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doi: 10.1097/01.iae.0000238095.97104.9b
Original Articles

Purpose: To investigate systematically the ophthalmoscopic fundus findings associated with central retinal artery occlusion (CRAO).

Methods: The study included 240 consecutive patients (248 eyes) with CRAO. The eyes underwent detailed fundus evaluation and stereoscopic color fundus photography at initial and follow-up visits. Patients without evidence of giant cell arteritis were advised to have carotid Doppler imaging and echocardiography to determine the source of emboli. CRAO was classified into 3 types: permanent CRAO (175 eyes), permanent CRAO with cilioretinal artery sparing (35 eyes), and transient CRAO (38 eyes). In the three types of CRAO, acute-phase and late-phase changes in the retina, optic disk, and retinal vessels were evaluated.

Results: The main findings during the initial examination in our clinic for permanent CRAO were retinal opacity in the posterior pole (58%), cherry-red spot (90%), box-carring (19%), retinal arterial attenuation (32%), and optic disk edema (22%) and pallor (39%). The most frequent findings identified at the late stage, based on survivorship curves, were optic atrophy (91%), retinal arterial attenuation (58%), cilioretinal collaterals (18%), and macular retinal pigment epithelial changes (11%). Compared with permanent CRAO, permanent CRAO with cilioretinal artery sparing was associated with a lower incidence of all macular and optic disk abnormalities. For transient CRAO, the incidence of initial findings varied greatly compared with the other types. Intraarterial emboli were observed in 20% of patients. Carotid Doppler evaluation identified carotid vascular plaques in 67% of patients tested and hemodynamically significant (>50%) obstruction in 32%. Four percent of CRAOs presented with simultaneous bilateral onset.

Conclusions: The type and incidence of fundus findings at the initial visit and in the late phase of CRAO vary by its type. This study confirms that retinal opacity is predominantly evident in the posterior retina, that optic disk findings at presentation are common, that CRAO associated with normal-appearing retinal vessels and/or optic disk is not rare, and that observation of emboli is infrequent. Clinicians should be aware of the various presentation findings during the acute and late stages of CRAO and its various types. A complete picture of CRAO is provided by combined information of our clinical and experimental studies of CRAO.

Ophthalmoscopic fundus findings in central retinal artery occlusion (CRAO), in 240 consecutive patients (248 eyes), showed that it is essential to classify CRAO into 3 types: permanent CRAO, permanent CRAO with cilioretinal artery sparing, and transient CRAO. Clinicians should be aware that the type and incidence of fundus findings during the acute stage and in the late phase of CRAO vary by its type. That also holds true for visual outcome. A complete picture of CRAO and evolution of fundus changes are discussed, based on combined information of our clinical (in 248 eyes) and experimental (in 101 eyes) studies of CRAO.

From the *Department of Ophthalmology and Visual Sciences, College of Medicine, and the †Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa.

Supported in part by Grant RO1-EY-1151 from the National Institutes of Health (Bethesda, MD), and in part by an unrestricted grant from Research to Prevent Blindness, Inc. (New York, NY).

The authors have no proprietary interest in this study.

Reprint requests: S.S. Hayreh, Department of Ophthalmology and Visual Sciences, University Hospitals & Clinics, 200 Hawkins Drive, Iowa City, IA; e-mail:

© The Ophthalmic Communications Society, Inc.