What follow-up care is indicated in the treatment of central retinal artery occlusion (CRAO)?

Updated: Jun 11, 2019
  • Author: Robert H Graham, MD; Chief Editor: Andrew G Lee, MD  more...
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Answer

A follow-up ophthalmic examination should be performed 1-4 weeks after the event to check for neovascularization of the disc or iris. Intravitreal injection of an anti-VEGF agent is first-line therapy for neovascularization of the iris, trabecular meshwork, or optic disc. Neovascularization of the iris occurs in 20% of patients at an average of 4-5 weeks after the event. Panretinal photocoagulation is effective in causing regression of iris neovascularization in 65% of patients. Neovascularization of the disc occurs in 2-3% of patients. Panretinal photocoagulation is effective for optic disc neovascularization.

A complete systemic workup should be performed by a primary care provider. Hospital admission, cranial MRI (including diffusion weighted imaging) and MRA, and consultation with the neurology stroke service may be useful, especially in acute cases.

If hyperbaric oxygen therapy (HBOT) is to be used, several treatments may be necessary, although this treatment is unproven.


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