• Yu-Jie Jia, Hong-Bo Liu, Yuan Qin, Jing-Hui Liu, Fa-Li Jia, Han Zhang, Jia-Hao Li, and Ying-Jun Li.
• Department of Ophthalmology, Fuyang People's Hospital of Anhui Medical University, Fuyang, Anhui, China.
• Medicine (Baltimore). 2022 Nov 11; 101 (45): e31204e31204.

RationaleCentral retinal artery occlusion (CRAO) sparing the cilioretinal artery (CLRA) with severe subretinal fluid and non-characteristic cherry-red spot is uncommon. In the present case, the patient received an intravitreal injection of anti- vascular endothelial growth factor, which is very rare.Patient ConcernsA 59-year-old man underwent vitrectomy of the left eye for diabetic retinopathy and vitreous hemorrhage. Six months after the operation, the patient presented with sudden painless visual-acuity decline in his left eye and was diagnosed with CRAO; his best corrected visual acuity was weak light perception. Whole retinal edema was seen on the fundus, and macular gray retinal opacification was present without a characteristic cherry-red spot. Optical coherence tomography revealed subretinal fluid (SRF) in the papillomacular bundle and inner retinal thickening. Fundus fluorescein angiography confirmed that the central retinal artery was not filled at 40 seconds and that the CLRA supplied a part of the macular area. Eight months after the second intravitreal injection of ranibizumab, Optical coherence tomography showed a significant reduction in inner retinal hyperreflectivity and the thickness of the nasal macular retina. The SRF was clearly absorbed, and the visual acuity improved to 1.1 logMAR units.DiagnosisAtypical CRAO.InterventionsThe patient was treated with intravitreal injection of anti-VEGF in his left eye. The thickness of the nasal macular retina decreased.OutcomesThe SRF was clearly absorbed, and the patient's visual acuity significantly improved.LessonsWhen CRAO occurs in patients with diabetic retinopathy sparing the CLRA, the non-characteristic cherry-red spot may be due to macular inner retinal edema, SRF and other factors. According to the patient's condition, anti-vascular endothelial growth factor can be administered as appropriate to inhibit choroidal neovascularization, reduce SRF in the macular retina, and save some vision.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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