Abstract T P191: Emergent Management of Acute Retinal Ischemia

Abstract

Background: Retinal artery occlusion (RAO) is characterized by acute monocular visual loss (AMVL). It is unclear how intravenous tissue-type plasminogen activator (IV tPA) affects this stroke subset. Other interventions have been explored, but clear benefit of these has yet to be demonstrated. Given the emergent nature of RAO, and absent uniform guidelines, we investigated the incidence of and approach to management of RAO at our institution. Methods: We retrospectively reviewed medical records at the University of California, San Diego from 1992 through December 2012. Charts were retrieved via the ICD-9 codes 362.30-362.37 (retinal vascular occlusion). We excluded patients with monocular visual loss for more than 24 hours before presentation, spontaneous symptom resolution, traumatic visual loss, and patients with other associated acute neurologic symptoms. We captured time from presentation to initial physician encounter, time to consultant evaluation, consultant specialty, and whether time was <4.5 hours since last known well. Results: Of 132 patient charts reviewed, 111 were excluded as per criteria above (>24 hours = 55, spontaneous resolution = 50, trauma = 2, other symptoms = 4). We identified 16 patients with AMVL: 11 with central RAO, 2 with branch RAO, 1 with temporal arteritis, and 1 with nonarteritic anterior ischemic optic neuropathy. Ophthalmology was consulted first in 12, Neurology and Interventional Radiology (IR) in 2 patients each. Mean time from presentation to consultant evaluation was 282 minutes; for Ophthalmology 308 minutes, for Neurology 90 minutes and for IR 315 minutes. Five patients presented within 4.5 hours from their last known well time; one received IV tPA. Conclusion: Acute central RAO is uncommon. Ophthalmology is most frequently consulted for RAO, but without a designated acute treatment plan, most patients are seen relatively late. Future studies must include predefined treatment and faster assessment algorithms and include multiple study centers to recruit patients.