Retinal Ischemic Perivascular Lesions in the Fellow Eyes of Patients with Central Retinal Artery Occlusion

PURPOSE: To evaluate the prevalence and characteristics of retinal ischemic perivascular lesions (RIPLs) in the clinically unaffected fellow eyes of patients with unilateral central retinal artery occlusion (CRAO) using spectral-domain optical coherence tomography (SD-OCT). METHODS: This retrospective case-control study included 39 fellow eyes of patients with CRAO and 57 age-, sex-, and hypertension-matched healthy controls. Macular SD-OCT scans were assessed for the presence, number, and morphology of RIPLs, classified as narrow (300 µm, flattened apex). Between-group comparisons were performed using appropriate parametric/non-parametric tests, and odds ratios (ORs) were calculated for RIPL presence. RESULTS: RIPLs were detected in 29/39 eyes (74.4%) in the CRAO fellow-eye group and 14/57 eyes (24.6%) in controls (p < 0.001). The mean number of lesions per eye was significantly higher in the CRAO group (1.36 ± 1.22) than in controls (0.35 ± 0.73; p < 0.001). Among CRAO fellow eyes with RIPLs, 5 eyes (17.2%) showed wide-type lesions, whereas all lesions in controls were narrow. The odds of RIPL presence were higher in the CRAO group (OR 8.12, 95% CI 3.20-20.57; p < 0.001). CONCLUSIONS: Increased RIPL burden in the fellow eyes of CRAO patients suggests that microstructural retinal changes may be detectable even in eyes without clinically evident arterial occlusion. Further longitudinal, multimodal studies are needed to determine the temporal course and underlying mechanisms.