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Advances in
eISSN: 2377-4290

Ophthalmology & Visual System

Editorial Volume 7 Issue 1

Ischemic Maculopathy: Anoccult Cause of an Irreversible Visual Loss

Burak Turgut

Department of Ophthalmology, Firat University, Turkey

Correspondence: Burak Turgut, Associate Professor of Ophthalmology, Firat University, Faculty of Medicine, Department of Ophthalmology, 23119, Elazig, Turkey, Tel +904242333555

Received: May 17, 2017 | Published: May 18, 2017

Citation: Turgut B (2017) Ischemic Maculopathy: Anoccult Cause of an irreversible Visual Loss. Adv Ophthalmol Vis Syst 7(1): 00206 DOI: 10.15406/aovs.2017.07.00206

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Keywords

ischemic maculopathy, macular ischemia, causes, irreversible visual loss

Editorial

In this editorial, I aimed to summarize the ischemic maculopathy (IM) or macular ischemia as a cause of irreversible visual loss because, to date, there is no successful treatment method for this fundus angiographic entity. Ischaemic maculopathy is a vision-threatening disorder because it does not respond to treatment and it causes severe irreversible visual loss. In IM, ischemia can occur in both the retina excluding macula and the macula. The microvascular changes including the breakdown of capillary walls and/or enlargement or blockage of capillaries located near the fovea and the loss of capillaries in the macula are responsible for maculopathy. IM can occur with or without macular edema. It causes painless and gradually severe visual loss in color and sharp vision.1‒8

Ischemic maculopathy is characterized by as enlarged or irregular FAZ (foveal avascular zone), the loss of perfusion to the capillary network surrounding the FAZ, the presence of FAZ abnormalities, capillary nonperfusion areas in the macula and the presence of microaneurysms at the border of FAZ due to perifoveal capillary occlusion in fundus angiography. IM is not caused by increased by vascular leakage; it is induced by microvascular blockage and enlargement, with capillary loss and adjacent edema.1‒8 The detection of IM is extremely difficult without the use of fundus angiography. If the visual loss is not explained ophthalmoscopically or optical coherence tomographically, especially in a diabetic patient, IM is usually responsible for unexplained visual loss, even if the clinical stage of the disease is early or mild.1‒8 Ischaemic maculopathy can occur in non-proliferative or proliferative diabetic retinopathy (DR), retinal arterial or venous occlusion, retinal arteritis, retinopathy of prematurity (ROP), ocular ischemic syndrome, talc retinopathy, proliferative or non-proliferative diabetic retinopathy, pars planitis, Sarcoidosis, cytomegalovirus retinitis caused by AIDS, familial exudative vitreoretinopathy, Eales’ disease involving the macula.5‒20 Additionally, it has been reported that it can be developed following intravitreal antivascular endothelial growth factor injection.21,22 However, it can also develop in the idiopathic form.23 The common causes of IM have been given in Table 1. The area of FAZ obtained optical coherence tomography angiography and fluorescein angiography ranges between 0.3-0.5 mm in healthy subjects. The measurement of FAZ area and the evaluation of FAZ integrity are very important because the enlargement of FAZ precedes the occurrence of microaneurisms and the diabetic retinopathy in this stage can be reversed.24,25 Ischemic maculopathy is an ophthalmoscopically occult maculopathy if there is no associated with cotton wool spots. Thus, the evaluation of FAZ in the cases with clinically and ophthalmoscopically unexplained visual loss is critical for both early treatment and prophylaxis.

The causes of ischemic maculopathy or macular ischemia

Nonproliferative or proliferative diabetic retinopathy

Retinal arterial or venous occlusion/obstruction

Embolic maculopathy (Talc retinopathy)

Ocular ischemic syndrome

Sarcoidosis

Pars planitis

Retinopathy of prematurity

Familial exudative vitreoretinopathy

Eales’ disease involving the macula

Cytomegalovirus Retinitis in Patients with AIDS

Intravitreal antivascular endothelial growth factor injection

Retinal vasculitis (especially arteritis)

Idiopathic

Table 1 The common causes of ischemic maculopathy or macular ischemia5‒23

Acknowledgments

None.

Conflicts of interest

The authors declare there are no conflicts of interest.

References

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