Capturing the Occult Central Retinal Artery Occlusion Using Optical Coherence Tomography

Balal, Shafi; J'Bari, Ahmed Said; Ali, Hassan; Sharma, Anant; Wagner, Siegfried; Pasu, Saruban

doi:10.1080/02713683.2021.1921219

Cited by 4 publications

(2 citation statements)

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“…Typically, CRAO is a clinical diagnosis, though funduscopic changes, such as a cherry red spot or retinal pallor, may be lacking within the IVT-relevant very early phase, while ischemic signs may already become apparent on optical coherence tomography (OCT) scans ( 8 ). OCT provides high resolution non-invasive microstructural retinal images and has been shown to be a valuable diagnostic instrument for CRAO ( 9 – 16 ).…”

Section: Introductionmentioning

confidence: 99%

“…Whereas the hyperreflectivity of the inner retinal layers is discussed to be most likely due to an increased intracellular ischemic edema, whereas consequently hyporeflectivity of the outer layers is caused by the decreased signal permeability of the edematous inner retinal layers ( 19 , 20 ). However, as the retinal thickness often is normal or only mildly increased within the first hours ( 8 , 10 , 16 ), we hypothesized that the ischemia-induced increase in optical intensity may potentially be visible as the first ischemic sign anteceding retinal edema. This study therefore investigated the optical intensity of the inner retinal layers as a diagnostic criterium of CRAO and as a discriminator between potential differential diagnoses of CRAO with (sub-)acute vision loss.…”

Section: Introductionmentioning

confidence: 99%

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Inner Retinal Layer Hyperreflectivity Is an Early Biomarker for Acute Central Retinal Artery Occlusion

et al. 2022

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PurposeTo investigate inner retinal hyperreflectivity on optical coherence tomography (OCT) as a potential biomarker indicating acute central retinal artery occlusion (CRAO).MethodsA total of 56 patients at two university hospitals with acute CRAO (symptom onset ≤48 h) were included in this retrospective study. The optical intensity of the inner retinal layers was determined in both eyes and the relationship between symptom onset and inner retinal layer optical intensity in OCT scans compared to the unaffected fellow eye was analyzed. Several differential diagnoses [central retinal vein occlusion, anterior ischemic optic neuropathy, diabetic macular edema, and subretinal fibrosis/disciform scar (Junius-Kuhnt)] served as controls to validate optical intensity-based diagnosis of CRAO.ResultsCRAO strongly correlated with an increased inner retinal layer hyperreflectivity in this cohort with acute CRAO with a time since symptom onset ranging from 1.1 to 48.0 h. Receiver operating characteristic (ROC) analysis showed an area under the curve of 0.99 to confirm CRAO with a true positive rate of 0.93 and a false positive rate of 0.02. No correlation between optical intensity and time since symptom onset was noticeable. None of the differential diagnoses did show an elevated optical intensity of the inner retinal layers as it was detectable in CRAO.ConclusionOCT-based determination of inner retinal layer hyperreflectivity is a very promising biomarker for a prompt diagnosis of CRAO in an emergency setting. This may be of major interest to speed up the administration of a possible thrombolytic treatment.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Inner Retinal Layer Hyperreflectivity Is an Early Biomarker for Acute Central Retinal Artery Occlusion

et al. 2022

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Comment: Visual Recovery in 2 Cases of Central Retinal Artery Occlusion Treated With Prompt Intraophthalmic Artery Fibrinolysis

Canizela,

Kishore

2024

Journal of Neuro-Ophthalmology

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at the age of 20 years with presenting symptoms of visual disturbances described as "bright zig zag lines" without headache that progressed over days to development of loss of temperature sensation followed by loss of proprioception in the right upper extremity and left lower extremities. These symptoms resolved with corticosteroid therapy. A definitive diagnosis of optic neuritis was not provided nor was genetic testing performed.Our examination 4 months after the initial decline in vision in the left eye revealed central acuities of "counting fingers" at 2 feet bilaterally. Funduscopy showed temporal pallor bilaterally. Optical coherence tomography in the central macula revealed thickness of the ganglion cell complex of 58 and 62 mm, respectively.Mitochondrial genetic testing was positive for the primary LHON mutation 3460G.A (with 7% heteroplasmy) located in the nicotinamide adenine dinucleotide hydrogen dehydrogenase subunit 1 (within Complex 1). 5 This case further extends the age range for presentation of LHON from the earliest reported case of 2 years 6 to 90 years. Older cases will surely be identified given the increase in human longevity. The oldest previously reported female who presented with LHON was 77 years old; the specific mutation was not cited in the report. 4 Later-life blindness does not exclude a diagnosis of LHON, and genetic testing for mitochondrial mutations should be considered whenever patients present with either rapidly sequential blindness due to an optic neuropathy without evidence of a more typical etiology or even when the optic neuropathies are old and severe and otherwise not explained.

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AI-based Detection of Central Retinal Artery Occlusion within 4.5 hours on Standard Fundus Photographs

Gungor,

Sarbout,

Gilbert

et al. 2024

Preprint

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Background: Prompt diagnosis of acute central retinal artery occlusion (CRAO) is crucial for therapeutic management and secondary prevention of associated neurological co-morbidities. However, most stroke centers lack on-site ophthalmic expertise prior to considering fibrinolytic treatments. We aimed to develop, train, and test a deep learning system (DLS) able to accurately detect hyper-acute CRAO on retinal color fundus photographs, during the critical treatment window of 4.5 hours after visual loss. We also evaluated the diagnostic performance of the DLS within 24 hours after visual loss, aiming to improve secondary prevention of stroke after CRAO. Methods: Our retrospective, multicenter, multiethnic study included 1,322 color fundus photographs from 771 patients with various causes of acute visual loss, including CRAO, central retinal vein occlusion, non-arteritic anterior ischemic optic neuropathy, and healthy controls. Photographs were collected from 9 expert neuro-ophthalmology centers in 6 countries, including 3 randomized clinical trials. Training was performed on 1,039 photographs (517 patients), followed by testing on two datasets to discriminate CRAO cases at (i) hyper-acute stage (54 photographs, 54 patients) and (ii) within 24 hours after visual loss (110 photographs, 109 patients). Results: The DLS achieved an area under the receiver operating characteristic curve (AUC) of 0.96 (95% confidence interval [CI], 0.95-0.98), a sensitivity of 92.6% (95% CI, 87.0-98.0), and a specificity of 85.0% (95% CI, 81.8-92.8) for detecting CRAO at hyper-acute stage, with similar results for CRAO diagnosis within 24 hours. The DLS outperformed neurologists on a subset of testing dataset at hyper-acute stage (120 photographs from 120 patients). Conclusions: A DLS can accurately detect hyper-acute CRAO on retinal photographs within a time-window compatible with urgent fibrinolysis. Delayed diagnosis (24h) did not alter the ability of the DLS to accurately identify CRAO. If further validated, such systems could improve patient selection for fibrinolytic trials and optimize secondary stroke prevention. Clinical Trial Registration: URL: https://www.clinicaltrials.gov; Unique identifier:NCT06390579.

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Capturing the Occult Central Retinal Artery Occlusion Using Optical Coherence Tomography

Cited by 4 publications

References 32 publications

Inner Retinal Layer Hyperreflectivity Is an Early Biomarker for Acute Central Retinal Artery Occlusion

Inner Retinal Layer Hyperreflectivity Is an Early Biomarker for Acute Central Retinal Artery Occlusion

Comment: Visual Recovery in 2 Cases of Central Retinal Artery Occlusion Treated With Prompt Intraophthalmic Artery Fibrinolysis

AI-based Detection of Central Retinal Artery Occlusion within 4.5 hours on Standard Fundus Photographs

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