Visual field defects and changes in central retinal artery occlusion

• Published in: PloS one Vol. 14; no. 1; p. e0209118
• Main Authors: Kim, Hyeong Min, Park, Young Joo, Park, Kyu Hyung, Woo, Se Joon
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 03.01.2019; Public Library of Science (PLoS)
• Subjects: Acuity; Aged; Biology and Life Sciences; Defects; Diabetes; Diabetic retinopathy; Earth Sciences; Edema; Eye (anatomy); Female; Fluorescein Angiography; Health aspects; Humans; Intestinal ischemia; Ischemia; Male; Medical imaging; Medicine; Medicine and Health Sciences; Middle Aged; Occlusion; Optical Coherence Tomography; Patients; Perfusion; Research and Analysis Methods; Retina; Retina - physiopathology; Retinal Artery Occlusion - physiopathology; Retinal diseases; Retrospective Studies; Scotoma - physiopathology; Social Sciences; Thrombolysis; Tomography; Vascular endothelial growth factor; Veins & arteries; Vision Disorders - physiopathology; Visual acuity; Visual Acuity - physiology; Visual field; Visual Field Tests; Visual fields; Visual Fields - physiology; Visual observation; South Korea
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0209118

To investigate the characteristics and temporal changes in visual field defects (VFDs) in eyes with acute central retinal artery occlusion (CRAO). Retrospective, observational case series. A total of 119 patients diagnosed with acute non-arteritic CRAO through examination with Goldmann perimetry were included among the patients who visited Seoul National University Bundang Hospital between January 2009 and December 2016. They were treated with either conservative treatments or intra-arterial thrombolysis (IAT). The baseline features and temporal changes of visual field examination results and the association with clinical parameters including visual acuity, optical coherence tomography (OCT) findings, and the CRAO stages. All of the 119 patients showed visual field defect and suffered unilateral acute CRAO. We observed five characteristic VFDs: peripheral constriction only (8%), paracentral scotoma (3%), central and cecocentral scotoma (19%), temporal island (59%), and no visual field (10%). Severe VFDs were associated with severe CRAO stages, poor baseline BCVA, delayed retinal arterial perfusion, and severe retinal morphologic changes on OCT. We found improvements in the visual field in 39% of all cases during the follow-up periods. Mild CRAO stages, good baseline BCVA, mild retinal morphologic changes, and mild initial VFDs were significantly associated with visual field improvement. The five characteristic types of VFDs and their improvement in eyes with CRAO are associated with baseline features related to the severity of retinal ischemia. We suggest that the underlying mechanisms of VFDs involve the balance between the retinal arterial perfusion and the ischemic vulnerability of each retinal area.