Central Retinal Vein Occlusion With Cilioretinal Infarction From Branch Flow Exclusion and Choroidal Arterial Steal

Abstract

In eyes with a cilioretinal supply, the probability that cilioretinal infarction will complicate retinal vein occlusion increases with increasing severity of venous obstruction and the more distally the cilioretinal artery arises from the posterior ciliary arterial tree. A distal branch point also facilitates observation of dye front reciprocation within the artery. Indicators of the degree of venous obstruction that may be necessary to instigate cilioretinal infarction include very prolonged dye transit times in the central retinal circulation, exaggerated venous cyanosis and tortuosity, perivenous cotton-wool sentinels, and macular perivenular whitening.

Evidence for an enduring ischaemic penumbra following central retinal artery occlusion, with implications for fibrinolytic therapy

“…2), albeit the embedded white material is always located close to that boundary (McLeod, 1975(McLeod, , 2009. This implies that the deeper part of the inner retina (i.e.…”

“…However, para-venous CWSs are frequently seen in these CRVO cases courtesy of the very high intraluminal pressure within the third-order retinal veins. These CWSs are induced mechanically by impingement of increasingly tortuous veins on adjacent axon-bundles (McLeod and Ring, 1976;McLeod, 2005McLeod, , 2009), but they have no counterpart in "partial" CRAO. Paradoxically, hypoperfusion maculopathy complicating CRVO (Grade I) is usually accompanied by cilioretinal infarction in eyes with a cilioretinal arterial supply (Browning, 2002;Paques and Gaudric, 2003;McLeod, 2009McLeod, , 2010, whereas hypoperfusion maculopathy associated with "partial" CRAO (Grade 2) is accompanied by cilioretinal sparing (Fig.…”

Combined branch retinal vein and branch retinal artery occlusion – clinical features, systemic associations, and outcomes

“…[123] Coexistent cilioretinal artery occlusion along with CRVO is most frequently reported and is equally well described. [45] Rarely, branch retinal arterial occlusion has been reported to coexist with CRVO. [67] Many of these combined vascular occlusions have been described in association with comorbidities such as diabetes, dyslipidemia, systemic lupus, and hyperhomocysteinemia.…”

Postoperative cilioretinal artery occlusion in Sturge Weber–associated glaucoma

“…Any additional increase in resistance to cilioretinal artery blood flow (such as would be expected with increased IOP) would preferentially divert blood flow toward the choroid, causing ''choroidal arterial steal.'' 5 We believe this phenomenon may be exaggerated in Sturge Weber syndrome with diffuse choroidal hemangiomas, due to expansion of the low-resistance vascular system within the hemangioma.…”