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IntroductionIt is reported that eyes with a branch retinal artery occlusion (BRAO) had normal full-field electroretinography (ERG) but the response of the multifocal electroretinography (mfERG) was reduced in the area of the arterial occlusion. Optical coherence tomography angiography (OCTA) is a recently appeared modality that can evaluate microvascularizations in different retinal layers and in different regions of the retina. The purpose of this study was to determine the density of the microcirculation and the function of the macular area of eyes with BRAO, and to determine whether they are significantly correlated.MethodsThe OCTA and mfERG findings of 7 eyes of 6 patients (3 men, 3 women) were studied. The mean age of the patients was 71.7±10.6 years. The OCTA examinations were made with volume scans of 3 × 3 and 6 × 6 mm squares centered on the fovea. The macular vessel densities (mVD) in the superficial retinal layer (SRL) and deep retinal layer (DRL) were measured for the superior and inferior halves of 3 × 3 and 6 × 6 mm diameter concentric circles. The mfERGs were recorded with targets set to stimulate the focal areas of the retina corresponding to the areas examined by OCTA.ResultsThe OCTA examinations showed that the mVD of the 3 mm concentric circle in the SRL was significantly lower on the affected side than on the unaffected side (P = 0.022). No such difference was observed in the DRL. The N1 amplitude of the 20.2° concentric circle and the N1–P1 amplitude of the 10.1° concentric circle of the mfERGs were significantly smaller on the affected side than on the unaffected side (P = 0.047 and 0.031). A significant positive correlation was found between the mVD of the 6 mm concentric circle in the DRL and the P1–N2 amplitude of the 20.2° concentric circle (ρ = −0.929 and p = 0.003).DiscussionThese findings indicate that OCTA images may be able to show changes in the density of the retinal macular microcirculation, and the mfERGs may be able to show alterations in the function of the macular area of the eyes with BRAO. A layer-by-layer analysis of the local retinal microcirculation and function should help in determining the pathogenesis of BRAO.

Branch Retinal Artery Occlusion (BRAO) has become a serious disorder causing permanent loss of vision. It is mainly caused due to the rupture of blood vessels which is too small in size and thereby increasing the risk for efficient detection. Therefore an efficient detection scheme is necessary to evaluate appropriately and pave the way for systemic therapy to preserve or recover vision in the affected eye. In this paper, a fully automatic detection scheme has been developed for accurate segmentation followed by classification of BRAO volumes using the fundus images. Coming to the point this is the first automatic classification framework using an optimized neural network for classifying BRAO. It's mainly a three-step process where the first step concentrates on removing noise and thereby mproving the quality of fundus image. According to which an boosted anisotropic diffusionbased enhancement filter is used here, which effectively removes the noise. This is justified using image quality metrics. Second step here involves adaptive cluster with super pixel segmentation which clearly segments the affected area with high contrast. For the segmented image IR Analyzer is used for extracting region properties. In the final step gray wolf optimization-based convolution neural network (GWO-CNN) classifier is used. Here GWO-CNN classifier is used to differentiate the normal and abnormal images. The effectiveness of the above method is evaluated and obtained an accuracy of 98.57% when it is implemented in MATLAB 2018 software. [ABSTRACT FROM AUTHOR]

Animal models of retinal artery occlusion (RAO) have been widely used in many studies. However, most of these studies prefer using a central retinal artery occlusion (CRAO) which is a typical global ischemia model of the retina, due to the technical limitation of producing single vessel targeted modeling with real-time imaging. A focal ischemia model, such as branch retinal artery occlusion (BRAO), is also needed for explaining interactions, including the immunological reaction between the ischemic retina and adjacent healthy retina. Accordingly, a relevant model for clinical RAO patients has been demanded to understand the pathophysiology of the RAO disease. Herein, we establish a convenient BRAO mouse model to research the focal reaction of the retina. As a photo-thrombotic agent, Rose bengal was intravenously injected into 7 week-old transgenic mice (CX3CR1-GFP) for making embolism occlusion, which causes pathology similarly to clinical cases. In an optimized condition, a 561 nm laser (13.1 mw) was projected to a targeted vessel to induce photo-thrombosis for 27 s by custom-built retinal confocal microscopy. Compared to previous BRAO models, the procedures of thrombosis generation were naturally and minimal invasively generated with real-time retinal imaging. In addition, by utilizing the self-remission characteristics of Rose bengal thrombus, a reflow of the BRAO with immunological reactions of the CX3CR1-GFP+ inflammatory cells such as the retinal microglia and monocytes was monitored and analyzed. In this models, reperfusion began on day 3 after modeling. Simultaneously, the activation of CX3CR1-GFP+ inflammatory cells, including the increase of activation marker and morphologic change, was confirmed by immunohistochemical (IHC) staining and quantitative real-time PCR. CD86 and Nox2 were prominently expressed on day 3 after the modeling. At day 7, blood flow was almost restored in the large vessels. CX3CR1-GFP+ populations in both superficial and deep layers of the retina also increased around even in the BRAO peri-ischemic area. In summary, this study successfully establishes a reproducible BRAO modeling method with convenient capabilities of easily controllable time points and selection of a specific single vessel. It can be a useful tool to analyze the behavior of inflammatory cell after spontaneous arterial recanalization in BRAO and further investigate the pathophysiology of BRAO.

Abstract Background/purpose Susac syndrome is a rare microangiopathy of suspected autoimmune origin affecting arteries of the retina, the cochlea and the brain. The aim of the study was to give a review of the disease entity and determine the proportion of cases and their characteristics in a uveitis referral centre. Patients and methods Charts of patients with the diagnosis of Susac syndrome seen in the Uveitis Clinic of the Centre for Ophthalmic Specialised Care (COS), Lausanne, Switzerland were reviewed retrospectively to determine the frequency of such cases in a uveitis referral centre. Clinical symptoms and signs, functional data, imaging signs and evolution were analysed in the 3 COS cases and one case shared with the Uveitis Clinic of the Department of Ophthalmology, University of Innsbruck, Austria. Characteristic signs were searched possibly allowing a prompt diagnosis. Results During the period from 1994 to 2019 (24 years, 2045 patients), 3 charts with the diagnosis of Susac syndrome were found (0.15%). The whole collective, including the additional case, comprised three women aged 28, 32 and 63 at presentation and one man, aged 42. None of the 3 cases that were referred were diagnosed beforehand. The characteristic item found in all 4 cases was the abrupt arterial stop or segmental interruption of arteries and increased staining of arterial wall on angiography more clearly shown on indocyanine green angiography that can potentially be proposed as a crucial diagnostic element. All 4 cases responded to dual steroidal and non-steroidal immunosuppression. Under treatment, all four patients did not show any further evolution. Conclusion Susac syndrome is a multilocation arteritis of the head that can involve the eye, ear and brain often first diagnosed by the ophthalmologist. The diagnosis is rapidly reached in uveitis referral centres but seems to be missed otherwise, A helpful angiographic sign to be searched is an abrupt or segmental arterial stop and increased staining of the arterial wall more clearly seen on indocyanine green angiography. Patients often present first to the ophthalmologist who should be acting as a whistleblower to avoid severe involvement of the brain.

Background: Retinal artery occlusion is an extremely rare diagnosis in the pediatric population and the etiology with risk factors of retinal artery occlusion are poorly understood in younger individuals. Methods and Results: This case report a rare case of transient branch retinal artery occlusion (BRAO) in a healthy young girl. A fifteen-year-old girl presented with painless decreased vision in her right eye. Fundus examination revealed in the right eye intensive edema of the part of superior half of the retina, but the vessels were absolutely normal. She was hospitalized for diagnosis and treatment. A thorough workup was performed to determine any etiologic factor. Her physical examination was normal, but from anamnesis has been found that patient began use oral contraception at the time of occurrence eye problems. The condition is evaluated as transient branch retinal artery occlusion by the course of the disease. The paper includes the review of the literature also. Conclusion: Though retinal arterial obstruction is rare in the pediatric population, this case highlights the importance of including this in the differential diagnosis of acute vision loss.

Purpose: To report branch retinal artery occlusion (BRAO) in a patient with patent foramen ovale (PFO). Case Report: A 29-year-old female patient was referred for sudden onset superior visual field defect in her left eye. Ocular examination revealed visual acuity of 20/32 in the affected eye along with a positive relative afferent pupillary defect. A calcified white embolus was noted at the first bifurcation of the inferior temporal artery in her left eye together with mild retinal edema. With a diagnosis of BRAO, the patient received oral acetazolamide, topical timolol, ocular massage and anterior chamber paracentesis. The visual field defect partially recovered and the embolus moved to the third bifurcation level as revealed by fundus examination. An extensive workup, including neurology, rheumatology, cardiology and hematology consultation, carotid ultrasonography, transthoracic/transesophageal echocardiography and laboratory testing was performed. All results were within normal limits except for a small-sized PFO detected by transesophageal echocardiography. Low-dose aspirin therapy was initiated and over the subsequent two years, no other embolic event occurred. Conclusion: The association between PFO and BRAO has not yet been reported. Intracardiac right-to-left shunting through a PFO, accentuated by Valsalva maneuver, may predispose to embolic events while the source of initial thrombosis remains unknown.

Background. Retinal artery occlusion is an extremely rare diagnosis in the pediatric population and the etiology with risk factors of retinal artery occlusion are poorly understood in younger individuals. Methods and Results. This case report a rare case of transient branch retinal artery occlusion (BRAO) in a healthy young girl. A fifteen-year-old girl presented with painless decreased vision in her right eye. Fundus examination revealed in the right eye intensive edema of the part of superior half of the retina, but the vessels were absolutely normal. She was hospitalized for diagnosis and treatment. A thorough workup was performed to determine any etiologic factor. Her physical examination was normal, but from anamnesis has been found that patient began use oral contraception at the time of occurrence eye problems. The condition is evaluated as transient branch retinal artery occlusion by the course of the disease. The paper includes the review of the literature also. Conclusion. Though retinal arterial obstruction is rare in the pediatric population, this case highlights the importance of including this in the differential diagnosis of acute vision loss. [ABSTRACT FROM AUTHOR]

Background Previous studies have established that radiation to the head and neck leads to atherosclerosis and stenosis of the carotid artery and subsequent increased stroke risk, but the ophthalmic sequella following cervical irradiation is less well-defined. Case presentation We present a single case of branch retinal artery occlusion (BRAO) in a 55 year-old Caucasian male seen at the University of Michigan in 2008 following unilateral head and neck radiation. Conclusion This case demonstrates that patients receiving radiation to the head and neck may be at increased risk for developing a BRAO secondary to atherosclerotic changes of vessels adjacent to the radiation target. Given this risk, it may be reasonable to obtain carotid artery imaging in patients with a history of cervical radiation who present with sudden or transient visual field defects, even in the absence of other conventional risk factors for atherosclerosis. [ABSTRACT FROM AUTHOR]

Background/purpose: Susac syndrome is a rare microangiopathy of suspected autoimmune origin affecting arteries of the retina, the cochlea and the brain. The aim of the study was to give a review of the disease entity and determine the proportion of cases and their characteristics in a uveitis referral centre. Patients and methods: Charts of patients with the diagnosis of Susac syndrome seen in the Uveitis Clinic of the Centre for Ophthalmic Specialised Care (COS), Lausanne, Switzerland were reviewed retrospectively to determine the frequency of such cases in a uveitis referral centre. Clinical symptoms and signs, functional data, imaging signs and evolution were analysed in the 3 COS cases and one case shared with the Uveitis Clinic of the Department of Ophthalmology, University of Innsbruck, Austria. Characteristic signs were searched possibly allowing a prompt diagnosis. Results: During the period from 1994 to 2019 (24 years, 2045 patients), 3 charts with the diagnosis of Susac syndrome were found (0.15%). The whole collective, including the additional case, comprised three women aged 28, 32 and 63 at presentation and one man, aged 42. None of the 3 cases that were referred were diagnosed beforehand. The characteristic item found in all 4 cases was the abrupt arterial stop or segmental interruption of arteries and increased staining of arterial wall on angiography more clearly shown on indocyanine green angiography that can potentially be proposed as a crucial diagnostic element. All 4 cases responded to dual steroidal and non-steroidal immunosuppression. Under treatment, all four patients did not show any further evolution. Conclusion: Susac syndrome is a multilocation arteritis of the head that can involve the eye, ear and brain often first diagnosed by the ophthalmologist. The diagnosis is rapidly reached in uveitis referral centres but seems to be missed otherwise, A helpful angiographic sign to be searched is an abrupt or segmental arterial stop and increased staining of the arterial wall more clearly seen on indocyanine green angiography. Patients often present first to the ophthalmologist who should be acting as a whistleblower to avoid severe involvement of the brain. [ABSTRACT FROM AUTHOR]

Purpose: To report branch retinal artery occlusion (BRAO) in a patient with patent foramen ovale (PFO)., Case Report: A 29-year-old female patient was referred for sudden onset superior visual field defect in her left eye. Ocular examination revealed visual acuity of 20/32 in the affected eye along with a positive relative afferent pupillary defect. A calcified white embolus was noted at the first bifurcation of the inferior temporal artery in her left eye together with mild retinal edema. With a diagnosis of BRAO, the patient received oral acetazolamide, topical timolol, ocular massage and anterior chamber paracentesis. The visual field defect partially recovered and the embolus moved to the third bifurcation level as revealed by fundus examination. An extensive workup, including neurology, rheumatology, cardiology and hematology consultation, carotid ultrasonography, transthoracic/transesophageal echocardiography and laboratory testing was performed. All results were within normal limits except for a small-sized PFO detected by transesophageal echocardiography. Low-dose aspirin therapy was initiated and over the subsequent two years, no other embolic event occurred., Conclusion: The association between PFO and BRAO has not yet been reported. Intracardiac right-to-left shunting through a PFO, accentuated by Valsalva maneuver, may predispose to embolic events while the source of initial thrombosis remains unknown.