Lei Tao , Wang Runsheng , Zhang Bo , Ma Teng , Wang Xiao , An Jinjin , Wang Kun , Wang Xiaotang , Wang Yong
  • Department of Ophtalmology, Xi'an People's Hospital (Xi'an Fourth Hospital), Xi’an 710004, China;
Wang Runsheng, Email: wangrunsheng0602@sohu.com
Internal boundary membrane detachment; Non-arteriotic central retinal artery occlusion; Visual prognosis; Retinal ischemia; Fluorescein fundus angiography; Tomography; optical coherence
10.3760/cma.j.cn511434-20240527-00205
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[Abstract]Objective  To observe the clinical and imaging features of non-arteriotic central retinal artery occlusion (NA-CRAO) with internal boundary membrane detachment (ILMD), and to analyze its relationship with visual prognosis. Methods A retrospective clinical study. A total of 88 patients with NA-CRAO hospitalized in Department of Ophtalmology, Xi'an People's Hospital (Xi'an Fourth Hospital) from January 2014 to June 2023 were included in the study. Best corrected visual acuity (BCVA), optical coherence tomography (OCT) and fluorescein fundus angiography (FFA) were performed. The BCVA test used the international standard visual acuity chart, which was statistically converted to the logMAR visual acuity. OCT observed the presence of ILMD and the thickening of the inner retina and the disappearance of anatomical stratification. FFA recorded arm-retinal circulation time (A-Rct) and retinal arterion-distal filling time (FT), and observed ciliary retinal artery, fluorescein retrograde filling, cotton spots, luciferin nodal filling, macular non-perfusion, capillary fluorescein leakage, optic disc strong fluorescence, choroidal background weak fluorescence and other characteristics. According to whether there was ILMD, the patients were divided into ILMD group and non-ILMD group, with 44 cases and 44 eyes respectively. The two groups received the same treatment. The follow-up time was 30 days after treatment. The clinical, FFA characteristics and BCVA before and after treatment were compared between the two groups. t-test was used for comparison between groups. Results In ILMD group and non-ILMD group, there were 43 cases of male and 1 case of female, respectively, and the proportion of male was significantly higher than that of female. Before and after treatment, the logMAR BCVA of ILMD group and non-ILMD group were 2.35±0.42, 2.01±0.46, 1.47±0.60, 0.77±0.49, respectively. There were significant differences in logMAR BCVA between the two groups before and after treatment (t=8.025, 12.358; P＜0.001). Before treatment, A-Rct and FT in ILMD group were longer than those in non-ILMD group, and the difference was statistically significant (t=3.052, 3.385; P＜0.05). After treatment, there was no significant difference (t=1.040, 1.447; P＞0.05). The proportion of ciliary retinal artery and cotton plaque in ILMD group was lower than that in non-ILMD group. There was no significant difference in ciliary retinal artery between the two groups (χ2=－0.961, P＞0.05), but there was a significant difference in cotton wool plaque between the two groups (χ2=－3.364, P＜0.05). Compared to the non-ILMD group, The proportion of retrograde fluorescein filling in retinal artery (χ2=－2.846), segment filling (χ2=－3.907), macular non-perfusion (χ2=－6.656), capillary fluorescein leakage (χ2=－4.367), optic disc strong fluorescence (χ2=－3.525) and choroidal background weak fluorescence (χ2=－2.276) increased, the difference was statistically significant (P＜0.05). Conclusions In patients with NA-CRAO, compared with those without ILMD, those with ILMD have more severe retinal ischemia and worse BCVA before and after treatment. ILMD is one of the poor prognostic markers of NA-CRAO vision.