Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/01/23 12:06:06」(JST)

wiki en

Central retinal artery occlusion (CRAO) is a disease of the eye where the flow of blood through the central retinal artery is blocked (occluded). There are several different causes of this occlusion, the most common is carotid artery atherosclerosis.

Signs and symptoms

Central retinal artery occlusions cause sudden, acute, and painless loss of vision in one eye. Fundoscopic exam will show a red lesion, called a "cherry red spot," with surrounding pale retina (the pale color is caused by ischemia of the retina).^[1]^[2]

Anatomy

The ophthalmic artery branches off into the central retinal artery which travels with the optic nerve until it enters the eye. This central retinal artery provides nutrients to the retina of the eye, more specifically the inner retina and the surface of the optic nerve.^[2]

Epidemiology

Risk factors for CRAO include the following: being between 60 and 65 years of age, being over the age of 40, male gender, hypertension, caucasian, smoking and diabetes mellitus.^[2] Additional risk factors include endocarditis, atrial myxoma, inflammatory diseases of the blood vessels, and predisposition to forming blood clots.^{[citation needed]}

Causes

The most common cause for CRAO is carotid artery atherosclerosis. In patients of 70 years of age and older, giant cell arteritis is more likely to be the cause than in younger patients. Other causes can include dissecting aneurysms and arterial spasms.^[2]

Treatment

The Undersea and Hyperbaric Medical Society lists Central Retinal Artery Occlusion (CRAO) as an approved indication for Hyperbaric Oxygen Therapy.^[3] This a treatment for CRAO that is covered by medical insurance in North America. Other treatments include ocular massage, anterior chamber paracentesis, and inhalation therapy of a mixture of 5% carbon dioxide and 95% oxygen.^[1]

Prognosis

The artery can re-canalize over time and the edema can clear. However, optic atrophy leads to permanent loss of vision. Irreversible damage to neural tissue occurs after only 90 minutes. Two thirds of patients experience 20/400 vision while only one in six will experience 20/40 vision or better.^[1]

References

^ ^a ^b ^c Kunimoto, Dr., Lecture, Vascular diseases of the retina, AT Still University SOMA, October 2012
^ ^a ^b ^c ^d Central and branch retinal artery occlusion. Uptodate.com. Mar 14, 2012.
^ https://www.uhms.org/6-arterial-insufficiencies/central-retinal-artery-occlusion.html

English Journal

A case report and review of the literature on bilateral retinal infarction following cardiopulmonary bypass for coronary artery bypass grafting.

Trethowan BA, Gilliland H, Popov AF, Varadajan B, Phillips SA, McWhirter L, Ghent R.AbstractABSTRACT: Postoperative visual loss is a devastating perioperative complication. The commonest aetiologies are anterior ischaemic optic neuropathy (AION), posterior ischaemic optic neuropathy (PION), and central retinal artery occlusion (CRAO). These appear to be related to certain types of operation, most commonly spinal and cardiac bypass procedures; with the rest divided between: major trauma causing excessive blood loss; head/neck and nasal or sinus surgery; major vascular procedures (aortic aneurysm repair, aorto-bifemoral bypass); general surgery; urology; gynaecology; liposuction; and liver transplantation. The non-surgical risk factors are multifactorial: advanced age, prolonged postoperative anaemia, positioning (supine v prone), alteration of venous drainage of the retina, hypertension, smoking, atherosclerosis, hyperlipidaemia, diabetes, hypercoagulability, hypotension, duration of surgery, blood loss and large volume resuscitation. Other important cardiac causes are septic emboli from bacterial endocarditis and emboli caused by atrial myxomata. The majority of AION cases occur during CPB followed by head/neck surgery and prone spine surgery. CPB is used to allow coronary artery bypass grafting on a motionless heart. It has many side-effects and complications associated with its use and we report here a case of bilateral retinal infarction during routine coronary artery bypass grafting in a young male patient with multiple risk factors for developing this complication despite steps to minimise its occurrence.
Journal of cardiothoracic surgery.J Cardiothorac Surg.2011 Nov 21;6(1):154. [Epub ahead of print]
ABSTRACT: Postoperative visual loss is a devastating perioperative complication. The commonest aetiologies are anterior ischaemic optic neuropathy (AION), posterior ischaemic optic neuropathy (PION), and central retinal artery occlusion (CRAO). These appear to be related to certain types of operatio
PMID 22104114

Churg-Strauss syndrome complicated by central retinal artery occlusion: case report and a review of the literature.

Asako K, Takayama M, Kono H, Kikuchi H.SourceDepartment of Internal Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.
Modern rheumatology / the Japan Rheumatism Association.Mod Rheumatol.2011 Oct;21(5):519-23. Epub 2011 Feb 9.
A 68-year-old man was admitted with rapid visual loss. Churg-Strauss syndrome (CSS) was diagnosed, based upon the symptoms of asthma, eosinophilia, interstitial pneumonitis, and positive myeloperoxidase-anti neutrophil cytoplasmic antibody (MPO-ANCA). Light reflexes were absent and vision was comple
PMID 21308387

Japanese Journal

BRAO,CRAOのマネージメント (特集網膜血管病の病態とマネージメント)

高橋博
眼科 53(9), 1099-1105, 2011-09
NAID 40018989893

網膜血管閉塞症における足関節上腕血圧比(ABI)と脈波速度(PWV)の臨床的意義

大黒浩,下川良一,大黒幾代 [他]
弘前医学 57(2-4), 65-70, 2006
… Five out of six patients with abnormally low ABI values (less than 0.9) had associated central retinal artery occlusion (CRAO). … Conclusion: Our present data provide the first evidence that measurement of ABI may be a clinical marker for management for retinal vascular occlusion, especially for CRAO. …
NAID 120000917230

Related Pictures

Central Retinal Artery Obstruction (CRAO CRAO CRAO management CRAO oil IGS Station: crao Central retinal artery (CRAO) or vein Incomplete CRAO

★リンクテーブル★

リンク元	「網膜静脈閉塞症」「網膜動脈閉塞症」「central retinal artery occlusion」
関連記事	「CR」

「網膜静脈閉塞症」

　　[★]

英: retinal vein occlusion, obstruction of the retinal vein

分類

リスクファクター

参考1

年齢、高血圧、糖尿病、喫煙、肥満、凝固亢進状態(factor V Leiden, activated protein C resistance)、緑内障、網膜細血管異常(retinal arteriolar abnormality)

出典不明

動脈硬化

比較

SOP.134

	網膜静脈分枝閉塞症	網膜中心静脈閉塞症	網膜中心動脈閉塞症
	BRVO	CRVO	CRAO
概念	網膜動静脈交差部で静脈が閉鎖	網膜中心静脈の閉塞	網膜中心動脈の閉塞
疫学	CRVOより遙かに頻度が高い	50歳以上の中高年で高血圧症のある人に好発	(1)血栓塞栓子、(2)乳頭内での粥状硬化、あるいは動脈炎による血管攣縮による動脈の閉塞、(3)緑内障や外力による高眼圧
病型		静脈うっ滞網膜症　venous stasis retinopathy：静脈拡張、出血など静脈閉塞のみを主症状とする。出血性網膜症　hemorrhagic retinopathy：高度の血管床閉塞など動脈の循環障害を併発
症状	黄斑部を支配する静脈が閉塞すれば視力低下を痔核。	無痛性の片眼性の急激な視力低下	無痛性の高度視力障害
眼底	閉塞した静脈域で静脈の拡張し、透過性亢進による出血、浮腫、綿花白斑を生じる。数ヶ月の経過で出血は吸収され、静脈は白線化し、硬性白斑が残る。	視神経乳頭から放射状の火炎状出血、(重症例)暗赤色の出血斑。乳頭の充血、浮腫、網膜静脈の拡張蛇行、綿花様白斑、黄斑浮腫から嚢胞様黄斑浮腫	網膜は混濁、白濁。cherry-red spot
合併症	新生血管形成と硝子体出血。再発性硝子体出血と牽引性網膜剥離症(閉塞した静脈域の毛細血管の閉塞によりその領域周辺の網膜や視神経乳頭での血管新生をきたす)。	新生血管緑内障：予後不良。発症から3ヶ月が好発時期。前房隅角や虹彩に新生血管が生じ眼圧上昇をきたす。
治療	光凝固術：黄斑浮腫、新生血管に対して。硝子体手術：硝子体手術、牽引性網膜剥離	原疾患の治療新生血管緑内障予防：汎光凝固術	眼球圧迫マッサージ亜硝酸アミル (高眼圧の場合)前房穿刺
予後			1時間以内に血行が改善しないと網膜機能の回復は期待できない。