| Affiliation |
(AGL) Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, Texas; Professor of Ophthalmology, Weill Cornell Medicine, New York City, New York |
| Transcript |
"So I want to tell you a little bit about cilioretinal artery, and why that's important to neuro-ophthalmology. So as you know, in the eye, in the retina, the central retinal artery penetrates the optic nerve and supplies the central retinal artery. It's a branch of the ophthalmic artery and so when we have embolic disease or vasculitis, like giant cell arteritis, it can produce a central retinal artery occlusion (CRAO) and in the eye what that looks like is you have diffuse retinal opacity because the retina is ischemic, but we can see a cherry red spot in the center, which is where the thinnest part of the retina is, and because the retina is thinner there we can see straight down into the choroid and we can see that choroidal spot as a cherry red spot. So that's a typical CRAO. Usually it's very bad because you damage the whole retina and you get visions like count fingers or hand motion or worse, and sometimes people have a cilioretinal artery and that's the thing that saves them. So the cilioretinal artery actually is coming from the ophthalmic, but it's like a posterior ciliary branch that comes out through the nerve head and is supplying a piece of the retina. So it looks like it's coming right out of the disc like this, and it just happens to be sparing this little piece right here, and so because the occlusion of the thrombus is in the central retinal artery, it did not hit this little posterior ciliary artery, cilioretinal artery, and so that is what we call cilioretinal artery sparing. So we can get sparing of a small patch, often in the macula itself that might preserve someone's vision to 20/30, even though they've had a central retinal artery occlusion just because they have this anatomic variant, which is just luck. If you see a cilioretinal artery occlusion by itself, you should really be thinking about vasculitis, that's giant cell arteritis, because giant cell arteritis has a predilection for these posterior ciliary arteries, but a central retinal artery occlusion without an embolus is also a sign of giant cell. So CRAO with or without the cilioretinal artery sparing or the cilioretinal arteries involvement alone are giant cell arteritis in elderly patients until proven otherwise. So you need to know a little bit about the cilioretinal artery. The last thing I'll tell you is if you have a central retinal vein occlusion. That increases the back pressure in the venous system, and because the pressure head is actually lower in the cilioretinal artery than in the central renal artery, just having a vein occlusion could cause a cilioretinal artery occlusion. So the setting of a vein occlusion you might get a cilioretinal artery occlusion at the same time, and you don't want to mistake that for vasculitis. That is just perfusion pressure, is lower in the cilioretinal artery and the back pressure produces the concomitant cilioretinal artery occlusion in the central retinal artery. So you need to know about both cilioretinal artery sparing and involvement in neuro-ophthalmology." |
