Neuro- and retinal degenerative diseases, including Alzheimer's, stroke, age-related macular degeneration, and central retinal artery occlusion, rob millions of their independence. Studying these diseases in human retinas has been hindered by the rapid loss of neuronal activity after death. While some CNS activity has been restored postmortem, synchronized neuronal transmission beyond 30 min has remained elusive. We overcome this barrier by reviving and sustaining light signal transmission in human retinas recovered up to 4 hours after death and stored for up to 48 hours. We also introduce infrared-based ex vivo imaging for precise sampling, a closed perfusion system for drug testing, and an ex vivo ischemia-reperfusion model in mouse and human retina. This platform enables testing of neuroprotective and neurotoxic effects of drugs targeting oxidative stress and glutamate excitotoxicity. Our advances question the irreversibility of ischemic injury, support preclinical studies in vision restoration, offer insights into treating CNS ischemia, and pave the way for human donor eye transplantation.

The C‑reactive protein-triglyceride glucose index (CTI), a composite marker of systemic inflammation and metabolic status, has been associated with cardiovascular and cerebrovascular risk. Its role in central retinal artery occlusion (CRAO) and subsequent adverse outcomes is unclear. In this cohort study, 122 CRAO patients and 488 matched controls who underwent coronary angiography without coronary artery disease were analyzed. CTI was calculated as 0.412 × ln [CRP (mg/L) + 0.5 × ln [TG × FPG(mg/dL)]. Logistic regression adjusted for demographic, clinical, laboratory, and medication variables was used to explore the relationship between CTI and the risk of CRAO. Restricted cubic spline models assessed the dose-response relationship between CTI and CRAO risk. The primary endpoint was CRAO and the secondary endpoint was major adverse cardiovascular and cerebrovascular events (MACCEs) during the 36‑month follow‑up. Higher CTI was independently associated with CRAO (adjusted OR = 1.46, 95% CI 1.14-1.88; P = 0.003). Restricted cubic spline analysis identified a CTI threshold of 9.810. CRAO patients with CTI > 9.810 had a higher incidence of MACCEs (31.1% vs. 10.1%, P < 0.001), particularly acute coronary syndromes (20.3% vs. 7.1%, P < 0.001). In subgroup analysis, CRAO patients with CTI > 9.810 had the highest MACCEs rate (40.0%) and significantly greater risk of all‑cause death, stroke, and acute coronary syndromes (all adjusted P < 0.05) compared with other groups. Time‑to‑event analysis revealed that among all groups, CRAO patients with CTI > 9.810 had the shortest median time to MACCEs occurrence at 6months (IQR, 4-11). Elevated CTI is independently associated with increased CRAO risk and predicts higher adverse MACCEs outcomes, suggesting CTI as a potential biomarker for risk stratification and secondary prevention in CRAO patients.

Every minute blinds: Temporal artery ultrasound in the real-time diagnosis of stroke of the eye.

Report of a case of central retinal artery occlusion after sphenopalatine artery (SPA) embolization. A review of the literature describing complications after SPA embolization and ligation. Retrospective case report and literature review. A 68-year-old woman with a history notable for hypertension, hyperlipidemia, and 8 years of intermittent right-sided epistaxis previously requiring blood transfusions underwent right-sided embolization of the SPA with the neurosurgery service. Sphenopalatine artery embolization was achieved with Embosphere microspheres and Concerto coils. No thromboembolic complications were noted at the conclusion of the case. On waking from general anesthesia, the patient reported painless right-sided vision loss and was found to have best-corrected visual acuity of light perception, a relative afferent pupillary defect, and a cherry-red spot with vascular attenuation consistent with central retinal artery occlusion. Central retinal artery occlusion can be a complication of ipsilateral SPA embolization.

The impact of first prescription of oral anticoagulation on ischemic stroke and major bleeding events among Medicare beneficiaries with atrial fibrillation (AF) is not known. A retrospective, observational, cohort study was performed based on a 5% sample of United States fee-for-service Medicare beneficiaries aged ≥66 years who developed AF from 2007 to 2020. The principal exposure was first prescription of an oral anticoagulant. The primary effectiveness end point was ischemic stroke (including cerebral or retinal ischemic stroke [central retinal artery occlusion]). The primary safety end point was major bleeding. To reduce the impact of selection bias and immortal time bias, unadjusted and adjusted hazard ratios (HRs) and rate differences were computed in a dataset comprised of pooled, sequential clinical trial replicates starting 1 month apart. In total, 144,969 patients (60.8% female; mean age 77.7 years [standard deviation (SD) 7.1]) were included in the study. First prescription of oral anticoagulation was not associated with a reduced hazard of ischemic stroke (adjusted HR [aHR] 1.01 [95% confidence interval (CI): 0.97-1.05]). However, first prescription of oral anticoagulation was associated with an increased hazard of a major bleeding event (aHR 1.38 [95% CI: 1.36-1.40]) and increased hazards of intracerebral hemorrhage (ICH) and major gastrointestinal hemorrhage. In this cohort study of Medicare beneficiaries aged 66 years and older with incident AF, the first anticoagulant prescription was not associated with a reduced hazard of ischemic stroke. Furthermore, unadjusted models suggested that clinicians are likely appropriately selecting patients for anticoagulation in routine clinical practice.

Posterior cervical surgery blindness (PCSB) is a rare but serious complication with significant implications for affected patients. Herein, we retrospectively analyzed two cases of postoperative blindness. Case 1: A 51-year-old with basilar invagination, atlantoaxial dislocation, and syringomyelia. Blindness, caused by central retinal artery occlusion, occurred after atlantoaxial decompression and fusion in the prone position. After the arterial thrombolytic therapy, the vision gradually improved. Case 2: A 58-year-old with radiculopathy-type cervical spondylosis. Blindness, caused by vitreous hemorrhage, occurred after dual-channel endoscopic cervical disc nucleotomy in the prone position. Vision did not recover after 1 year. PCSB is linked to the prone position and use of a horseshoe headrest. Early intra-arterial thrombolysis can significantly promote visual recovery. Preoperative counseling, careful intraoperative management, and active postoperative care are essential to reducing the risk.

To characterize the impact of neovascular glaucoma (NVG) and its underlying etiology on mortality and determine the association between NVG and cause of death. Retrospective cohort study. A total of 210 subjects with NVG were included in the descriptive study. Of the 210 subjects, 132 with a definite date of NVG onset were included in the survival analysis. Patients with NVG seen at our tertiary care center from 2015-2016 were identified. Demographic information, underlying etiology, and medical conditions were documented. The Centers for Disease Control and Prevention National Death Index (CDC NDI) was used to designate if subjects were alive on December 31, 2021, and to determine the primary cause of death. Kaplan-Meier and Cox proportional hazard regression analyses were performed on subjects with a definitive date of NVG onset. Of the 210 subjects, 32% were deceased by December 31, 2021. The commonest diagnosis was proliferative diabetic retinopathy (PDR) (57%), followed by central retinal vein occlusion (CRVO) (29%). Of 132 subjects included in the Kaplan-Meier survival analysis, the mean survival time was 154 ± 15 months (95% CI: 125-183). Cox regression analysis demonstrated that older age (HR 1.03, 95% CI: 1.004-1.06, P = 0.02) and central retinal artery occlusion (CRAO) (HR: 4.63, 95% CI: 1.7-12.44, P = 0.002) were associated with poorer survival. Increasing age and CRAO-related NVG (compared to CRVO-unrelated) were important predictors of increased mortality. Our results highlight the need for aggressive management of underlying systemic co-morbid conditions contributing to early mortality in patients with NVG.

Introduction: Ophthalmoscopy is a key component of both neurological and general medical examinations, yet medical students consistently report low confidence and competence in performing the skill. Newly qualified doctors are expected to perform direct ophthalmoscopy with indirect supervision, yet opportunities for students to develop this skill are often limited due to reduced ophthalmology teaching and limited access to suitable patients. Simulation-based education has emerged as a valuable adjunct to clinical teaching, providing opportunities for deliberate practice, feedback, and safe skill acquisition. This study evaluated the educational impact of the Eyesi Direct Ophthalmoscopy simulator (Haag-Streit Group, Köniz, Switzerland) on medical students' confidence and perceived competence in fundoscopy.Methods: 122 undergraduate medical students from the University of Dundee (fourth-year medical students and third-year ScotGEM students) attended a two-hour ophthalmology workshop in groups of four to eight. Each session incorporated a short teaching component followed by hands-on practice using the Eyesi simulator. Students examined simulated patients with normal fundi and various pathological findings, including swollen optic discs, central retinal vein occlusion (CRVO), central retinal artery occlusion (CRAO), and proliferative diabetic retinopathy (PDR). Immediate feedback was provided by facilitators, allowing for guided, deliberate practice. After the sessions, participants were invited to complete an anonymous online questionnaire assessing perceived confidence, learning effectiveness, and engagement, accessed via QR code or email link. Participation was voluntary, and feedback was collected anonymously.Results: All 122 students provided feedback. Feedback indicated that 98% of students felt confident performing ophthalmoscopy under supervision after training. One hundred percent reported increased competence in fundoscopy, and 100% recommended integration of simulator training into the undergraduate curriculum. Qualitative feedback highlighted realism, repeated practice without patient discomfort, and the value of immediate visual feedback from facilitators who could observe the same fundus view. Conclusion: The Eyesi simulator offers an effective and engaging method for teaching ophthalmic examination skills to undergraduate medical students. By combining realistic visualisation, varied pathology exposure, and immediate feedback, the simulator fosters confidence and diagnostic competence while reducing the anxiety often associated with clinical fundoscopy. Integrating simulator-based teaching into undergraduate curricula aligns with General Medical Council (GMC) outcomes and addresses key educational challenges in ophthalmology. The results support wider adoption of virtual reality simulation as a core component of undergraduate ophthalmology training.

Retinal microvascular alterations in affected and contralateral eyes of individuals with unilateral central retinal artery occlusion.

Optical coherence tomography findings in acute central retinal artery occlusion and their association with visual outcomes.

Understanding disease epidemiology is critical for planning and implementing health programs, particularly in countries like Bhutan with limited resources and data. We reviewed published data on vitreoretinal diseases in Bhutan and found 16 such publications. Of those, two were population-based Rapid Assessment of Avoidable Blindness surveys, and others included hospital-based national survey publications and five case reports. The Rapid Assessment of Avoidable Blindness survey conducted in 2009 reported that posterior segment disorders caused 22.1% of blindness, while a similar follow-up survey in 2018 reported it had reduced to 7.8%. This improvement perhaps was due to national Vitreoretinal services established in early 2012. Hypertensive retinopathy was the most common disorder (18.9%), and other disorders included diabetic retinopathy, diabetic macular edema, retinal detachment, age-related macular degeneration, macular hole, myopic retinal degeneration and vitreous hemorrhage. Even rare disorders like seasonal hyper-acute pan-uveitis, acute retinal necrosis, central retinal artery occlusion, and nephrotic maculopathy had been treated. Bhutan, with its serene environment, is no exception to the varied vitreoretinal disease spectrum. Bhutan needs to focus on changing lifestyles, while still improving human resources and management strategies.

The effects of hyperbaric oxygen treatment for non-arteritic central retinal artery occlusion (HBOT-CRAO).

Visual outcome comparison of intravenous thrombolysis after central retinal artery occlusions.

Rationale:Summarize the clinical experience of interventional thrombolysis treatment for a variant central retinal artery occlusion(CRAO).Patient concerns:The patient experienced a sudden decline in left eye vision for 3 hours.Diagnoses and interventions:One case of a special type of CRAO was reported, treated with microcatheter super selective middle meningeal artery thrombolysis.Outcomes:The blood supply of the central artery on both sides of the patient comes from the branch of the middle meningeal artery. The middle meningeal artery was selected by microcatheter and treated with urokinase via microcatheter. The patient’s vision was significantly improved.Lessons:Transcatheter super selective ophthalmic artery thrombolysis is currently a favorable surgical approach for treating CRAO. Accumulating clinical experience with variant ophthalmic arteries is beneficial for the prognosis of patients with CRAO.

Background. Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic vasculitis characterized by an initial prodromal phase with eosinophil-driven manifestations such as asthma, nasal polyposis, and rhinitis, followed by an antineutrophil cytoplasmic antibody (ANCA)-associated vasculitic phase. Ocular involvement is possible but uncommon (approximately 15% of cases), and central retinal artery occlusion (CRAO) represents an exceedingly rare event. Although benralizumab, a monoclonal antibody targeting the IL-5 receptor, has proven effective in managing eosinophilic manifestations such as asthma and nasal polyposis, its ability to prevent vasculitic damage remains uncertain. We report a case of EGPA complicated by bilateral CRAO occurring during benralizumab therapy. Case report. A 61-year-old man with a history of adult-onset chronic rhinosinusitis and severe asthma, treated with benralizumab since 2022, presented to the emergency department in June 2024 with sudden bilateral blindness preceded by transient amaurosis episodes, without systemic symptoms or ocular pain. Ophthalmologic examination revealed markedly reduced visual acuity in both eyes (hand motion only) and a relative afferent pupillary defect. Fundus examination showed pale optic discs with central cherry-red spots. Optical coherence tomography (OCT) demonstrated inner retinal layer edema and hyperreflectivity (Figure 1a–c), while fluorescein angiography confirmed delayed retinal arteriolar filling (Figure 1d), findings consistent with CRAO. Laboratory tests revealed elevated inflammatory markers and high-titer myeloperoxidase (MPO)-ANCA positivity (134 IU/mL; positive &gt;3 IU/mL) in the absence of peripheral eosinophilia, likely due to benralizumab therapy. Based on clinical and serological findings, a diagnosis of EGPA was established. High-dose corticosteroids and combined rituximab–cyclophosphamide therapy were initiated according to KDIGO and PEXIVAS recommendations. After an initial improvement, disease relapse occurred with increased MPO-ANCA levels, requiring steroid escalation and two additional cyclophosphamide infusions (cumulative dose: 4 g). Within six months, inflammatory markers and antibody titers normalized; however, visual loss persisted with only partial recovery (finger counting at 1 meter OD, 2/10 OS). Maintenance therapy with rituximab 500 mg every six months was started. Conclusions. This is the first reported case of EGPA complicated by bilateral CRAO occurring during benralizumab treatment. Suppression of eosinophilia did not prevent the development of a severe ANCA-mediated complication, suggesting distinct pathogenic pathways for eosinophilic and vasculitic damage. This case highlights the limitations of IL-5R inhibition in preventing systemic vasculitis and underscores the importance of early and aggressive immunosuppression to avoid irreversible outcomes.

Background. Giant cell arteritis (GCA) is an idiopathic vasculitis affecting the large- and medium-sized arteries of the elderly. GCA is characterized by systemic inflammation and patchy arterial inflammation resulting in arterial wall thickening and potential remodelling with stenosis/occlusion or aneurysms. Accordingly, GCA may be complicated by end-organ ischemia, especially in the eye, due to arteritic ischemic optic neuropathy, occlusion of central retinal artery (CRAO) or of one of its branches. Optical coherence tomography (OCT) is an imaging technique that exploits interferometry with short-coherence-length light to characterize the tissues on the micron scale, allowing to visualize retinal features and thickness. High resolution OCT (HR-OCT) is an evolution of OCT not yet available on the market. It has a higher spatial resolution tha traditional OCT. Being potentially able to characterize the arterial walls of the branches of the central retinal artery, HR-OCT is being developed to study retinal vasculopathies. Here we present the first case of GCA with visual involvement (specifically CRAO), evaluated with HR-OCT. Case Report. An 80 year old woman with history of hypertension, dyslipidemia, diverticolitis, and crhonic headache, present to the emergency room in March 2024 for visual loss. She refers that her chronic headhace had changed since the spring of 2023, affecting the temporal area bilaterally and being more prevalent in the morning. The patient also reported astenia for 6-12 months, worsening exertional dyspnea for 5-6 months and blurred vision for 2-3 months, for which she had a diagnosis of cataract. On the 21st of February 2024 the patient experienced loss of vision from the left eye for which she went to the ER of another hospital, and was diagnosed with CRAO. The patient was discharged with prescription of blood test which showed an ESR of 39 mm/h and a CRP of 76 mg/L. On the 4th of March 2024 GCA was suspected and the patient was referred to our center. The diagnosis was confirmed and she was treated with intravenous methylprednisone 1000 mg for three days, followed by oral prednisone 50 mg which was gradually tapered. High resolution-OCT was performed four days after the initial presentation showed a recanalization of the left retinal artery, with a thickened arterial wall as compared to the controlateral eye. Follow-up after one week showed an improvement in the arterial wall thickening. Conclusions. A novel semeiologic sign of GCA involvement in the branches of the retinal artery by HR-OCT is reported for the first time. This non-invasive finding is promising for its much higher spatial accuracy as compared to temporal artery ultrasonography or angio-CT/MR. However, the technique is not yet standardized and more data are required to assess its clinical relevance.

Central retinal artery occlusion (CRAO), a retinal vascular disease that causes severe vision loss, can be evaluated by noninvasive modalities such as optical coherence tomography angiography (OCTA). However, no longitudinal quantitative studies have assessed OCTA in eyes with CRAO treated with carbogen inhalation. In this prospective, observational study, we evaluated the parametric changes of OCTA in patients with acute nonarteritic CRAO treated with carbogen inhalation. Best-corrected visual acuity and all OCTA parameters in eyes with acute nonarteritic CRAO were obtained before initiating carbogen inhalation, 12 to 24 hours and 36 to 48 hours after, and at 1 to 2 weeks and 4 to 6 weeks of follow-up. Twenty-five CRAO eyes were included. The initial OCTA showed reduced vessel density (VD) in both the superficial and deep capillary plexus in the whole-image area, parafovea, and perifovea, which remained decreased until 4 to 6 weeks. The VD at the fovea initially increased, followed by a reduction at 1 to 2 weeks and 4 to 6 weeks. Retinal edema was universal and improved at 1 to 2 weeks and 4 to 6 weeks. No VD recovery was observed after carbogen inhalation. Eyes with acute nonarteritic CRAO showed VD reduction, except at the fovea. No VD recovery was observed after carbogen inhalation. Baseline OCTA parameters did not predict favorable visual outcomes.

Kynurenine-mediated redox regulation provides neuroprotection in central retinal artery occlusion

Introduction: Calcitonin gene-related peptide (CGRP) inhibitors are increasingly used in the United States (US) for the prevention and treatment of migraine, but population-based data on their cardiovascular risk profile are lacking. Research Objective/Aims: To evaluate the association between CGRP inhibitor initiation and cardiovascular events. Methods: This was a retrospective, observational, cohort study using claims data from a proprietary, insurance-based registry – Marketscan (by Merative). Beneficiaries with at least one migraine-related claim and continuous coverage for at least 12 months prior to migraine diagnosis were included. Using a sequential trial framework, the rate of cardiovascular events was computed in those who did and did not initiate a CGRP inhibitor, using both crude estimates and those derived in propensity score-overlap weighted cohorts. The primary end point was a composite of myocardial infarction, cerebral ischemic stroke, revascularization, the development of peripheral arterial disease, or central retinal artery occlusion. Secondary end points included each component of the composite end point individually. A falsification end point (humeral fracture) was included. Adjusted hazard ratios (HR) and corresponding 95% confidence intervals (CI) were computed. Results: In total, 900,370 beneficiaries (median age 41 [Q1, Q3: 31, 51]; 77.8% female) were included of whom 58,679 initiated a CGRP inhibitor and 841,691 did not initiate a CGRP inhibitor during the study period. The derivation of the study population is shown in Figure 1. Characteristics of the included patients by CGRP use status are shown in Figure 2. In the propensity score overlap-weighted analysis, there was a higher rate of the primary end point in beneficiaries who initiated a CGRP inhibitor (8.77 events/1,000 person-years vs. 6.76 events/1,000 person-years; aHR 1.26 [95% CI: 1.10 – 1.45]). Initiation of a CGRP inhibitor was associated with a significantly higher rate of one secondary end point (ischemic stroke [aHR 1.26 (95% CI: 1.07 – 1.49)]) but not 4 other secondary end points: MI, revascularization, CRAO, and ICH. Overall results of primary and secondary endpoints are summarized in Figure 3. Conclusions: In a population-based cohort study, initiation of a CGRP inhibitor was associated with an increased risk of a composite of cardiovascular events, however the magnitude of the increased risk was low and results are vulnerable to residual, unmeasured confounding.

Central retinal artery occlusion (CRAO) is a rare but vision-threatening ophthalmic emergency characterized by sudden, painless loss of vision. This review discusses the incidence, clinical presentation, diagnostic methods, and management strategies of retinal artery occlusion (RAO), with a special emphasis on postoperative cases following ophthalmic surgeries under regional anesthesia, especially cataract surgery. The pathophysiological mechanisms behind RAO include embolism, vasculitis, and iatrogenic factors such as anesthetic techniques. Despite its low incidence, RAO has been observed after various types of ocular blocks, and no single anesthetic agent or technique has been definitively linked. Risk mitigation strategies include the use of shorter needles, avoidance of adrenaline or preservatives in local anesthetics, and limiting anesthetic volume and ocular compression. Transient RAO (TRAO), a likely underdiagnosed condition, can result in temporary visual symptoms postoperatively and may be detectable via optical coherence tomography. The paper emphasizes the importance of early recognition, risk factor assessment, and tailored anesthetic approaches to minimize the incidence of this serious complication.