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Central Retinal Artery Occlusion Follow-up

  • Author: Robert H Graham, MD; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Aug 12, 2015
 

Further Outpatient Care

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  • A follow-up ophthalmic examination should be performed 1-4 weeks after the event to check for neovascularization of the disc or iris.
    • Neovascularization of the iris occurs in 20% of patients at an average of 4-5 weeks after the event. The range is 1-15 weeks. Panretinal photocoagulation is effective in causing regression of iris neovascularization in 65% of patients.
    • Neovascularization of the disc occurs in 2-3% of patients. Panretinal photocoagulation is effective for optic disc neovascularization. Intravitreal injection of an anti-VEGF agent is first-line therapy for iris, trabecular meshwork, or optic disc neovascularization.
  • A complete systemic workup should be performed by a primary care provider.
  • If hyperbaric oxygen therapy (HBOT) is to be used, several treatments may be necessary, although this treatment is unproven.
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Further Inpatient Care

Inpatient care is indicated only if comorbid disease is present.

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Inpatient & Outpatient Medications

In/out patient medications are indicated only if comorbid disease is present.

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Transfer

Transfer to a hyperbaric facility is necessary if HBOT is to be administered.

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Deterrence/Prevention

Patients should control their blood pressure, lower their cholesterol, avoid intravenous drugs, and take their medication.

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Complications

See the list below:

  • Further emboli to the brain resulting in a cerebrovascular accident
  • Further emboli to the same or contralateral eye, resulting in further visual loss
  • Progression of temporal arteritis, resulting in loss of vision to the contralateral eye
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Prognosis

Most patients continue to experience severe vision loss in the counting fingers to hand motion range.[8]

As many as 10% of patients retain central vision because of the presence of a cilioretinal artery. In this case, visual acuity improves to 20/50 or better in 80% of cases over a 2-week period.

The presence of a retinal embolus is associated with a 56% mortality rate over 9 years compared to 27% in patients without arterial emboli.

Life expectancy of patients with central retinal artery occlusion (CRAO) is 5.5 years compared to 15.4 years for an age-matched population without CRAO.

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Patient Education

Patients must understand that the prognosis for visual recovery is poor and that the visual changes are usually a result of a systemic process that needs treatment.

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Contributor Information and Disclosures
Author

Robert H Graham, MD Consultant, Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona

Robert H Graham, MD is a member of the following medical societies: American Academy of Ophthalmology, Arizona Ophthalmological Society, American Medical Association

Disclosure: Partner received salary from Medscape/WebMD for employment.

Coauthor(s)

Shehab A Ebrahim, MD Assistant Professor, Department of Ophthalmology, Tulane University; Vitreoretinal Surgeon, The Retina Institute, LLC

Shehab A Ebrahim, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, Association for Research in Vision and Ophthalmology, American Society of Retina Specialists

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Steve Charles, MD Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine

Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Macula Society, Retina Society, Club Jules Gonin

Disclosure: Received royalty and consulting fees for: Alcon Laboratories.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

V Al Pakalnis, MD, PhD Professor of Ophthalmology, University of South Carolina School of Medicine; Chief of Ophthalmology, Dorn Veterans Affairs Medical Center

V Al Pakalnis, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, South Carolina Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous coauthors, Enoch Huang, MD, MPH, and DooHo Brian Kim, BA, to the development and writing of this article.

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