ObjectiveTo observe alterations in center retinal thickness (CRT) in patients diagnosed with central retinal artery occlusion (CRAO) before and after undergoing superselective arterial thrombolysis (IAT) treatment. MethodsA retrospective clinical study. From August 2022 to September 2023, 12 patients (12 eyes) diagnosed with CRAO and treated with IAT at the ophthalmology department of Shenzhen Second People's Hospital. Among these patients, there were 8 males (8 eyes) and 4 females (4 eyes), all experiencing unilateral onset. The mean age was (47.00±15.06) years. The mean duration from onset to thrombolysis was (30.00±30.42) h. All eyes underwent best corrected visual acuity (BCVA) and optical coherence tomography (OCT) assessments; additionally, 6 eyes underwent Fluorescein fundus angiography (FFA). BCVA assessments were conducted using a standard logarithmic chart and transformed into logarithm of the minimum angle of resolution (logMAR) values for statistical analysis. The OCT measured CRT at various locations around the macular fovea (M), including upper (S1, S3), lower (I1, I3), nasal (N1, N3), and temporal (T1, T3) areas at 1 mm and 3 mm distances from the fovea. CRT was defined as the vertical distance between the inner retinal boundary membrane and the inner interface of the retinal pigment epithelial layer. Pre- and post-IAT examinations were performed using the same equipment and methodologies within a 24-hour interval. Changes in CRT at different macular points were compared and observed, while arterial imaging time changes were assessed in 6 eyes that underwent FFA. Paired t-tests were utilized to analyze logMAR BCVA, CRT at different locations, and arterial imaging time pre- and post-treatment. ResultsPrior to IAT treatment, the logMAR BCVA for the affected eye was 3.48±1.42, while the arterial imaging time for the 6 eyes undergoing FFA examination was (27.50±5.47) s. After 24 hours, the logMAR BCVA had improved to 2.35±1.59 for the affected eye, with 9 eyes showing varying degrees of BCVA improvement. The arterial imaging time was (24.17±7.28) s post-treatment. The differences in logMAR BCVA and arterial imaging time before and after treatment were found to be statistically significant (t=2.489, 3.262; P＜0.05). Additionally, the comparison of CRT at S3 (t=2.871), I1 (t=2.325), and T3 (t=3.446) before and after treatment yielded statistically significant differences (P＜0.05). Conversely, the comparison of CRT at S1 (t=1.879), I3 (t=1.915), N1 (t=2.001), N3 (t=1.987), T1 (t=2.180), and M (t=－0.490) showed no statistically significant differences (P＞0.05). ConclusionsIAT treatment for CRAO has been shown to be effective in achieving therapeutic effects by reducing CRT in the macular area. However, the short-term improvement in retinal edema in the macular area is limited.
ObjectivesTo explore the changes of some peripheral blood cells related to inflammation in patients with non-arteritis central retinal artery occlusion (NA-CRAO). MethodsA retrospective clinical study. From July 2019 to July 2021, a total of 218 patients with NA-CRAO hospitalized (NA-CRAO group) in Department of Ophthalmology, Xi'an People's Hospital (Xi'an Fourth Hospital) and 218 patients with routine physical examination (control group) during the same period were included in the study. There were no significant differences in age (t=0.60), sex composition ratio (χ2=0.83) and body mass index (t=0.77) between the two groups (P＞0.05). 0.2 ml fasting peripheral blood was collected from the subject, and white blood cells (WBC), neutrophils (NEUT), lymphocytes (LYMPH), red blood cells (RBC), RBC distribution width (RDW), platelets (PLT), mean PLT volume (MPV), and large PLT ratio (PLCR) were detected. The NEUT/LYMPH ratio (NLR) and PLT/LYMPH ratio (PLR) were calculated. t test was used to compare measurement data between groups. Multiple logistic regression analysis was performed for blood cells with P＜0.05. The receiver operating characteristic curve (ROC curve) was used to calculate the area under the curve (AUC) and 95% confidence interval (95%CI) of each inflammatory indicator, and the optimal cutoff value was determined according to the Jorden index (sensitivity+specificity－1). ResultsCompared with control group, WBC, NEUT, NLR, RDW, PLR were increased in NA-CRAO group, while RBC and LYMPH were decreased, with statistical significance (t=9.68, 12.43, 9.47, 3.64, 5.54, 5.18, 0.46; P＜0.001). There was no significant difference in PLT, MPV and PLCR between the two groups (t=0.32, 1.56, 0.84; P＞0.05). Multivariate logistic regression analysis showed that NLR was a possible risk factor for the occurrence of NA-CRAO (odds ratio=2.51, 95%CI 0.780-0.859, P=0.031). ROC curve analysis showed that the AUC predicted by NLR was 0.819, the optimal critical value was 3.05, and the sensitivity and specificity were 59.2% and 92.7%, respectively. ConclusionsIn peripheral blood cells of NA-CRAO patients, NEUT is significantly increased and LYMPH is decreased. NLR is a possible risk factor for NA-CRAO.
[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. MethodsA 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. ResultsIn 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). ConclusionsIn 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.