Microemboli are not a prerequisite in retinal artery occlusive diseases

Embolic central retinal artery occlusion detected by orbital color Doppler imaging

OBJECTIVE

To describe the detection of emboli to the retrobulbar circulation using orbital color Doppler imaging in patients with central retinal artery occlusions (CRAO) without visible retinal emboli.

DESIGN

Noncomparative, retrospective, observational case series.

PATIENTS AND METHODS

Twenty-nine patients with CRAO, without funduscopic evidence of embolic material within the retinal arterioles, underwent neuroophthalmic examination and evaluation with orbital color Doppler imaging.

MAIN OUTCOME MEASURES

The detection of retrobulbar plaques using orbital color Doppler imaging.

RESULTS

Nine of 29 (31%) patients with CRAO demonstrated hyperechoic retrobulbar plaques. All nine patients had visual acuity of counting fingers or worse at presentation. Six of the nine patients (67%) had a history of hypertension, and seven (78%) had coronary artery disease as vascular risk factors for arterial occlusive disease. Two of the nine patients (22%) subsequently died from cardiac-related events.

CONCLUSIONS

This study demonstrates that orbital color Doppler imaging is an important diagnostic procedure for establishing embolism as the cause of CRAO when no emboli are visible in the retinal circulation. This noninvasive technology enables prompt differentiation of embolic disease from arterial occlusion caused by intrinsic atherosclerosis, vasospasm, or vasculitis from giant cell arteritis. Recognition of emboli has important management implications for these patients.

Update on ischemic stroke

Stroke is the second most common cause of death worldwide, exceeded only by heart disease. Epidemiologic studies have greatly enhanced our understanding of the factors that increase stroke risk. There have also been many recent developments in the understanding of the various etiologies of stroke as well as specific new treatments. The characteristic sudden onset and rapid tissue damage make stroke particularly challenging to treat. The most promising therapy for acute ischemic stroke is the use of a thrombolytic agent. This has been the focus of recent large trials and remains a challenging treatment for cerebral ischemic stroke as well as for retinal artery occlusion. Because neuro-ophthalmic symptoms and signs such as vision loss and diplopia are common in patients with stroke, patients are often seen by ophthalmologists prior to their primary care physicians or neurologists. The ophthalmologist should be aware of some of the new diagnostic and therapeutic issues in the management of patients with acute ischemic stroke. This review emphasizes some of the controversial topics published during the past few years.