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Central retinal artery occlusion - rethinking retinal survival time.

Abstract The critical time from onset of complete occlusion of the central retinal artery (CRA) to functionally significant inner retinal infarction represents a window of opportunity for treatment and also has medical-legal implications, particularly when central retinal artery occlusion (CRAO) complicates therapeutic interventions. Here, we review the evidence for time to infarction from complete CRAO and discuss the implications of our findings.
PMID
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Central retinal artery occlusion. Retinal survival time.

Authors

Mayor MeshTerms
Keywords

Central retinal artery occlusion

Cherry red spot

Choroidal infarction

Post-operative visual loss

Retinal infarction

Retinal stroke

Journal Title bmc ophthalmology
Publication Year Start




PMID- 29669523
OWN - NLM
STAT- MEDLINE
DCOM- 20180430
LR  - 20180501
IS  - 1471-2415 (Electronic)
IS  - 1471-2415 (Linking)
VI  - 18
IP  - 1
DP  - 2018 Apr 18
TI  - Central retinal artery occlusion - rethinking retinal survival time.
PG  - 101
LID - 10.1186/s12886-018-0768-4 [doi]
AB  - BACKGROUND: The critical time from onset of complete occlusion of the central
      retinal artery (CRA) to functionally significant inner retinal infarction
      represents a window of opportunity for treatment and also has medical-legal
      implications, particularly when central retinal artery occlusion (CRAO)
      complicates therapeutic interventions. Here, we review the evidence for time to
      infarction from complete CRAO and discuss the implications of our findings.
      METHODS: A Medline search was performed using each of the terms "central retinal 
      artery occlusion", "retinal infarction", "retinal ischemia", and "cherry red
      spot" from 1970 to the present including articles in French and German. All
      retrieved references as well as their reference lists were screened for
      relevance. An Internet search using these terms was also performed to look for
      additional references. RESULTS: We find that the experimental evidence showing
      that inner retinal infarction occurs after 90-240 min of total CRAO, which is the
      interval generally accepted in the medical literature and practice guidelines, is
      flawed in important ways. Moreover, the retinal ganglion cells, supplied by the
      CRA, are part of the central nervous system which undergoes infarction after
      non-perfusion of 12-15 min or less. CONCLUSIONS: Retinal infarction is most
      likely to occur after only 12-15 min of complete CRAO. This helps to explain why 
      therapeutic maneuvers for CRAO are often ineffective. Nevertheless, many CRAOs
      are incomplete and may benefit from therapy after longer intervals. To try to
      avoid retinal infarcton from inadvertent ocular compression by a headrest during 
      prone anesthesia, the eyes should be checked at intervals of less than 15'.
FAU - Tobalem, Stephan
AU  - Tobalem S
AD  - Department of Ophthalmology, University Hospitals and School of Medicine, Geneva,
      Switzerland.
FAU - Schutz, James S
AU  - Schutz JS
AD  - Department of Ophthalmology, University Hospitals and School of Medicine, Geneva,
      Switzerland.
FAU - Chronopoulos, Argyrios
AU  - Chronopoulos A
AD  - Department of Ophthalmology, University Hospitals and School of Medicine, Geneva,
      Switzerland. [email protected]
AD  - Department of Ophthalmology, Addenbrooke's Hospital, Cambridge University
      Hospital NHS Foundation Trust, Box 41, Hills Road, Cambridge, CB2 0QQ, UK.
      [email protected]
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20180418
PL  - England
TA  - BMC Ophthalmol
JT  - BMC ophthalmology
JID - 100967802
SB  - IM
MH  - Fluorescein Angiography
MH  - Humans
MH  - Infarction
MH  - Regional Blood Flow/*physiology
MH  - Retinal Artery Occlusion/*physiopathology
MH  - Retinal Ganglion Cells/*physiology
MH  - Time Factors
PMC - PMC5907384
OTO - NOTNLM
OT  - Central retinal artery occlusion
OT  - Cherry red spot
OT  - Choroidal infarction
OT  - Post-operative visual loss
OT  - Retinal infarction
OT  - Retinal stroke
EDAT- 2018/04/20 06:00
MHDA- 2018/05/01 06:00
CRDT- 2018/04/20 06:00
PHST- 2017/12/15 00:00 [received]
PHST- 2018/04/03 00:00 [accepted]
PHST- 2018/04/20 06:00 [entrez]
PHST- 2018/04/20 06:00 [pubmed]
PHST- 2018/05/01 06:00 [medline]
AID - 10.1186/s12886-018-0768-4 [doi]
AID - 10.1186/s12886-018-0768-4 [pii]
PST - epublish
SO  - BMC Ophthalmol. 2018 Apr 18;18(1):101. doi: 10.1186/s12886-018-0768-4.