,需要根据患者的具体情况选择合适的手术方式。