Cilioretinal artery occlusion is an uncommon retinal vascular emergency that can cause acute monocular visual loss, particularly when the macular region is involved. Non-arteritic anterior ischemic optic neuropathy is another ischemic disorder involving the optic nerve head and is usually associated with optic disc edema and sudden painless visual impairment. Although both conditions involve vascular territories related to the posterior ciliary circulation, the temporal and pathophysiological relationship between cilioretinal artery occlusion and optic nerve head ischemia remains incompletely defined. This case describes a 62-year-old woman with poorly controlled type 2 diabetes mellitus who presented with acute painless visual loss in the right eye. Initial fundus examination showed optic disc pallor and edema, grayish-white retinal edema extending from the optic disc to the macular region, macular involvement, and arterial attenuation. Multimodal ophthalmic evaluation, including fundus photography, Humphrey visual field testing, optical coherence tomography, visual evoked potential testing, and fundus fluorescein angiography, supported a diagnosis of cilioretinal artery occlusion with concurrent and progressive optic nerve head ischemic involvement, clinically consistent with suspected non-arteritic anterior ischemic optic neuropathy. Because the time window for thrombolysis had passed, conservative management for retinal arterial occlusion was initiated. After progression of optic disc edema and angiographic evidence of optic nerve head leakage, parabulbar triamcinolone was administered after consideration of systemic steroid-related risks. Partial reduction of optic disc edema and limited visual improvement were observed during follow-up; however, the single-case design and concurrent treatments preclude any conclusion regarding treatment efficacy. This case emphasizes that optic disc changes in cilioretinal artery occlusion should be monitored dynamically and interpreted using multimodal imaging rather than assumed to represent a fixed sequential diagnostic pattern.

Ocular ischemic syndrome (OIS) is a vision-threatening disorder characterized by retinal ischemia, oxidative stress, and inflammation. In this study, the protective effects of anakinra, an interleukin-1 receptor antagonist, were investigated and compared with those of tocilizumab, an interleukin-6 receptor antagonist. Twenty-four male Wistar rats were randomly assigned to four groups (n = 6 per group): sham-operated (SG), carotid artery clamping/unclamping (CUG), anakinra-treated carotid artery clamping/unclamping (ACUG), and tocilizumab-treated carotid artery clamping/unclamping (TCUG). An experimental ocular ischemic injury model induced by transient bilateral common carotid artery occlusion was established by transient bilateral common carotid artery clamping followed by reperfusion. Retinal tissues were analyzed for malondialdehyde (MDA), total glutathione (tGSH), superoxide dismutase (SOD), catalase (CAT), tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), and interleukin-6 (IL-6) levels, and histopathological examinations were performed. OIS markedly increased MDA, TNF-α, IL-1β, and IL-6 levels while significantly decreasing tGSH, SOD, and CAT activities. Both anakinra and tocilizumab attenuated oxidative stress and inflammatory responses; however, anakinra produced notably greater improvements in MDA, tGSH, SOD, and CAT levels. Histopathological evaluation demonstrated that both treatments reduced retinal injury, edema, vascular congestion, and inflammatory cell infiltration. Although retinal architecture appeared slightly better preserved in the anakinra-treated group, histopathological scores were comparable between the treatment groups. These findings suggest that anakinra may attenuate oxidative and inflammatory retinal damage in this experimental ocular ischemic injury model and may provide greater biochemical protection than tocilizumab, whereas histopathological protection was comparable between treatments. Nevertheless, further experimental and clinical studies are required to confirm these findings.

Purtscher-like retinopathy is a rare retinal microangiopathy characterised by sudden visual loss, cotton wool spots, retinal whitening and variable retinal haemorrhage in the absence of trauma. Giant cell arteritis is an ophthalmic emergency that usually presents with ischaemic optic neuropathy or retinal arterial occlusion or choroidal ischaemia; however, in very rare cases, it may mimic Purtscher-like retinopathy. We report the case of a 60-year-old man who presented with sudden painless vision loss in the left eye. Fundus examination showed marked optic disc oedema, cotton wool spots, arterial narrowing and multiple discrete white retinal lesions in the posterior pole. Optical coherence tomography demonstrated inner retinal thickening and hyperreflectivity, whereas fluorescein angiography revealed markedly delayed retinal perfusion, capillary nonperfusion, branch retinal arterial occlusion, nasal/inferotemporal choroidal hypoperfusion and optic disc hyperfluorescence. Her erythrocyte sedimentation rate was 52 mm/h, and temporal artery biopsy confirmed giant cell arteritis. The patient received intravenous methylprednisolone followed by oral corticosteroids. Visual acuity did not improve over the first week, although optic disc oedema decreased. This case should not be interpreted as isolated or pure Purtscher-like retinopathy; rather, it represents Purtscher-like retinal findings occurring within a broader giant cell arteritis-related retinal and choroidal ischaemic process. The report broadens the spectrum of ocular presentations of giant cell arteritis and highlights the need to consider occult giant cell arteritis in the differential diagnosis of older patients with sudden painless visual loss and retinal ischaemic signs suggestive of Purtscher-like retinopathy.

Central retinal artery occlusion (CRAO) is a vision-threatening ophthalmic emergency requiring rapid recognition and evaluation. Although embolic etiologies predominate, low-flow ischemia related to hemodynamic instability represents an underrecognized mechanism. We report the case of a 66-year-old woman with end-stage renal disease (ESRD) on hemodialysis who experienced recurrent transient right-eye visual symptoms near the end of dialysis sessions. She had chronic intradialytic hypotension, with systolic blood pressures ranging from 90 to 100 mmHg and post-dialysis pressures averaging 90/50 mmHg. Ophthalmologic examination demonstrated markedly reduced visual acuity in the right eye, normal intraocular pressures, full extraocular movements, and full confrontation visual fields bilaterally. Dilated fundus examination showed diffuse retinal pallor with a characteristic cherry-red spot, consistent with CRAO. Comprehensive evaluation, including carotid Doppler ultrasound, CT angiography of the head and neck, brain magnetic resonance imaging, and transthoracic echocardiography, revealed no embolic or large-vessel source. The event was attributed to recurrent intradialytic systemic hypoperfusion superimposed on impaired microvascular autoregulation from diabetes and cardiovascular disease. Management included antiplatelet therapy and optimization of intradialytic blood pressure, after which no further visual ischemic episodes were reported. This case highlights intradialytic hypotension as a potential nonembolic cause of CRAO in patients undergoing hemodialysis and underscores the importance of early recognition and hemodynamic optimization in this high-risk population.

Retinoblastoma (Rb) is the most common primary intraocular malignancy in children. Intra-arterial chemotherapy (IAC), often termed ophthalmic artery chemosurgery, has emerged as an important globe-preserving treatment modality for advanced intraocular Rb. We focused on technical delivery, clinical indications, regimen selection, oncological safety, globe salvage, functional preservation and complications. Current evidence indicates that, in appropriately selected patients and experienced centers, IAC can improve local tumor control and globe salvage while reducing systemic toxicity when compared with intravenous chemotherapy. While melphalan remains the backbone chemotherapeutic agent, escalation to topotecan and/or carboplatin should be guided by tumor burden, vitreous or subretinal seeding, prior treatment response, evidence strength and expected functional potential. Functional preservation should be defined as more than anatomical globe retention; it should include age-appropriate visual acuity or fixation, electroretinography, macular and foveal integrity, avoidance of retinal or choroidal ischemia, amblyopia management, binocular visual development and quality-of-life outcomes. IAC remains associated with ocular and vascular risks, including retinal or choroidal ischemia, cataract formation and ophthalmic artery stenosis or occlusion. Future multicenter prospective studies should use standardized outcome measures, scenario-specific recommendations and molecular monitoring, including aqueous humor cell-free DNA analysis, to refine patient selection and support function-preserving care.

'Time is brain' is an important concept in ischaemic brain stroke, where expeditious intervention is essential for the preservation of neural tissue. Therapeutic strategies involve the prompt administration of thrombolytic agents and in select circumstances the implementation of mechanical thrombectomy. Central retinal artery occlusion (CRAO) constitutes an ophthalmological emergency and is a form of ischaemic stroke, frequently resulting in profound and irreversible visual impairment. There are currently no universally accepted guidelines delineating the optimal therapeutic time window. In this report, we present the case of a man in his 60s who developed acute, painless monocular vision loss, was rapidly diagnosed with CRAO and subsequently received intravenous tenecteplase and showed near-complete visual recovery within 1 week. This case demonstrates the importance of early interdisciplinary collaboration between ophthalmology and stroke teams and the need for establishment of standardised clinical pathways for the management of CRAO.

Background: This study aimed to evaluate longitudinal changes in retinal layers, retinal vessel diameters, and choroidal thickness using optical coherence tomography (OCT) in patients with central retinal artery occlusion (CRAO). Methods: This retrospective study included 35 patients (70 eyes) diagnosed with unilateral CRAO between 1 January 2020 and 5 January 2024. Unaffected fellow eyes served as internal controls. OCT-based macular segmentation, retinal arterial and venous diameter measurements, and subfoveal and peripapillary choroidal thickness were assessed in the acute phase (<24 h) and at 1-month and 6-month follow-up visits. Subgroup analyses compared patients who received hyperbaric oxygen therapy (HBOT) with those who did not. Statistical analyses included t-tests, Mann-Whitney U, Wilcoxon signed-rank, and chi-square tests. Results: Retinal arterial and venous diameters showed significant narrowing during follow-up (arteries: 77.91 ± 11.77 µm to 70.74 ± 15.12 µm; veins: 130.94 ± 22.54 µm to 118.57 ± 20.61 µm; both p < 0.05). Macular segmentation demonstrated marked thinning of the inner retinal layers, most prominently in the retinal nerve fiber layer and ganglion cell layer (40.09 ± 26.86 to 12.51 ± 4.99 µm and 61.20 ± 25.83 to 24.26 ± 12.11 µm, respectively; both p = 0.001). Subfoveal choroidal thickness progressively decreased over time (from 206.40 ± 34.91 µm to 178.86 ± 28.28 µm, p = 0.009). Peripapillary choroidal thickness increased across all quadrants at 6 months, most consistently in the inferior quadrant (p = 0.001). No significant differences in retinal or choroidal parameters were observed between HBOT-treated and non-treated patients. All cases exhibited persistent vascular occlusion without reperfusion. Conclusions: CRAO is characterized by progressive inner retinal atrophy, retinal vessel narrowing, and distinct temporal changes in choroidal morphology. The relative preservation and subsequent increase in peripapillary choroidal thickness during follow-up suggest dynamic choroidal involvement despite persistent occlusion. OCT-based macular segmentation and retinal vessel analysis provide objective biomarkers for longitudinal structural assessment in CRAO. By jointly quantifying retinal layer, retinal vascular, and choroidal remodeling, these findings may also provide reference data for future studies of structural evolution in non-reperfused CRAO.