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Retinal artery occlusion (RAO) results in painless, catastrophic vision loss in a period of seconds. Optical coherence tomography angiography (OCTA) can image retinal microcirculation, which is helpful to evaluate treatment response during the follow-up period. Using a single case with central RAO, we report its retinal perfusion changes before and after treatment using OCTA.A 36-year-old Chinese man came to our clinic with a sudden, painless loss of vision (hand motion) in his left eye. A vasodilator (nicotinic acid) was used as the primary treatment. OCTA imaging and a visual field examination were performed to assess the retinal perfusion changes before and after treatment.Retinal artery occlusion was considered.This patient was treated with an inhaled oxygen-carbon dioxide mixture, nicotinic acid tablets (100 mg) taken orally twice a day, and intravenous infusion of nicotinic acid injections (60 mg) combined with 0.9% sodium chloride injections (100 ml) once a day for vasodilation.After treatment and 9 months of follow-up, the vessel density of the left eye at the 9-month follow-up appointment was improved in all quadrants.Retinal edema and retinal atrophy were observed at the RAO onset and several months later, respectively. However, macular perfusion gradually increased after treatment. The timely administration of a vasodilator and the presence of the cilioretinal artery play important roles in the prevention of profound vision loss.