The Characteristics of Retinal Emboli and its Association With Vascular Reperfusion in Retinal Artery Occlusion

Abstract

Citation: Cho KH, Ahn SJ, Cho JH, et al. The characteristics of retinal emboli and its association with vascular reperfusion in retinal artery occlusion. Invest Ophthalmol Vis Sci. 2016;57:4589-4598. DOI:10.1167/ iovs.16-19887 PURPOSE. To analyze the characteristics of retinal emboli and their association with vascular reperfusion in retinal artery occlusion (RAO). METHODS.In this retrospective comparative case series, we analyzed emboli in patients with acute central retinal artery occlusion (CRAO) or branch retinal artery occlusion (BRAO) and visible emboli, and analyzed vascular reperfusion in patients with visible emboli causing blockage of perfusion. The patients were divided into emboli ''movement'' and ''no movement'' groups and their vascular reperfusion states were compared.RESULTS. There were 52/248 (21%) eyes with RAO and visible retinal emboli (31/187 [17%] eyes with CRAO and 21/61 [34%] eyes with BRAO) showing various embolic features. Plateletfibrin emboli were observed most commonly, and showed the earliest and highest rate of movement. In the movement group, which comprised platelet-fibrin (60%) and cholesterol (40%) emboli, early complete reperfusion was observed in 80% of eyes; however, 67% of eyes in the no movement group, comprising cholesterol (67%) and calcific (33%) emboli, showed late incomplete reperfusion. There were no cases of permanent vascular blockage. The mechanisms of vascular reperfusion could be summarized as complete degradation, peripheral migration, partial dislodgement, angiophagy, and collateral circulation. CONCLUSIONS.Retinal emboli in RAO patients have various characteristics that affect their movement. Movement of emboli may affect vascular reperfusion. Various mechanisms are associated with vascular reperfusion, including in cases without movement of emboli. These mechanisms may apply to cerebrovascular occlusion and stroke in general.Keywords: retinal emboli, vascular reperfusion, retinal artery occlusion R etinal artery occlusion (RAO) is a visually disabling ocular vascular occlusive disorder. It is usually divided into central retinal artery occlusion (CRAO), branch retinal artery occlusion (BRAO), and cilioretinal artery occlusion based on the site of occlusion. 1 Numerous studies of the visual prognosis of RAO have been published, and our group has also published articles recently on the incidence and visual prognosis of RAO, a study of optical coherence tomography in CRAO and BRAO, and cosmetic facial filler-related RAO. 2-9 However, while a few studies suggest that movable retinal emboli are responsible for most cases of RAO, there is still limited information about the natural course of retinal emboli and their association with vascular reperfusion, particularly in Asian people. 10,11The causes of vascular occlusion are thought to include emboli, blood clots, and lipid plaques, and similar mechanisms apply in RAO. A vascular etiology with stroke and embolism derived from carotid artery plaques is the most common pathogenetic mechanism. 12,13 In previous ...

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“…Refractile emboli comprised of cholesterol are typically found unilaterally within the peripheral retinal arterioles in patients with cardiovascular risk factors . In contrast to the refractile nature of cholesterol emboli, fibrin emboli appear dull and grey‐white in colour while calcific emboli are commonly white and large . Crystal deposits associated with chronic retinal detachment, especially with retinal dialysis, are located within the inner retina centrally or throughout the posterior pole (Figure ).…”

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