Advertisement

Treatment of Central Retinal Artery Occlusion

  • Michael Dattilo
  • Valérie BiousseEmail author
  • Klara Landau
  • Nancy J. Newman
Chapter

Abstract

Central retinal artery occlusion (CRAO) is the ocular equivalent of an acute cerebral ischemic event. It is most commonly caused by an embolus from the ipsilateral carotid artery, aortic arch or heart, leading to partial or complete occlusion of the central retinal artery. Patients with a CRAO need a thorough stroke evaluation to search for the cause of the embolus, since the risk factors for a CRAO are very similar, if not identical, to the risk factors for stroke. In addition, since about 20% of patients with a CRAO have concurrent acute cerebral ischemia, an emergent brain MRI is necessary, even in the absence of neurologic symptoms. To date, there are no therapeutic interventions that have shown improved visual outcomes compared to the natural history of CRAO. Therefore, management of an acute CRAO is focused on secondary prevention and minimizing the risk of subsequent ischemic events, such as myocardial infarction, cerebral ischemia, and cardiovascular death.

Keywords

Central retinal artery occlusion Stroke Ischemia Management Treatment Thrombolysis 

References

  1. 1.
    Biousse V, Newman N. Retinal and optic nerve ischemia. Continuum (Minneap Minn). 2014;20(4 Neuro-ophthalmology):838–56.Google Scholar
  2. 2.
    Cugati S, Varma DD, Chen CS, Lee AW. Treatment options for central retinal artery occlusion. Curr Treat Options Neurol. 2013;15(1):63–77.PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Lorentzen SE. Incidence of cilioretinal arteries. Acta Ophthalmol. 1970;48(3):518–24.CrossRefGoogle Scholar
  4. 4.
    Hayreh SS. Ocular vascular occlusive disorders: natural history of visual outcome. Prog Retin Eye Res. 2014;41:1–25.PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Callizo J, Feltgen N, Pantenburg S, Wolf A, Neubauer AS, Jurklies B, et al. Cardiovascular risk factors in central retinal artery occlusion: results of a prospective and standardized medical examination. Ophthalmology. 2015;122(9):1881–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Douglas DJ, Schuler JJ, Buchbinder D, Dillon BC, Flanigan DP. The association of central retinal artery occlusion and extracranial carotid artery disease. Ann Surg. 1988;208(1):85–90.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Hayreh SS, Podhajsky PA, Zimmerman MB. Retinal artery occlusion: associated systemic and ophthalmic abnormalities. Ophthalmology. 2009;116(10):1928–36.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Klein R, Klein BE, Moss SE, Meuer SM. Retinal emboli and cardiovascular disease: the beaver dam eye study. Arch Ophthalmol. 2003;121(10):1446–51.PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Rudkin AK, Lee AW, Chen CS. Vascular risk factors for central retinal artery occlusion. Eye (Lond). 2010;24(4):678–81.CrossRefGoogle Scholar
  10. 10.
    Biousse V. Acute retinal arterial ischemia: an emergency often ignored. Am J Ophthalmol. 2014;157(6):1119–21.PubMedCrossRefGoogle Scholar
  11. 11.
    Patel M, Shah G, Davies JB, Mittra RA, Eliott D. Re-evaluating our perspective on retinal artery occlusion from carotid dissection: a report of three cases and review of the literature. Ophthalmic Surg Lasers Imaging Retina. 2013;44(6):555–60.PubMedCrossRefGoogle Scholar
  12. 12.
    Biousse V, Touboul PJ, D'Anglejan-Chatillon J, Levy C, Schaison M, Bousser MG. Ophthalmologic manifestations of internal carotid artery dissection. Am J Ophthalmol. 1998;126(4):565–77.PubMedCrossRefGoogle Scholar
  13. 13.
    Schmidt D, Hetzel A, Geibel-Zehender A, Schulte-Monting J. Systemic diseases in non-inflammatory branch and central retinal artery occlusion--an overview of 416 patients. Eur J Med Res. 2007;12(12):595–603.PubMedGoogle Scholar
  14. 14.
    Chen CS, Lee AW. Management of acute central retinal artery occlusion. Nat Clin Pract Neurol. 2008;4(7):376–83.PubMedCrossRefGoogle Scholar
  15. 15.
    Hayreh SS. Acute retinal arterial occlusive disorders. Prog Retin Eye Res. 2011;30(5):359–94.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Varma DD, Cugati S, Lee AW, Chen CS. A review of central retinal artery occlusion: clinical presentation and management. Eye (Lond). 2013;27(6):688–97.CrossRefGoogle Scholar
  17. 17.
    Brown GC, Magargal LE, Shields JA, Goldberg RE, Walsh PN. Retinal arterial obstruction in children and young adults. Ophthalmology. 1981;88(1):18–25.PubMedCrossRefGoogle Scholar
  18. 18.
    Bruno A, Jones WL, Austin JK, Carter S, Qualls C. Vascular outcome in men with asymptomatic retinal cholesterol emboli. A cohort study. Ann Intern Med. 1995;122(4):249–53.PubMedCrossRefGoogle Scholar
  19. 19.
    Chang SH, Miller NR. The incidence of vision loss due to perioperative ischemic optic neuropathy associated with spine surgery: the Johns Hopkins Hospital experience. Spine (Phila Pa 1976). 2005;30(11):1299–302.CrossRefGoogle Scholar
  20. 20.
    Sys J, Michielsen J, Mertens E, Verstreken J, Tassignon MJ. Central retinal artery occlusion after spinal surgery. Eur Spine J. 1996;5(1):74–5.PubMedCrossRefGoogle Scholar
  21. 21.
    Park SW, Woo SJ, Park KH, Huh JW, Jung C, Kwon OK. Iatrogenic retinal artery occlusion caused by cosmetic facial filler injections. Am J Ophthalmol. 2012;154(4):653–62. e1PubMedCrossRefGoogle Scholar
  22. 22.
    Park SJ, Choi NK, Seo KH, Park KH, Woo SJ. Nationwide incidence of clinically diagnosed central retinal artery occlusion in Korea, 2008 to 2011. Ophthalmology. 2014;121(10):1933–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Leavitt JA, Larson TA, Hodge DO, Gullerud RE. The incidence of central retinal artery occlusion in Olmsted County, Minnesota. Am J Ophthalmol. 2011;152(5):820–3.e2.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Rumelt S, Dorenboim Y, Rehany U. Aggressive systematic treatment for central retinal artery occlusion. Am J Ophthalmol. 1999;128(6):733–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Hayreh SS, Zimmerman MB. Central retinal artery occlusion: visual outcome. Am J Ophthalmol. 2005;140(3):376–91.PubMedCrossRefGoogle Scholar
  26. 26.
    Hayreh SS, Zimmerman MB. Fundus changes in central retinal artery occlusion. Retina. 2007;27(3):276–89.PubMedCrossRefGoogle Scholar
  27. 27.
    Shinoda K, Yamada K, Matsumoto CS, Kimoto K, Nakatsuka K. Changes in retinal thickness are correlated with alterations of electroretinogram in eyes with central retinal artery occlusion. Graefes Arch Clin Exp Ophthalmol. 2008;246(7):949–54.PubMedCrossRefGoogle Scholar
  28. 28.
    Beatty S, Au Eong KG. Acute occlusion of the retinal arteries: current concepts and recent advances in diagnosis and management. J Accid Emerg Med. 2000;17(5):324–9.PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Hayreh SS, Jonas JB. Optic disk and retinal nerve fiber layer damage after transient central retinal artery occlusion: an experimental study in rhesus monkeys. Am J Ophthalmol. 2000;129(6):786–95.PubMedCrossRefGoogle Scholar
  30. 30.
    Hayreh SS, Zimmerman MB, Kimura A, Sanon A. Central retinal artery occlusion. Retinal survival time. Exp Eye Res. 2004;78(3):723–36.PubMedCrossRefPubMedCentralGoogle Scholar
  31. 31.
    Vu HT, Keeffe JE, McCarty CA, Taylor HR. Impact of unilateral and bilateral vision loss on quality of life. Br J Ophthalmol. 2005;89(3):360–3.PubMedPubMedCentralCrossRefGoogle Scholar
  32. 32.
    Hankey GJ, Slattery JM, Warlow CP. Prognosis and prognostic factors of retinal infarction: a prospective cohort study. BMJ. 1991;302(6775):499–504.PubMedPubMedCentralCrossRefGoogle Scholar
  33. 33.
    Helenius J, Arsava EM, Goldstein JN, Cestari DM, Buonanno FS, Rosen BR, et al. Concurrent acute brain infarcts in patients with monocular visual loss. Ann Neurol. 2012;72(2):286–93.PubMedPubMedCentralCrossRefGoogle Scholar
  34. 34.
    Park SJ, Choi NK, Yang BR, Park KH, Lee J, Jung SY, et al. Risk and risk periods for stroke and acute myocardial infarction in patients with central retinal artery occlusion. Ophthalmology. 2015;122(11):2336–43.e2.PubMedCrossRefGoogle Scholar
  35. 35.
    Rim TH, Han J, Choi YS, Hwang SS, Lee CS, Lee SC, et al. Retinal artery occlusion and the risk of stroke development: twelve-year Nationwide Cohort Study. Stroke. 2016;47(2):376–82.PubMedCrossRefGoogle Scholar
  36. 36.
    Rudkin AK, Lee AW, Chen CS. Ocular neovascularization following central retinal artery occlusion: prevalence and timing of onset. Eur J Ophthalmol. 2010;20(6):1042–6.PubMedCrossRefGoogle Scholar
  37. 37.
    Klein R, Klein BE, Jensen SC, Moss SE, Meuer SM. Retinal emboli and stroke: the Beaver Dam Eye Study. Arch Ophthalmol. 1999;117(8):1063–8.PubMedCrossRefGoogle Scholar
  38. 38.
    Wang JJ, Cugati S, Knudtson MD, Rochtchina E, Klein R, Klein BE, et al. Retinal arteriolar emboli and long-term mortality: pooled data analysis from two older populations. Stroke. 2006;37(7):1833–6.PubMedCrossRefGoogle Scholar
  39. 39.
    Chang YS, Jan RL, Weng SF, Wang JJ, Chio CC, Wei FT, et al. Retinal artery occlusion and the 3-year risk of stroke in Taiwan: a nationwide population-based study. Am J Ophthalmol. 2012;154(4):645–52.e1.PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJ, Culebras A, et al. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(7):2064–89.PubMedCrossRefGoogle Scholar
  41. 41.
    Atkins EJ, Bruce BB, Newman NJ, Biousse V. Translation of clinical studies to clinical practice: survey on the treatment of central retinal artery occlusion. Am J Ophthalmol. 2009;148(1):172–3.PubMedCrossRefGoogle Scholar
  42. 42.
    Abel AS, Suresh S, Hussein HM, Carpenter AF, Montezuma SR, Lee MS. Practice patterns after acute embolic retinal artery occlusion. Asia Pac J Ophthalmol (Phila). 2017;6(1):37–9.CrossRefGoogle Scholar
  43. 43.
    Lee J, Kim SW, Lee SC, Kwon OW, Kim YD, Byeon SH. Co-occurrence of acute retinal artery occlusion and acute ischemic stroke: diffusion-weighted magnetic resonance imaging study. Am J Ophthalmol. 2014;157(6):1231–8.PubMedCrossRefGoogle Scholar
  44. 44.
    Biousse V, Trobe JD. Transient monocular visual loss. Am J Ophthalmol. 2005;140(4):717–21.PubMedCrossRefGoogle Scholar
  45. 45.
    Lauda F, Neugebauer H, Reiber L, Juttler E. Acute silent brain infarction in monocular visual loss of ischemic origin. Cerebrovasc Dis. 2015;40(3–4):151–6.PubMedCrossRefGoogle Scholar
  46. 46.
    Golsari A, Bittersohl D, Cheng B, Griem P, Beck C, Hassenstein A, et al. Silent brain infarctions and leukoaraiosis in patients with retinal ischemia: a prospective single-center observational study. Stroke. 2017;48(5):1392–6.PubMedCrossRefGoogle Scholar
  47. 47.
    Greven CM, Slusher MM, Weaver RG. Retinal arterial occlusions in young adults. Am J Ophthalmol. 1995;120(6):776–83.PubMedCrossRefGoogle Scholar
  48. 48.
    Bossert M, Prati C, Balblanc JC, Lohse A, Wendling D. Aortic involvement in giant cell arteritis: current data. Joint Bone Spine. 2011;78(3):246–51.PubMedCrossRefGoogle Scholar
  49. 49.
    Dasgupta B, Borg FA, Hassan N, Alexander L, Barraclough K, Bourke B, et al. BSR and BHPR guidelines for the management of giant cell arteritis. Rheumatology (Oxford). 2010;49(8):1594–7.CrossRefGoogle Scholar
  50. 50.
    Vodopivec I, Cestari DM, Rizzo JF 3rd. Management of transient monocular vision loss and retinal artery occlusions. Semin Ophthalmol. 2017;32(1):125–33.PubMedCrossRefGoogle Scholar
  51. 51.
    Gilbert AL, Choi C, Lessell S. Acute management of central retinal artery occlusion. Int Ophthalmol Clin. 2015;55(4):157–66.PubMedCrossRefGoogle Scholar
  52. 52.
    Fraser SG, Adams W. Interventions for acute non-arteritic central retinal artery occlusion. Cochrane Database Syst Rev. 2009;1:CD001989.Google Scholar
  53. 53.
    Almeida DR, Mammo Z, Chin EK, Mahajan VB. Surgical embolectomy for fovea-threatening acute retinal artery occlusion. Retin Cases Brief Rep. 2016;10(4):331–3.PubMedPubMedCentralGoogle Scholar
  54. 54.
    Pielen A, Pantenburg S, Schmoor C, Schumacher M, Feltgen N, Junker B, et al. Predictors of prognosis and treatment outcome in central retinal artery occlusion: local intra-arterial fibrinolysis vs. conservative treatment. Neuroradiology. 2015;57(10):1055–62.PubMedCrossRefGoogle Scholar
  55. 55.
    Augsburger JJ, Magargal LE. Visual prognosis following treatment of acute central retinal artery obstruction. Br J Ophthalmol. 1980;64(12):913–7.PubMedPubMedCentralCrossRefGoogle Scholar
  56. 56.
    Rudkin AK, Lee AW, Aldrich E, Miller NR, Chen CS. Clinical characteristics and outcome of current standard management of central retinal artery occlusion. Clin Exp Ophthalmol. 2010;38(5):496–501.PubMedCrossRefGoogle Scholar
  57. 57.
    Reynard M, Hanscom TA. Neodymium:yttrium-aluminum-garnet laser arteriotomy with embolectomy for central retinal artery occlusion. Am J Ophthalmol. 2004;137(1):196–8.PubMedCrossRefGoogle Scholar
  58. 58.
    Opremcak E, Rehmar AJ, Ridenour CD, Borkowski LM, Kelley JK. Restoration of retinal blood flow via translumenal Nd:YAG embolysis/embolectomy (TYL/E) for central and branch retinal artery occlusion. Retina. 2008;28(2):226–35.PubMedCrossRefGoogle Scholar
  59. 59.
    Rassam SM, Patel V, Kohner EM. The effect of acetazolamide on the retinal circulation. Eye (Lond). 1993;7(Pt 5):697–702.CrossRefGoogle Scholar
  60. 60.
    Landa E, Rehany U, Rumelt S. Visual functions following recovery from non-arteritic central retinal artery occlusion. Ophthalmic Surg Lasers Imaging. 2004;35(2):103–8.PubMedGoogle Scholar
  61. 61.
    Atebara NH, Brown GC, Cater J. Efficacy of anterior chamber paracentesis and carbogen in treating acute nonarteritic central retinal artery occlusion. Ophthalmology. 1995;102(12):2029–34. discussion 34–5PubMedCrossRefGoogle Scholar
  62. 62.
    Arend O, Harris A, Martin BJ, Holin M, Wolf S. Retinal blood velocities during carbogen breathing using scanning laser ophthalmoscopy. Acta Ophthalmol. 1994;72(3):332–6.CrossRefGoogle Scholar
  63. 63.
    Harino S, Grunwald JE, Petrig BJ, Riva CE. Rebreathing into a bag increases human retinal macular blood velocity. Br J Ophthalmol. 1995;79(4):380–3.PubMedPubMedCentralCrossRefGoogle Scholar
  64. 64.
    Deutsch TA, Read JS, Ernest JT, Goldstick TK. Effects of oxygen and carbon dioxide on the retinal vasculature in humans. Arch Ophthalmol. 1983;101(8):1278–80.PubMedCrossRefGoogle Scholar
  65. 65.
    Incandela L, Cesarone MR, Belcaro G, Steigerwalt R, De Sanctis MT, Nicolaides AN, et al. Treatment of vascular retinal disease with pentoxifylline: a controlled, randomized trial. Angiology. 2002;53(Suppl 1):S31–4.PubMedGoogle Scholar
  66. 66.
    Iwafune Y, Yoshimoto H. Clinical use of pentoxifylline in haemorrhagic disorders of the retina. Pharmatherapeutica. 1980;2(7):429–38.PubMedGoogle Scholar
  67. 67.
    Beiran I, Goldenberg I, Adir Y, Tamir A, Shupak A, Miller B. Early hyperbaric oxygen therapy for retinal artery occlusion. Eur J Ophthalmol. 2001;11(4):345–50.PubMedCrossRefGoogle Scholar
  68. 68.
    Anderson B Jr, Saltzman HA, Heyman A. The effects of hyperbaric oxygenation on retinal arterial occlusion. Arch Ophthalmol. 1965;73:315–9.PubMedCrossRefGoogle Scholar
  69. 69.
    Cope A, Eggert JV, O'Brien E. Retinal artery occlusion: visual outcome after treatment with hyperbaric oxygen. Diving Hyperb Med. 2011;41(3):135–8.PubMedGoogle Scholar
  70. 70.
    Menzel-Severing J, Siekmann U, Weinberger A, Roessler G, Walter P, Mazinani B. Early hyperbaric oxygen treatment for nonarteritic central retinal artery obstruction. Am J Ophthalmol. 2012;153(3):454–9.e2.PubMedCrossRefPubMedCentralGoogle Scholar
  71. 71.
    Ahn SJ, Kim JM, Hong JH, Woo SJ, Ahn J, Park KH, et al. Efficacy and safety of intra-arterial thrombolysis in central retinal artery occlusion. Invest Ophthalmol Vis Sci. 2013;54(12):7746–55.PubMedCrossRefPubMedCentralGoogle Scholar
  72. 72.
    Pettersen JA, Hill MD, Demchuk AM, Morrish W, Hudon ME, Hu W, et al. Intra-arterial thrombolysis for retinal artery occlusion: the Calgary experience. Can J Neurol Sci. 2005;32(4):507–11.PubMedPubMedCentralGoogle Scholar
  73. 73.
    Agarwal N, Gala NB, Karimi RJ, Turbin RE, Gandhi CD, Prestigiacomo CJ. Current endovascular treatment options for central retinal arterial occlusion: a review. Neurosurg Focus. 2014;36(1):E7.PubMedCrossRefPubMedCentralGoogle Scholar
  74. 74.
    Noble J, Weizblit N, Baerlocher MO, Eng KT. Intra-arterial thrombolysis for central retinal artery occlusion: a systematic review. Br J Ophthalmol. 2008;92(5):588–93.PubMedCrossRefPubMedCentralGoogle Scholar
  75. 75.
    Aldrich EM, Lee AW, Chen CS, Gottesman RF, Bahouth MN, Gailloud P, et al. Local intraarterial fibrinolysis administered in aliquots for the treatment of central retinal artery occlusion: the Johns Hopkins Hospital experience. Stroke. 2008;39(6):1746–50.PubMedCrossRefPubMedCentralGoogle Scholar
  76. 76.
    Hattenbach LO, Kuhli-Hattenbach C, Scharrer I, Baatz H. Intravenous thrombolysis with low-dose recombinant tissue plasminogen activator in central retinal artery occlusion. Am J Ophthalmol. 2008;146(5):700–6.PubMedCrossRefPubMedCentralGoogle Scholar
  77. 77.
    Nowak RJ, Amin H, Robeson K, Schindler JL. Acute central retinal artery occlusion treated with intravenous recombinant tissue plasminogen activator. J Stroke Cerebrovasc Dis. 2012;21(8):913.e5–8.CrossRefGoogle Scholar
  78. 78.
    Arnold M, Koerner U, Remonda L, Nedeltchev K, Mattle HP, Schroth G, et al. Comparison of intra-arterial thrombolysis with conventional treatment in patients with acute central retinal artery occlusion. J Neurol Neurosurg Psychiatry. 2005;76(2):196–9.PubMedPubMedCentralCrossRefGoogle Scholar
  79. 79.
    Hwang G, Woo SJ, Jung C, Park KH, Hwang JM, Kwon OK. Intra-arterial thrombolysis for central retinal artery occlusion: two cases report. J Korean Med Sci. 2010;25(6):974–9.PubMedPubMedCentralCrossRefGoogle Scholar
  80. 80.
    Biousse V, Calvetti O, Bruce BB, Newman NJ. Thrombolysis for central retinal artery occlusion. J Neuroophthalmol. 2007;27(3):215–30.PubMedCrossRefGoogle Scholar
  81. 81.
    Mercier J, Kastler A, Jean B, Souteyrand G, Chabert E, Claise B, et al. Interest of local intra-arterial fibrinolysis in acute central retinal artery occlusion: clinical experience in 16 patients. J Neuroradiol. 2015;42(4):229–35.PubMedCrossRefGoogle Scholar
  82. 82.
    Schumacher M, Schmidt D, Jurklies B, Gall C, Wanke I, Schmoor C, et al. Central retinal artery occlusion: local intra-arterial fibrinolysis versus conservative treatment, a multicenter randomized trial. Ophthalmology. 2010;117(7):1367–75.e1.PubMedCrossRefGoogle Scholar
  83. 83.
    Chen CS, Lee AW, Campbell B, Lee T, Paine M, Fraser C, et al. Efficacy of intravenous tissue-type plasminogen activator in central retinal artery occlusion: report from a randomized, controlled trial. Stroke. 2011;42(8):2229–34.PubMedCrossRefGoogle Scholar
  84. 84.
    Biousse V. Thrombolysis for acute central retinal artery occlusion: is it time? Am J Ophthalmol. 2008;146(5):631–4.PubMedPubMedCentralCrossRefGoogle Scholar
  85. 85.
    Egan RA, Van Stavern R. Should patients with acute central retinal artery occlusion be treated with intra-arterial t-PA? J Neuroophthalmol. 2015;35(2):205–9.PubMedCrossRefGoogle Scholar
  86. 86.
    Dumitrascu OM, Shen JF, Kurli M, Aguilar MI, Marks LA, Demaerschalk BM, et al. Is intravenous thrombolysis safe and effective in central retinal artery occlusion? A critically appraised topic. Neurologist. 2017;22(4):153–6.PubMedCrossRefGoogle Scholar
  87. 87.
    Preterre C, Godeneche G, Vandamme X, Ronziere T, Lamy M, Breuilly C, et al. Management of acute central retinal artery occlusion: intravenous thrombolysis is feasible and safe. Int J Stroke. 2017;12(7):720–3.  https://doi.org/10.1177/1747493016687578.CrossRefPubMedGoogle Scholar
  88. 88.
    Plant GT, Landau K. Thrombolysis for central retinal artery occlusion. J Neurol Neurosurg Psychiatry. 2005;76(2):160–1.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Michael Dattilo
    • 1
  • Valérie Biousse
    • 1
    • 2
    Email author
  • Klara Landau
    • 4
  • Nancy J. Newman
    • 2
    • 3
    • 5
  1. 1.Department of OphthalmologyEmory University School of MedicineAtlantaUSA
  2. 2.Department of NeurologyEmory University School of MedicineAtlantaUSA
  3. 3.Department of Neurologic SurgeryEmory University School of MedicineAtlantaUSA
  4. 4.Department of OphthalmologyUniversity Hospital and University of ZurichZurichSwitzerland
  5. 5.Department of Neurologic SurgeryEmory University School of MedicineAtlantaUSA

Personalised recommendations