The effect of internal boundary membrane detachment on visual acuity in the affected side of non-arteriotic central retinal artery occlusion_Chinese Journal of Ocular Fundus Diseases

Authors：

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;

Corresponding author：

Wang Runsheng, Email: wangrunsheng0602@sohu.com

Keywords：

Internal boundary membrane detachment; Non-arteriotic central retinal artery occlusion; Visual prognosis; Retinal ischemia; Fluorescein fundus angiography; Tomography, optical coherence

DOI：

10.3760/cma.j.cn511434-20240527-00205

Video：

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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 logarithm of the minimum angle of resolution (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.

Citation： Lei Tao, Wang Runsheng, Zhang Bo, Ma Teng, Wang Xiao, An Jinjin, Wang Kun, Wang Xiaotang, Wang Yong. The effect of internal boundary membrane detachment on visual acuity in the affected side of non-arteriotic central retinal artery occlusion. Chinese Journal of Ocular Fundus Diseases, 2024, 40(11): 854-859. doi: 10.3760/cma.j.cn511434-20240527-00205 Copy

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1. Hayreh SS. Central retinal artery occlusion[J]. Indian J Ophthalmol, 2018, 66(12): 1684-1694. DOI: 10.4103/ijo.IJO_1446_18.
2. Ahn SJ, Woo SJ, Park KH, et al. Retinal and choroidal changes and visual outcome in central retinal artery occlusion: an optical coherence tomography study[J]. Am J Ophthalmol, 2015, 159(4): 667-676. DOI: 10.1016/j.ajo.2015.01.001.
3. Venkatesh R, Jayadev C, Sridharan A, et al. Internal limiting membrane detachment in acute central retinal artery occlusion: a novel prognostic sign seen on OCT[J]. Int J Retina Vitreous, 2021, 7(1): 51. DOI: 10.1186/s40942-021-00323-7.
4. Wenzel DA, Poli S, Casagrande M, et al. Inner retinal layer hyperreflectivity is an early biomarker for acute central retinal artery occlusion[J/OL]. Front Med (Lausanne), 2022, 9: 854288[2022-07-06]. https://pubmed.ncbi.nlm.nih.gov/35872772/. DOI: 10.3389/fmed.2022.854288.
5. Kim H, Kim HK, Yang JY, et al. Optical coherence tomography measurement and visual outcome in acute central retinal artery occlusion[J]. Korean J Ophthalmol, 2018, 32(4): 303-311. DOI: 10.3341/kjo.2017.0093.
6. Schnieder M, Fischer-Wedi CV, Bemme S, et al. The retrobulbar spot sign and prominent middle limiting membrane as prognostic markers in non-arteritic retinal artery occlusion[J]. J Clin Med, 2021, 10(2): 338. DOI: 10.3390/jcm10020338.
7. Feucht N, Zapp D, Reznicek L, et al. Multimodal imaging in acute retinal ischemia: spectral domain OCT, OCT-angiography and fundus autofluorescence[J]. Int J Ophthalmol, 2018, 11(9): 1521-1527. DOI: 10.18240/ijo.2018.09.15.
8. Chen H, Chen X, Qiu Z, et al. Quantitative analysis of retinal layers' optical intensities on 3D optical coherence tomography for central retinal artery occlusion[J/OL]. Sci Rep, 2015, 5: 9269[2015-04-18]. https://pubmed.ncbi.nlm.nih.gov/25784298/. DOI: 10.1038/srep09269.
9. Bringmann A, Karol M, Unterlauft JD, et al. Foveal regeneration after resolution of cystoid macular edema without and with internal limiting membrane detachment: presumed role of glial cells for foveal structure stabilization[J]. Int J Ophthalmol, 2021, 14(6): 818-833. DOI: 10.18240/ijo.2021.06.06.
10. Syrbe S, Kuhrt H, Gärtner U, et al. Müller glial cells of the primate foveola: an electron microscopical study[J]. Exp Eye Res, 2018, 167: 110-117. DOI: 10.1016/j.exer.2017.12.004.
11. MacDonald RB, Randlett O, Oswald J, et al. Müller glia provide essential tensile strength to the developing retina[J]. J Cell Biol, 2015, 210(7): 1075-1083. DOI: 10.1083/jcb.201503115.
12. 雷涛, 王润生, 张博, 等. 尿激酶动脉溶栓对非动脉炎性视网膜中央动脉阻塞患者的疗效和安全性[J]. 眼科新进展, 2023, 43(3): 198-202. DOI: 10.13389/j.cnki.rao.2023.0040.Lei T, Wang RS, Zhang B, et al. Efficacy and safety of urokinase in arterial thrombolytic therapy of non-arteritic central retinal artery occlusion[J]. Rec Adv Ophthalmol, 2023, 43(3): 198-202. DOI: 10.13389/j.cnki.rao.2023.0040.
13. Delhiwala KS, Rao C. Cystoid macular edema with idiopathic acute central retinal artery occlusion in a healthy child[J]. J Ophthalmic Vis Res, 2017, 12(3): 348-350. DOI: 10.4103/jovr.jovr_211_16.
14. Bringmann A, Iandiev I, Pannicke T, et al. Cellular signaling and factors involved in Müller cell gliosis: neuroprotective and detrimental effects[J]. Prog Retin Eye Res, 2009, 28(6): 423-451. DOI: 10.1016/j.preteyeres.2009.07.001.
15. Bringmann A, Pannicke T, Grosche J, et al. Müller cells in the healthy and diseased retina[J]. Prog Retin Eye Res, 2006, 25(4): 397-424. DOI: 10.1016/j.preteyeres.2006.05.003.
16. Ng WY, Wong DW, Yeo IY, et al. Cystoid macular edema in acute presentation of central retinal artery occlusion[J/OL]. Case Rep Ophthalmol Med, 2012, 2012: 530128[2012-04-04]. https://pubmed.ncbi.nlm.nih.gov/22606497/. DOI: 10.1155/2012/530128.
17. Scott IU, Campochiaro PA, Newman NJ, et al. Retinal vascular occlusions[J]. Lancet, 2020, 396(10266): 1927-1940. DOI: 10.1016/S0140-6736(20)31559-2.
18. Dattilo M, Newman NJ, Biousse V. Acute retinal arterial ischemia[J]. Ann Eye Sci, 2018, 3: 28. DOI: 10.21037/aes.2018.05.04.
19. Mehta N, Marco RD, Goldhardt R, et al. Central retinal artery occlusion: acute management and treatment[J]. Curr Ophthalmol Rep, 2017, 5(2): 149-159. DOI: 10.1007/s40135-017-0135-2.
20. Kurimoto T, Okamoto N, Oku H, et al. Central retinal artery occlusion resembling Purtscher-like retinopathy[J]. Clin Ophthalmol, 2011, 5: 1083-1088. DOI: 10.2147/OPTH.S22786.
21. Wenzel DA, Kromer R, Poli S, et al. Optical coherence tomography-based determination of ischaemia onset - the temporal dynamics of retinal thickness increase in acute central retinal artery occlusion[J/OL]. Acta Ophthalmol, 2021, 99(2): e247-e252[2020-08-06]. https://pubmed.ncbi.nlm.nih.gov/32767551/. DOI: 10.1111/aos.14563.
22. Ochakovski GA, Wenzel DA, Spitzer MS, et al. Retinal oedema in central retinal artery occlusion develops as a function of time[J/OL]. Acta Ophthalmol, 2020, 98(6): e680-e684[2020-02-10]. https://pubmed.ncbi.nlm.nih.gov/32040258/. DOI: 10.1111/aos.14375.

Chinese Journal of Ocular Fundus Diseases

The effect of internal boundary membrane detachment on visual acuity in the affected side of non-arteriotic central retinal artery occlusion

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