Abstract

We investigated the full-field electroretinographic (ERG) parameters with visual function and prognosis in central retinal artery occlusion (CRAO), according to its severity. 110 affected eyes of CRAO patients were enrolled and compared with fellow uninvolved eyes (N = 110) and normal control eyes (N = 30). B/A ratio and photopic negative response amplitude (PhNR) resulted in statistically significant differences among the CRAO subgroups according to the severity of retinal ischemia. Amplitudes of PhNR indicating ganglion cell function showed a more marked decline in mild to severe ischemia than those of the B-wave. In terms of visual function and outcome, baseline visual acuity and visual field defects were correlated with B/A ratio only (both, P < .001), whereas improvements in visual acuity and visual field were correlated with B-wave amplitude in dark-adapted 3.0 (P = .004 and .006), B/A ratio (P = .023 and .008), and PhNR amplitude (P < .001 and .004). These three ERG parameters were found to be credible predictive factors of visual prognosis. In conclusion, B-wave amplitude in dark-adapted 3.0, B/A ratio, and PhNR amplitude changes in eyes with CRAO are associated with baseline features related to the severity of retinal ischemia, and these are correlated with visual function and prognosis.

Highlights

  • We investigated the full-field electroretinographic (ERG) parameters with visual function and prognosis in central retinal artery occlusion (CRAO), according to its severity. 110 affected eyes of CRAO patients were enrolled and compared with fellow uninvolved eyes (N = 110) and normal control eyes (N = 30)

  • These clinical visual functions and prognoses are known to be related to the severity of CRAO; in other words, the degree of retinal ischemia categorized as incomplete, subtotal, or total CRAO by Schmidt and ­colleagues[6]: Incomplete CRAO is characterized by reduced visual acuity (VA), minimal retinal edema with indistinct cherry-red spots found in the fundus photo and OCT, and mildly delayed retinal arterial perfusion on fluorescein angiography (FA); Subtotal CRAO by severe decrease in VA, definite retinal edema with cherry-red spots, and severely delayed retinal arterial perfusion; and Total CRAO by deteriorated VA as to hand motion, light perception or less, massive diffuse retinal edema with disruption of retinal structures accompanied by possible choroidal perfusion delay

  • The baseline and final Best corrected visual acuities (BCVA), and initial visual field defects (VFDs) were statistically different among the CRAO subgroups, while the tendency of declining VA and VFDs were observed according to the stages of CRAO

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Summary

Introduction

B-wave amplitude in dark-adapted 3.0, B/A ratio, and PhNR amplitude changes in eyes with CRAO are associated with baseline features related to the severity of retinal ischemia, and these are correlated with visual function and prognosis. Most CRAO patients suffer from marked reduction of visual function such as visual acuity (VA) of counting fingers or less, and visual field defects such as central scotoma or temporal island with classic signs of infarction observed in the ­fundus[4,5] These clinical visual functions and prognoses are known to be related to the severity of CRAO; in other words, the degree of retinal ischemia categorized as incomplete, subtotal, or total CRAO by Schmidt and ­colleagues[6]: Incomplete CRAO is characterized by reduced VA, minimal retinal edema with indistinct cherry-red spots found in the fundus photo and OCT, and mildly delayed retinal arterial perfusion on fluorescein angiography (FA); Subtotal CRAO by severe decrease in VA, definite retinal edema with cherry-red spots, and severely delayed retinal arterial perfusion; and Total CRAO by deteriorated VA as to hand motion, light perception or less, massive diffuse retinal edema with disruption of retinal structures accompanied by possible choroidal perfusion delay. This response is known to reflect the retinal ganglion cell (RGC) function, and PhNR has been widely used for clinical purposes such as evaluation of inner retinal d­ iseases[19]

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