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Abstract
Abstract
Ischemic Tolerance - A New Pathophysiologic Approach to the Clinical Entity of Partial Central Retinal Artery Occlusion (CRAO)
Junk A. K., Rosenbaum P. S., Engel H. M. , Rosenbaum D. M.
Albert Einstein College of Medicine, Ophthalmology, Pathology, Neurology and Neuroscience, Bronx, New York/USA
Purpose: Ischemic tolerance has been studied extensively in experimental models of heart and brain ischemia. We have recently demonstrated that this phenomenon occurs in the retina as well and it may, in part, be related to anti-apoptotic mechanisms (IOVS 2002, 43, 3059-66). While there is some clinical evidence of ischemic tolerance in the heart and brain, it is not known whether the same is true in the human retina. The purpose of this study was to determine if prior brief episodes of ischemia protect the retina from subsequent ischemic insults.
Method: Retrospective review of four cases of partial CRAO: all patients experienced typical prodromal visual symptoms consistent with retinal ischemia. Complete eye examination included retinal photography, fluorescein angiography, and visual field testing. Echocardiogram and carotid doppler studies were part of the medical work up. Ophthalmological and medical treatment followed the concurrent recommendations of the AAO and AMA.
Results: All four patients demonstrated a sudden decrease in visual acuity, relative afferent pupillary defect, and retinal edema with extensive cotton wool spots subsequent to prodromal ophthalmological symptoms. Fluorescein angiogram revealed a severe delay of the arterial filling phase (34 to 61 se