ObjectiveTo observe the center retinal thickness (CRT) and subfoveal choroidal thickness (SFCT) in eyes with central retinal artery occlusion (CRAO) before and after treatment.MethodsA total of 34 patients (34 eyes) diagnosed with CRAO by fundus fluorescence angiography (FFA) were retrospectively analyzed. There were 18 males (18 eyes) and 16 females (16 eyes). The average age was (61.42±14.09) years. The mean onset time was (2.64±3.73) days. The mean hospitalization time was (11.92±4.95) days. The mean axial length (AL) was (23.53±2.04) mm. The best-corrected visual acuity (BCVA), slit-lamp biomicroscopy, indirect ophthalmoscopy, fundus color photography, fundus fluorescein angiography, spectral domain optical coherence tomography (OCT) and AL measurement were performed. BCVA was converted to the logarithm of the minimum angle of resolution (logMAR). According to FFA, visual loss and the results of OCT, patients were divided into 3 groups: incomplete CRAO (15 eyes) , subtotal CRAO (8 eyes), total CRAO (11 eyes). SFCT and CRT in affected and the fellow eye were measured by OCT for enhanced deep imaging. Follow up lasted for 1 month after treatment, with an average follow-up of (34.71±6.82) days. The changes of SFCT, CRT, and BCVA before and after treatment were observed. The correlation between BCVA after treatment and pretreatment CRT was also analyzed.ResultsAfter 1 month of follow-up, the logMAR BCVA in incomplete group, subtotal group and total group were significantly higher than before treatment (t=3.74, 3.61, 3.26; P=0.004, 0.009, 0.017). Before treatment, the average CRT of the contralateral eyes in the total, subtotal and incomplete group were (215.00±19.85), (224.00±22.79), (214.00±8.21) μm, and the mean SFCT were (264.54±121.71), (266.50±58.17), (261.86±90.95) μm. The average CRT of the affected eyes were (353.18±60.26), (280.14±11.08), (266.63±19.65) μm, and the average SFCT were (233.72±111.35), (237.75±53.30), (259.86±98.14) mm. Compared with the fellow eyes, the average CRT in the 3 groups were thickened, and the difference were statistically significant (t=8.274, 3.694, 11.577; P＜0.001, 0.008, ＜0.001); the average SFCT in the total group was decreased, the difference was statistically significant (t=−2.138, P=0.048). The mean CRT among the 3 groups of eyes was statistically significant (F=12.02, P＜0.001). There was no significant difference in the average SFCT (F=0.178, P=0.838). After 1 month follow-up, the mean CRT in the total, subtotal and incomplete group were (231.18±49.28), (219.16±21.34), (217.86±24.98) μm, and the average SFCT were (239.81±109.57), (241.86±42.81), (260.57±91.67) μm. Compared with before treatment, the average CRT in the three groups of eyes were decreased, the difference were statistically significant (t=13.032, 3.711, 4.970; P＜0.001, 0.008, 0.003); the difference in mean SFCT were not statistically significant (t=−0.785, −0.202, −0.078; P=0.466, 0.845, 0.940). Correlation analysis showed that BCVA after treatment was positively correlated with pretreatment CRT (odds ratio=0.578, P=0.002).ConclusionCRAO resulted in CRT in the preliminary stage and became thinner after receiving treatments. There exists a positive correlation between visual outcome and CRT before receiving treatments.
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.