Structural and Functional Imaging of the Retina in Central Retinal Artery Occlusion - Current Approaches and Future Directions
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Structural and Functional Imaging of the Retina in Central Retinal Artery Occlusion - Current Approaches and Future Directions. / Mac Grory, Brian; Schrag, Matthew; Poli, Sven; Boisvert, Chantal J; Spitzer, Martin S; Schultheiss, Maximillian; Nedelmann, Max; Yaghi, Shadi; Guhwe, Mary; Moore, Elizabeth E; Hewitt, Hunter R; Barter, Kelsey M; Kim, Taewon; Chen, Maomao; Humayun, Lucas; Peng, Chang; Chhatbar, Pratik Y; Lavin, Patrick; Zhang, Xuxiang; Jiang, Xiaoning; Raz, Eytan; Saidha, Shiv; Yao, Junjie; Biousse, Valérie; Feng, Wuwei.
In: J STROKE CEREBROVASC, Vol. 30, No. 7, 105828, 07.2021.Research output: SCORING: Contribution to journal › SCORING: Review article › Research
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TY - JOUR
T1 - Structural and Functional Imaging of the Retina in Central Retinal Artery Occlusion - Current Approaches and Future Directions
AU - Mac Grory, Brian
AU - Schrag, Matthew
AU - Poli, Sven
AU - Boisvert, Chantal J
AU - Spitzer, Martin S
AU - Schultheiss, Maximillian
AU - Nedelmann, Max
AU - Yaghi, Shadi
AU - Guhwe, Mary
AU - Moore, Elizabeth E
AU - Hewitt, Hunter R
AU - Barter, Kelsey M
AU - Kim, Taewon
AU - Chen, Maomao
AU - Humayun, Lucas
AU - Peng, Chang
AU - Chhatbar, Pratik Y
AU - Lavin, Patrick
AU - Zhang, Xuxiang
AU - Jiang, Xiaoning
AU - Raz, Eytan
AU - Saidha, Shiv
AU - Yao, Junjie
AU - Biousse, Valérie
AU - Feng, Wuwei
N1 - Copyright © 2021 Elsevier Inc. All rights reserved.
PY - 2021/7
Y1 - 2021/7
N2 - Central retinal artery occlusion (CRAO) is a form of acute ischemic stroke which affects the retina. Intravenous thrombolysis is emerging as a compelling therapeutic approach. However, it is not known which patients may benefit from this therapy because there are no imaging modalities that adequately distinguish viable retina from irreversibly infarcted retina. The inner retina receives arterial supply from the central retinal artery and there is robust collateralization between this circulation and the outer retinal circulation, provided by the posterior ciliary circulation. Fundus photography can show canonical changes associated with CRAO including a cherry-red spot, arteriolar boxcarring and retinal pallor. Fluorescein angiography provides 2-dimensional imaging of the retinal circulation and can distinguish a complete from a partial CRAO as well as central versus peripheral retinal non-perfusion. Transorbital ultrasonography may assay flow through the central retinal artery and is useful in the exclusion of other orbital pathology that can mimic CRAO. Optical coherence tomography provides structural information on the different layers of the retina and exploratory work has described its utility in determining the time since onset of ischemia. Two experimental techniques are discussed. 1) Retinal functional imaging permits generation of capillary perfusion maps and can assay retinal oxygenation and blood flow velocity. 2) Photoacoustic imaging combines the principles of optical excitation and ultrasonic detection and - in animal studies - has been used to determine the retinal oxygen metabolic rate. Future techniques to determine retinal viability in clinical practice will require rapid, easily used, and reproducible methods that can be deployed in the emergency setting.
AB - Central retinal artery occlusion (CRAO) is a form of acute ischemic stroke which affects the retina. Intravenous thrombolysis is emerging as a compelling therapeutic approach. However, it is not known which patients may benefit from this therapy because there are no imaging modalities that adequately distinguish viable retina from irreversibly infarcted retina. The inner retina receives arterial supply from the central retinal artery and there is robust collateralization between this circulation and the outer retinal circulation, provided by the posterior ciliary circulation. Fundus photography can show canonical changes associated with CRAO including a cherry-red spot, arteriolar boxcarring and retinal pallor. Fluorescein angiography provides 2-dimensional imaging of the retinal circulation and can distinguish a complete from a partial CRAO as well as central versus peripheral retinal non-perfusion. Transorbital ultrasonography may assay flow through the central retinal artery and is useful in the exclusion of other orbital pathology that can mimic CRAO. Optical coherence tomography provides structural information on the different layers of the retina and exploratory work has described its utility in determining the time since onset of ischemia. Two experimental techniques are discussed. 1) Retinal functional imaging permits generation of capillary perfusion maps and can assay retinal oxygenation and blood flow velocity. 2) Photoacoustic imaging combines the principles of optical excitation and ultrasonic detection and - in animal studies - has been used to determine the retinal oxygen metabolic rate. Future techniques to determine retinal viability in clinical practice will require rapid, easily used, and reproducible methods that can be deployed in the emergency setting.
U2 - 10.1016/j.jstrokecerebrovasdis.2021.105828
DO - 10.1016/j.jstrokecerebrovasdis.2021.105828
M3 - SCORING: Review article
C2 - 34010777
VL - 30
JO - J STROKE CEREBROVASC
JF - J STROKE CEREBROVASC
SN - 1052-3057
IS - 7
M1 - 105828
ER -
