To investigate the retinal and choroidal changes using spectral-domain optical coherence tomography (SD OCT) and to identify factors associated with visual outcome in eyes with central retinal artery occlusion (CRAO).

Retrospective, observational case series.

setting: Institutional. patients: A total of 134 eyes diagnosed with acute (symptom onset ≤ 7 days) nonarteritic CRAO examined with SD OCT at baseline and follow-up visits. observations: Based on funduscopic and angiographic findings, CRAO was categorized into 3 stages: incomplete, subtotal, and total. Abnormal morphologic features were evaluated from SD OCT images. Central macular thickness (CMT), inner and outer retinal thicknesses, and subfoveal choroidal thickness (SFCT) were measured. The clinical and SD OCT features were correlated with the final best-corrected visual acuities (BCVA). main outcome measures: Retinal and choroidal thickness and BCVA.

Features of SD OCT at the initial presentation included inner and outer retinal thickening. At baseline, the frequency of inner and outer retinal thickening and macular edema (CMT > 300 μm) differed significantly among CRAO stages (all P < .05). SFCT in eyes with total CRAO was significantly thinner compared with that of the contralateral eyes (P = .009). A higher CRAO stage was associated significantly with macular edema at baseline (P < .001) and retinal thinning at the final visit (P = .010). Baseline CMT was correlated significantly with final BCVA (P < .001). Multivariate logistic regression analyses revealed that severe vision loss (BCVA < 20/200) was associated significantly with CRAO stage (P < .001) and baseline CMT (P = .005).

CRAO resulted in inner and outer retinal thickening in the acute stages and subsequent atrophic changes in the inner and outer retina. SD OCT may be a useful noninvasive imaging tool for diagnosis, staging, and prognosis of CRAO.