[Isolated cilioretinal artery occlusion - clinical findings and outcome in 31 cases]

Abstract

Purpose: The aim of this study was to evaluate the outcome of this rare type of retinal vascular occlusion in a large patient series.

Patients and methods: A retrospective chart review of all patients with an isolated cilioretinal artery obstruction seen at the University Eye Clinic Mainz (Germany) between 1/1998 and 12/2009 was performed. Standard treatment was intravenous anticoagulation with heparin. Follow-up mean was 51 months.

Results: Included in this study were 31 eyes from 31 patients (mean patient age 49 years, range 25 - 71 years). Significant atherosclerotic carotid artery obstruction in 17/31 cases. All occlusions were located temporally and involved some portion of the fovea (2 × cholesterol emboli). Fluorescein angiography revealed no eye with complete occlusion of the cilioretinal artery, but late retrograde filling in all eyes and associated choroidal filling defects in 10/31 eyes. During follow-up the scotomatous visual field defect (centrocaecal in 25/31 eyes) usually reduced in size, but scotoma was a persisting remnant of this episode in all eyes. Optical coherence tomography during the acute injury revealed intraretinal oedema in the area of the infarct and months afterwards an attenuated retinal thickness, consistent with retinal atrophy. Visual outcome achieved 20/50 (reading vision) in 23/31 eyes, but in only 2 of 10 eyes with associatted choroidal perfusion defects.

Conclusions: The visual prognosis of isolated cilioretinal artery obstructions seems to be significantly better than for other types of retinal artery occlusion, unless the entire perifoveal capillary network is affected and choroidal involvement is shown angiographically.