Central Retinal Artery Occlusion Patients Research Articles

Comparative efficacy of conservative, hyperbaric oxygen, and endovascular retinal surgery approaches in central retinal artery occlusion.

To assess and compare the efficacy of three treatment modalities for central retinal artery occlusion (CRAO): conservative therapy, hyperbaric oxygen therapy (HBOT), and endovascular retinal surgery (ERS). We retrospectively analyzed the cases of CRAO patients treated at the Toyama University Hospital. Their age range was 44-87years; a balanced gender distribution was observed. The conservative therapy group included 13 eyes (6 males, 7 females, average age 74years). HBOT group: 11 eyes from 10 patients (5 males, 5 females, average age 70years). ERS group: 10 eyes (7 males, 3 females, average age 74years). The treatments were as follows. Conservative group: ocular massage and sublingual nitroglycerin. HBOT: 60-min sessions at 2 atmospheres. ERS: vitrectomy followed by tissue plasminogen activator injection using a 47-ga. microneedle. Visual acuity was assessed using logMAR units, with statistical analyses by paired t-test, Kruskal-Wallis test, and Mann-Whitney U-test with Bonferroni correction. The conservative group showed a slight visual acuity change from 1.96 ± 0.53 to 1.88 ± 0.56 (p = 0.56). The HBOT group exhibited a significant improvement from 1.79 ± 0.80 to 1.28 ± 0.81 (p = 0.007). The ERS group displayed the most substantial improvement, with scores moving from 1.98 ± 0.36 to 0.68 ± 0.49 (p = 0.0000413). The ERS group's outcomes were significantly superior to those of the other groups. These results suggest that while conservative treatment may not be sufficient, both HBOT and endovascular retinal surgery show promise, with the latter demonstrating the most significant improvement.

Outcomes of Hyperbaric Oxygen Treatment for Central Retinal Artery Occlusion: A Single Center Experience

PurposeTo describe the outcomes of hyperbaric oxygen therapy (HBOT) for patients with central retinal artery occlusion (CRAO) at a single tertiary care center. DesignRetrospective clinical cohort study. MethodsMedical records of all patients diagnosed with CRAO who received HBOT at Mayo Clinic in Rochester, Minnesota from 1/1/2009 to 12/31/2020 were reviewed to confirm diagnosis, time from onset to presentation, exam findings, treatments, and follow-up data. Main outcome measures included final visual acuity (VA) and number of lines of improvement. ResultsThere were 41 patients diagnosed with CRAO who received HBOT during the 12 year study period. Median time from symptom onset to HBOT treatment was 9.5 hours (interquartile range [IQR] 6.5, 14.0 hours), and patients received a median of 4 HBOT sessions (IQR 2.5, 6.0 sessions). There were 20 patients who received HBOT within 9 hours, 14 (70%) of which had clinically meaningful improvement in VA of ≥0.3 logMAR. In comparison, of the 21 patients treated after 9 hours, 6 (28.6%) had VA improvement of ≥0.3 logMAR (p=0.008). For all patients, the median logMAR VA at presentation was 2.00 (IQR 1.70, 2.30) and the median logMAR VA at follow-up was 1.94 (IQR 1.00, 2.00) (p<0.001), with median lines of improvement of 3.0 (IQR 0.0, 7.0). For patients treated within 9 hours, the median logMAR VA at presentation was 2.00 (IQR 1.93, 2.30) and the median logMAR VA at follow-up was 1.70 (IQR 0.54, 2.00). Patients treated within 9 hours had statistically significant greater median lines of VA improvement than cases that were treated after >9 hours from symptom onset at 5.9 (IQR 3.0, 10.0) and 0.0 (IQR 0.0, 3.0), respectively (p<0.001). There was no difference in VA recovery associated with specific retinal exam findings such as cherry-red spot (p=0.22) and cilioretinal artery perfusion (p=0.36) compared to patients without those findings. ConclusionThere was a statistically significant improvement in VA after HBOT treatment in CRAO patients among patients that received early HBOT, with patients receiving the most benefit when receiving treatment within 9 hours. Randomized control trials in patients with CRAO are required to confirm the efficacy of HBOT.

Multimodal Imaging Characteristics and Correlation to Outcomes in Patients with CRAO Presenting to a Large Academic Center

PurposeTo characterize a large modern cohort of patients with central retinal artery occlusion (CRAO) by describing presenting features and outcomes relating to manually segmented optical coherence tomography (OCT) features, angiographic reperfusion, and visual recovery. DesignRetrospective clinical cohort study. MethodsPatients with CRAO (ICD-10: H34.1) initially presenting to a tertiary referral center between January 2017 and December 2021 were included. Demographics, eye exam findings, fundus photographs, OCT, and fluorescein angiography (FA) were analyzed. Main outcome measures included total and inner retinal thickness on macular OCT, reperfusion, visual outcomes, and development of neovascularization. Results145 eyes of 144 patients with mean age at of 69.4±13.6 years were included. The mean time to presentation was 1.6±4.2 days, with 19% examined within 4.5 hours and 26% within 6 hours of vision loss. 19% had cilioretinal artery (CLRA) sparing. Mean initial visual acuity (VA) was 1.68±1.10 LogMAR (CLRA sparing) compared to 2.53±0.58 LogMAR (non-CLRA sparing), P<0.001. 32% had elevated inflammatory makers. Out of 47 eyes with final fluorescein angiography, one-third showed some reperfusion. Final vision was 1.40±1.16 LogMAR (CLRA sparing) compared to 2.46±0.81 (non-CLRA sparing), P<0.001. A third of patients improved in VA in both groups, 27% of patients gained more than 2 lines of vision in the CLRA sparing group and 36% in the non-CLRA sparing group. 17% improved to better than 20/200 in CLRA-sparing and 4% in non-CLRA sparing. 11% developed neovascularization all in non-CLRA sparing. In a multiple linear regression, VA at presentation was associated with regaining vision of 2 lines or more (OR=2.603, P=0.007). OCT showed progressive thinning over time, reaching lowest measurements at 6 months, and stabilizing thereafter. ConclusionsIn this modern cohort of acute CRAO patients, presentation to a tertiary facility within 12 hours of symptoms was seen in almost half of the patients. Final visual acuity improved in almost a third of the patients, however, vision better than the legal blindness limit was rare (∼5%). Interestingly, a third of patients had some mild elevation of systemic inflammatory markers. Better visual acuity at presentation was associated with visual gain, while baseline OCT values had poor correlation with final outcome.

The association between triglyceride-glucose atherogenic predictor index and central retinal artery occlusion

Purpose: Central retinal artery occlusion (CRAO) is an acute ischemic event causing severe visual loss and is a precursor to further cerebrovascular and cardiovascular events. The triglyceride-glucose index (TyG) indicates insulin resistance in healthy individuals. Numerous research links the TyG index to metabolic syndrome, hypertension, and new-onset diabetes. Recent research also suggests its role as a sign of atherosclerosis in cardiovascular diseases, with potential clinical significance in assessing vascular damage. In this study, the relationship between CRAO and TyG index was evaluated. Materials and Methods: This case-control study involved 116 adults (50 CRAO patients and 66 control subjects without chronic eye diseases) at our hospital from January 2018 to March 2023. The TyG index was formulated as ln[fasting TG (mg/dL) × fasting plasma glucose (mg/dL)/2]. Results: The CRAO group had a mean age of 65.0±14.7 years, with 27 (55.1 % 54) females. The control group had a mean age of 61.2±12.1 years, with 32 (48.5) females. The mean TyG index was 9.05±0.7 in the CRAO group and 8.7±0.7 in controls, a statistically significant difference. Univariate regression analysis showed an association between the TyG index and CRAO (OR=2.04; CI: 1.11-3.73). This association remained significant in multivariate logistic regression analysis (OR=1.88; CI: 1.01-3.50). Conclusion: This study found a significantly higher mean TyG index, an atherogenic indicator, in CRAO patients compared to controls.

Relation between peripheral blood inflammatory indices and severity of central retinal artery occlusion.

Central retinal artery occlusion (CRAO) has been identified as an acute emergency resulting in vision loss, with its pathogenesis potentially involving systemic inflammation and abnormal lipid metabolism. Over recent years, it has been established that peripheral blood inflammatory indices, including the neutrophil-to-lymphocyte ratio (NLR), the systemic immunoinflammatory index (SII), and the monocyte-to-high-density lipoprotein ratio (MHR), play significant roles in assessing systemic inflammation and lipid metabolism. However, the role of these indices in assessing the severity of CRAO has rarely been explored. This study aimd to investigate the relationship between these inflammatory indices and the severity of CRAO. This was a retrospective clinical study with a total of 49 CRAO patients and 50 age- and sex-matched controls involved. The patients with CRAO were divided into three groups (13 with incomplete CRAO, 16 with subtotal CRAO and 20 with total CRAO). Data were compared across these groups, and additionally, correlation analysis, restricted cubic spline plots, and receiver operating characteristic curve analysis were performed. The values of NLR, SII and MHR were significantly higher in the CRAO group compared to controls (NLR: 2.49(1.71,3.44) vs 1.60(1.24,1.97), P<0.001; SII: 606.46(410.25,864.35) vs 403.91(332.90,524.31), P=0.001; MHR: 0.33(0.26,0.44) vs 0.25(0.21,0.34), P<0.001). MHR was also significantly higher in total CRAO than in incomplete CRAO and subtotal CRAO (0.41(0.32,0.60) vs 0.29(0.21,0.43), P=0.036; 0.41(0.32,0.60) vs 0.29(0.23,0.38), P=0.017). Significant positive associations were found between MHR, NLR, SII and both the incidence (all P<0.001) and severity (P<0.001, P<0.001, P=0.003, respectively) of CRAO. MHR had a linear relationship with both the occurrence and severity of CRAO (P-overall=0.013, P-non-linear=0.427 and P-overall=0.013, P-non-linear=0.825). Combining MHR and NLR significantly improved diagnostic efficacy for CRAO and total CRAO, with area under the curve of 0.816 and 0.827, respectively, compared to using MHR alone (0.705 and 0.816). Elevated levels of peripheral blood NLR, SII, and MHR are positively associated with CRAO incidence, highlighting their potential as early predictive markers. The combined NLR and MHR index further enhances diagnostic accuracy and may facilitate timely assessment of CRAO severity by ophthalmologists and internists.

Spontaneous brain activity in patients with central retinal artery occlusion: a resting-state functional MRI study using machine learning.

Central retinal artery occlusion (CRAO) is a serious eye condition that poses a risk to vision, resulting from the blockage of the central retinal artery. Because of the anatomical connection between the ocular artery, which derives from the internal carotid artery, and the anterior middle cerebral artery, hemodynamic alterations and sudden vision loss associated with CRAO may impact brain functionality. This study aimed to examine alterations in spontaneous neural activity among patients with CRAO by resting-state functional MRI. In addition, we selected the amplitude of low-frequency fluctuation (ALFF) and fractional amplitude of low-frequency fluctuation (fALFF) values as classification features for distinguishing CRAO from healthy controls (HCs) using a support vector machine classifier. A total of 18 patients diagnosed with CRAO and 18 HCs participated in the study. Resting-state brain function images and structural images were acquired from both groups. Aberrant changes in spontaneous brain functional activity among CRAO patients were investigated utilizing ALFF and fALFF analysis methods. Group differences in ALFF/fALFF values were assessed through a two-sample t-test. Subsequently, a machine learning classifier was developed to evaluate the clinical diagnostic potential of ALFF and fALFF values. In comparison to HCs, individuals with CRAO exhibited significantly higher ALFF values in the left cerebellum_6, vermis_7, left superior frontal gyrus, and left inferior frontal gyrus, triangular part. Conversely, the CRAO group displayed notably lower ALFF values in the left precuneus and left median cingulum gyri. Furthermore, higher fALFF values were observed in the left inferior frontal gyrus, triangular part, whereas lower fALFF values were noted in the right cerebellum_Crus2, left precuneus, right angular gyrus, left angular gyrus, right supramarginal gyrus, right superior parietal gyrus, and left precuneus. Utilizing the ALFF/fALFF values, the receiver operating characteristic curves (area under the curve) yielded 0.99 and 0.94 through machine learning analysis techniques. CRAO patients exhibit atypical neural activity in the brain, characterized by ALFF and fALFF values predominantly localized in the frontal, parietal, and cerebellar regions, which are closely linked to visual cognition and motor control impairments. Furthermore, ALFF and fALFF could serve as potential neuroimaging markers beyond the orbit among CRAO.

Analysis of the Effect of Superselective Ophthalmic Artery Thrombolysis for Central Retinal Artery Occlusion

Introduction: The aim of the study was to investigate the clinical efficacy of superselective ophthalmic artery thrombolysis for central retinal artery occlusion (CRAO). Methods: Retrospective study of CRAO patients who attended the Department of Ophthalmology of Affiliated Hospital of Weifang Medical University from January 2022 to July 2023, 138 CRAO patients with onset time of 1–3 days were selected for the study. Among them, 86 patients refused thrombolytic treatment and chose to adopt traditional treatment, which was categorized as the control group; 52 patients adopted superselective ophthalmic artery thrombolytic treatment, which was categorized as the observation group. The visual acuity of the patients treated with traditional modality on the 4th day after the onset of the disease and the visual acuity of the patients treated with superselective ophthalmic artery thrombolysis on the 1st postoperative day were recorded, and the visual acuity improvement after different modalities of treatment was compared between the two groups. Results: In the control group, 77 (89.5%) of the treated patients had no improvement in visual acuity, 9 (10.5%) had improvement, 0 (0.0%) had significant improvement, and the total improvement was 9 (10.5%); in the observation group, 18 (34.6%) of the treated patients had no improvement in visual acuity, 21 (40.4%) had improvement, 13 (25.0%) had significant improvement, and the total improvement was 34 (65.4%). The total improvement rate of treatment in the observation group was 65.4%, which was significantly higher than the 10.5% in the control group, and the difference was statistically significant (p < 0.05). Conclusion: Superselective ophthalmic artery thrombolysis for patients with CRAO is clinically effective, promotes improvement in patient vision, and has a high safety profile.

Risk factors of non-arteritic anterior ischaemic optic neuropathy and central retinal artery occlusion.

To investigate the difference in risk factors between non-arteritic anterior ischaemic optic neuropathy (NAION) and central retinal artery occlusion (CRAO) and develop a predictive diagnostic nomogram. The study included 37 patients with monocular NAION, 20 with monocular CRAO, and 24 with hypertension. Gender, age, and systemic diseases were recorded. Blood routine, lipids, hemorheology, carotid and brachial artery doppler ultrasound, and echocardiography were collected. The optic disc area, cup area, and cup-to-disc ratio (C/D) of the unaffected eye in the NAION and CRAO group and the right eye in the hypertension group were measured. The carotid artery intimal medial thickness (C-IMT) of the affected side of the CRAO group was thicker (P=0.039) and its flow-mediated dilation (FMD) was lower (P=0.049) than the NAION group. Compared with hypertension patients, NAION patients had higher whole blood reduced viscosity low-shear (WBRV-L) and erythrocyte aggregation index (EAI; P=0.045, 0.037), and CRAO patients had higher index of rigidity of erythrocyte (IR) and erythrocyte deformation index (EDI; P=0.004, 0.001). The optic cup and the C/D of the NAION group were smaller than the other two groups (P<0.0001). The diagnostic prediction model showed high diagnostic specificity (83.7%) and sensitivity (85.6%), which was highly related to hypertension, the C-IMT of the affected side, FMD, platelet (PLT), EAI, and C/D. CRAO patients show thicker C-IMT and worse endothelial function than NAION. NAION and CRAO may be related to abnormal hemorheology. A small cup and small C/D may be involved in NAION. The diagnostic nomogram can be used to preliminarily identify NAION and CRAO.

Nationwide Incidence and Trends in Central Retinal Arterial Occlusion Management: A 5000-Patient Analysis.

Central retinal artery occlusion (CRAO) is a rare and visually debilitating vascular condition characterized by sudden and severe vision loss. CRAO is a compelling target for intravenous alteplase (tPA) and endovascular mechanical thrombectomy (MT) due to pathophysiological similarities with acute ischemic stroke; however, the utility of these interventions in CRAO remains dubious due to limited sample sizes and potential risks. To assess usage and outcomes of tPA and MT in CRAO, we queried the National Inpatient Sample database using International Classification of Disease, Ninth and Tenth edition for patients with CRAO and acute ischemic stroke between 2010 and 2019. Our cohort of 5009 CRAO patients were younger with higher rates of obesity, hypertension, long-term anticoagulant use, and tobacco use compared to acute ischemic stroke patients. CRAO patients had lower rates of tPA administration (3.41% vs 6.21%) and endovascular MT (0.38% vs 1.31%) but fewer complications, including deep vein thrombosis, pneumonia, urinary tract infection, acute kidney injury, and acute myocardial infarction (all P < 0.01). CRAO patients had lower rates of poor functional outcome (31.74% vs 58.1%) and in-hospital mortality (1.2% vs 5.64%), but higher rates of profound blindness (9.24% vs 0.58%). A multivariate regression showed no relationship between tPA and MT and profound blindness, although the limited sample size of patients receiving interventions may have contributed to this apparent insignificance. Further investigation of larger patient cohorts and alternative treatment modalities could provide valuable insights for revascularization therapies in CRAO to optimize visual restoration and clinical outcomes.

Clinical application of multicolor scanning laser ophthalmology in diagnosis and grading of central retinal artery occlusion.

To characterize features of central retinal artery occlusion (CRAO) using multicolor (MC) imaging and to assess the differences in CRAO grading between color fundus photography (CFP) and MC image qualitatively and quantitatively. We conducted a prospective, cross-sectional study in the Department of Ophthalmology of Renmin Hospital of Wuhan University. In total, 86 acute CRAO patients were included. Spectral-domain optical coherence tomography (SD-OCT), CFP, and MC examinations were taken at baseline. Based on the findings of these three examinations, CRAO was divided into three grades (incomplete, subtotal, and total). Based on OCT grading criteria, we qualitatively compared the ability of grading CRAO by CFP and MC. CRAO patient's visual acuity (VA) was obtained from the initial visit. The retinal thickness was measured by SD-OCT. Superficial capillary plexus (SCP) and deep capillary plexus (DCP) were obtained from optical coherence tomography angiography (OCTA) examinations. Quantitative data were compared across the three acute CRAO subgroups and against three examination findings. MC image had significantly higher power of acute CRAO detection than CFP (P = 0.03). In the same group of CRAO patients, there was no significant difference in VA when comparing OCT with the MC grading system or with the CFP grading system (all P > 0.05). Significant differences in VA were found between the three CRAO subgroups only under MC grading (P = 0.016). In incomplete CRAO patients, significant differences were found in central fovea thickness (CFT) when comparing OCT with the CFP grading system (P = 0.019). In the same group of CRAO patients, there was no significant difference in retinal thickness when comparing OCT with the MC grading system (All P > 0.05). Significance differences in CFT (P < 0.001), innermost retinal layer (IMRL; P < 0.01), middle retinal layer (MRL; P < 0.001), and outer retinal layer (ORL; P = 0.021) were found between the three CRAO subgroups by MC grading. Vessel density of SCP showed a statistically increased as the severity of three CRAO subgroups (P = 0.03), whereas DCP did not have significant differences (P = 0.745). Comparisons were made between the OCT grading method and the MC and CFP grading methods; there is no significant difference in vessel density of SCP and DCP (All P > 0.05). The images obtained by MC are superior to those obtained by CFP in CRAO grading, retinal thickness, and vessel density measurement. MC imaging may be more capable of CRAO grading than OCT. We recommend MC imaging to determine CRAO severity to guide disease treatment and predict visual prognosis.

Thrombolysis treatment and multi- disciplinary management of central retinal artery occlusion in comparison with traditional ophthalmological treatment options

<p>The management of central retinal artery occlusion (CRAO) has long been conservative therapy with limited efficacy carried out in ophthalmology departments together with etiolo&shy;gi&shy;cal investigations lacking a standardised protocol. However, CRAO is analogous to ischemic central nervous system stroke and is associated with increased stroke risk, thus, systemic thrombolysis treatment and multidisciplinary management can be beneficial. Since May 2022, at Semmelweis University CRAO patients diagnosed within 4.5 hours are given intravenous thrombolysis therapy and undergo etiologic workup based on current stroke protocols. Here we report our experience with the multidisciplinary, protocol-based management of CRAO in comparison with former non-protocol based ophthalmological conservative treatment.</p>. <p>We reviewed CRAO patients&rsquo; data treated conservatively and with paracentesis within 6 hours at the Department of Ophthalmology between 2013 and 2022 including changes in visual acuity, neurolo&shy;gical and cardiovascular findings compared to those in the thrombolysis project.&nbsp;</p>. <p>Of the 78 patients receiving non-protocol care, visual improvement was seen in 37% with natural course, 47% with conservative treatment and 47% with paracentesis. Four patients had significant carotid stenosis (2 underwent endarterectomy), 1 carotid dissection, 6 cardioembolism and 1 giant cell arteritis. Of the 4 patients within 4,5 hours, 3 gave their consent to the clinical trial and were treated with thrombolysis and underwent a full etiological assessment.&nbsp;<br>2 pa&shy;tients had improved visual acuity, 2 pa&shy;tients had significant carotid stenosis and underwent endarterectomy, 1 patient was started on anticoagulation for newly diagnosed atrial fibrillation.</p>. <p>CRAO patients presenting within 4,5 hours are rare and more patients are needed in our study to establish the efficacy of thrombolysis. However uniform protocollized evaluation helps identifying embolic sources thus, avoiding further and potentially more serious thromboembolic events.</p>.

Peripheral blood transcriptomic analysis identifies potential inflammation and immune signatures for central retinal artery occlusion

Central retinal artery occlusion (CRAO) is an acute retinal ischaemic disease, but early diagnosis is challenging due to a lack of biomarkers. Blood samples were collected from CRAO patients and cataract patients. Gene expression profiles were distinct between arterial/venous CRAO blood (A–V group) and venous CRAO/control blood (V–C group) samples. Differentially expressed genes (DEGs) were subjected to GO and KEGG enrichment analyses. Hub genes were identified by Cytoscape and used to predict gene interactions via GeneMANIA. Immune cell infiltration was analysed by CIBERSORT. More than 1400 DEGs were identified in the A–V group and 112 DEGs in the V–C group compared to controls. The DEGs in both groups were enriched in the ribosome pathway, and those in the V–C group were also enriched in antigen processing/MHC pathways. Network analysis identified ribosomal proteins (RPS2 and RPS5) as the core genes of the A–V group and MHC genes (HLA-F) as the core genes of the V–C group. Coexpression networks showed ribosomal involvement in both groups, with additional immune responses in the V–C group. Immune cell analysis indicated increased numbers of neutrophils and T cells. Ribosomal and MHC-related genes were identified as potential CRAO biomarkers, providing research directions for prevention, diagnosis, treatment and prognosis.

Plasmalogens and Octanoylcarnitine Serve as Early Warnings for Central Retinal Artery Occlusion

Central retinal artery occlusion (CRAO) is a kind of ophthalmic emergency which may cause loss of functional visual acuity. However, the limited treatment options emphasize the significance of early disease prevention. Metabolomics has the potential to be a powerful tool for early identification of individuals at risk of CRAO. The aim of the study was to identify potential biomarkers for CRAO through a comprehensive analysis. We employed metabolomics analysis to compare venous blood samples from CRAO patients with cataract patients for the venous difference, as well as arterial and venous blood from CRAO patients for the arteriovenous difference. The analysis of metabolites showed that PC(P-18:0/22:6(4Z,7Z,10Z,13Z,16Z,19Z)), PC(P-18:0/20:4(5Z,8Z,11Z,14Z)) and octanoylcarnitine were strongly correlated with CRAO. We also used univariate logistic regression, random forest (RF), and support vector machine (SVM) to screen clinical parameters of patients and found that HDL-C and ApoA1 showed significant predictive efficacy in CRAO patients. We compared the predictive performance of the clinical parameter model with combined model. The prediction efficiency of the combined model was significantly better with area under the receiver operating characteristic curve (AUROC) of 0.815. Decision curve analysis (DCA) also exhibited a notably higher net benefit rate. These results underscored the potency of these three substances as robust predictors of CRAO occurrence.

THE ASSOCIATION BETWEEN ATRIAL FIBRILLATION AND CENTRAL RETINAL ARTERY OCCLUSION: A META-ANALYSIS AND SYSTEMATIC REVIEW

Introduction&#x0D; Central retinal artery occlusion (CRAO) is a condition where the central retinal artery is blocked. Atrial Fibrillation (AF) is commonly associated with retinal embolism that originates anywhere between the heart and the ophthalmic artery. This study aims to explore the incidence of AF in CRAO.&#x0D; Methods&#x0D; A systematic search was performed in three databases: Pubmed, EBSCO host, and Proquest. Newcastle-Ottawa Scale was used to assess the risk of bias in the study included.&#x0D; Results&#x0D; Our systematic review comprises six studies, 4 studies included CRAO patients as the study population and AF as the endpoint, and the other 2 studies with CRAO as the endpoint. Meta-analysis of the first group resulted in a significantly favorable AF incident after CRAO with an odds ratio (OR) of 1.46 (95% CI 1.17-1.81, p=0.0007). The second metaanalysis supports CRAO with an OR of 4.86 (95% CI 2.30-10.28, p&lt;0.0001).&#x0D; Discussion&#x0D; Our study indicates that AF is a significant risk factor for CRAO. Extended cardiac monitoring may play a crucial diagnostic role in CRAO patients, and longer-term monitoring (23 years) may be a reasonable option as part of the diagnostic workup. Short-term monitoring alone may fail to detect a significant proportion of patients with underlying AF.&#x0D; Conclusions&#x0D; It is crucial to identify AF in preventing ocular infarction. This study revealed that AF was identified as a risk factor in patients with CRAO and vice versa.

The Association between Atrial Fibrillation and Central Retinal Artery Occlusion: A Meta-Analysis and Systematic Review

Abstract&#x0D; Introduction &amp; Objectives : Central retinal artery occlusion (CRAO) is a condition where the central retinal artery is blocked. Atrial Fibrillation (AF) is commonly associated with retinal embolism that originates anywhere between the heart and the ophthalmic artery. This study aims to explore the incidence of AF in CRAO.&#x0D; Methods : A systematic search was performed in three databases: Pubmed, EBSCO host, and Proquest. Newcastle-Ottawa Scale was used to assess the risk of bias in the study included.&#x0D; Results : Our systematic review comprises six studies, 4 studies included CRAO patients as the study population and AF as the endpoint, and the others 2 studies with CRAO as the endpoint. Meta- analysis of the first group resulted in a significantly favorable AF incident after CRAO with an odds ratio (OR) of 1.46 (95% CI 1.17-1.81, p=0.0007). The second meta-analysis supports CRAO with an OR of 4.86 (95% CI 2.30-10.28, p&lt;0.0001).&#x0D; Conclusion : It is crucial to identify AF in preventing ocular infarction. This study revealed that AF was identified as a risk factor in patients with CRAO and vice versa.

Endothelial Dysfunction is Related to Central Retinal Artery Occlusion

Objective: Central retinal artery occlusion (CRAO) is severe and painless vision loss due to retinal infarction. Most CRAO patients have atherosclerotic risk factors. Flow-mediated dilatation (FMD) and pulse wave velocity (PWV) may indicate the presence or progression of atherosclerosis. This study aims to evaluate the arterial stiffness parameters and the presence of endothelial dysfunction in patients with CRAO. Materials and Methods: 33 consecutive CRAO patients (63 ± 7 years, 21 men (63.6%)) were recruited in the study. 35 age /sex-matched participants were included as a control group, FMD and PWV were measured from the brachial artery, as indicators of endothelial dysfunction and atherosclerosis in the arterial wall, respectively. Additionally, the transthoracic echocardiographic parameters of the patients were investigated. Results: CRAO patients had significantly higher frequencies of hypertension, hyperlipidemia, and smoking status. Furthermore, the frequency of diabetes was also higher in the CRAO group, but the difference was not statistically significant. CRAO patients had significantly higher PWV and lower FMD compared to the controls. There were no significant differences between groups regarding left ventricle systolic and diastolic functions. Conclusion: Our study showed that CRAO patients may have endothelial dysfunction and increased arterial stiffness. Systemic endothelial dysfunction and atherosclerosis may be linked to the development of CRAO.

Thrombolytic Therapy for Central Retinal Artery Occlusion in an Academic Multi-Site Stroke Centre

ABSTRACT Central retinal artery occlusion (CRAO) is a subtype of acute ischaemic stroke leading to severe visual loss. A recent American Heart Association scientific statement proposed time-windows for thrombolysis in CRAO similar to acute ischaemic cerebral strokes. We aimed to review our academic multi-site stroke centre experience with intravenous (IVT) and intra-arterial thrombolysis (IAT) in CRAO between 1997 and 2022. Demographic, clinical characteristics, thrombolysis timeline, concurrent therapies, complications, and 3-month follow-up visual acuity (VA) were collected. The thrombolysed cohort follow-up VA was compared with an age, gender and baseline VA matched cohort of CRAO patients that received conservative therapies. Thrombolytic therapy was administered to 3.55% (n = 20) of CRAO admissions; 13 IVT (mean age 68, 61.5% male, 12 alteplase and 1 tenecteplase, all embolic aetiology, 1 CRAO mimic) and 7 IAT (mean age 55, 85.7% male, 3 post-operative and 3 embolic). Additional conservative CRAO-targeting therapies was received by 60%. The median time from onset of visual loss to IVT was 158 minutes (range 67–260). Improvement by at least two Snellen lines was achieved by 25% with 12.5% improving to 20/100 or better. Intracranial haemorrhage post IVT occurred in 1/13 (7.6%). The median time from onset of visual loss to IAT was 335 minutes. Improvement by at least two Snellen lines was achieved by 42%. No difference in 3-month VA was noted between patients that received thrombolysis, either alone (n = 8) or combined with other therapies, and those that received conservative therapies. Our results suggest that the management of acute CRAO remains heterogeneous. The lack of obvious benefit of thrombolysis in our small series supports the need for randomizsd clinical trials comparing thrombolysis to placebo to guide hyperacute CRAO management.

Central retinal artery occlusion without cherry-red spots

BackgroundCherry-red spots are a very important sign for the clinical diagnosis of central retinal artery occlusion (CRAO). We retrospectively summarized the clinical manifestations of CRAO and analysed the causes and characteristics of CRAO without cherry-red spots. In this study, we explored a diagnostic method for CRAO without cherry red spots.MethodsSeventy patients (70 eyes) with CRAO were examined retrospectively. Corrected distance visual acuity, fundus photos, FA and OCT images were collected at the first outpatient visit. The causes of CRAO without cherry-red spots were analysed through fundus photos. The incidence of increased hyperreflectivity of the inner retina, central macular thickness (CMT) and arteriovenous transit time in patients with and without cherry-red spots were compared.ResultsFundus examination showed posterior retinal whitening in 57 cases (81.43%) and cherry-red spots in 39 cases (55.71%). Thirty-one patients presented at the first outpatient visit without cherry-red spots. The reasons for the absence of cherry-red spots included leopard fundus (32.26%), retinal vein occlusion (25.81%), no obvious inner retinal coagulative necrosis (19.35%), ciliary retinal artery sparing (12.90%), high macular oedema (9.68%) and cherry-red spot enlargement (3.23%). OCT revealed increased hyperreflectivity of the inner retina in 67 CRAO patients (95.71%). All 3 patients without increased hyperreflectivity of the inner retina did not present with cherry-red spots at the first visit. The median CMT in patients without cherry-red spots was 166.00 μm, while the median MCT in patients with cherry-red spots was 180.00 μm; there was no significant difference between these two groups (P = 0.467). FA showed delayed arteriovenous transit time > 23 s in 20 patients (28.57%), > 15 s in 43 patients (61.43%) and no delay in 27 patients (30.77%). The median arteriovenous transit time in patients without cherry-red spots was 19.00 s, while it was 18.00 s in patients with cherry-red spots; there was no significant difference between these two groups (P = 0.727).ConclusionsThere are multiple factors that could cause the absence of cherry-red spots in CRAO. The use of OCT to observe increased hyperreflectivity of the inner retina is the most effective imaging method for the early diagnosis of CRAO without cherry-red spots.

Visual acuity assessment of central retinal artery occlusion patients with or without paracentral acute middle maculopathy via OCT-A

PurposeThe association between paracentral acute middle maculopathy (PAMM) and visual acuity in patients with central retinal artery occlusion (CRAO) is still unclear. The present study investigated the visual acuity of CRAO patients with and without PAMM.MethodsCRAO patients with PAMM or without PAMM were included. Optical coherence tomography angiography (OCT-A) was used to record the macular retinal thickness and density of shallow and deep vessels. The Best-corrected visual acuity (BCVA) was converted to a logarithm of the minimum angle of resolution (LogMAR) for statistical analysis.ResultsThere were 34 CRAO patients with PAMM (43.13%), other 30 CRAO patients without PAMM (46.87%). Compared with the no-PAMM group, PAMM group had better LogMAR BCVA (1.48 (0.49, 1.85) Vs. 1.85 (1.70, 1.96), P < 0.01). There was also a significant difference in retinal thickness of the central macular sulcus (328.00 (304.50–332.25) Vs. 352.50 (311.75–420.50), P = 0.01). A significant correlation between LogMAR BCVA and macular retinal thickness was found (r = 0.42; P < 0.01).ConclusionCRAO patients with PAMM had significantly better visual acuity and less macular edema. OCT-A can be used to distinguish different levels of damage due to CRAO.

Optometric Practice Patterns for Acute Central and Branch Retinal Artery Occlusion.

Optometrists are often the first providers to evaluate patients with acute vision loss and are often the first to diagnose a central retinal artery occlusion (CRAO). How quickly these patients present to the optometrist, are diagnosed, and referred for evaluation are major factors influencing the possibility of acute therapeutic intervention. Our aim was to survey the U.S. optometric community to determine current optometric practice patterns for management of CRAO. An anonymous seven-question survey was emailed in 2020 to the 5,101 members of the American Academy of Optometry and the 26,502 members of the American Optometric Association. Of 31,603 optometrists who were sent the survey, 1,926 responded (6.1%). Most respondents (1,392/1,919, 72.5%) worked in an optometry-predominant outpatient clinic and were less than 30 minutes from a certified stroke center (1,481/1,923, 77.0%). Ninety-eight percent (1,884/1,922) of respondents had diagnosed less than 5 CRAOs in the previous year, and 1,000/1,922 (52.0%) had not diagnosed a CRAO in the prior year. Of the optometrists who diagnosed at least one CRAO in the previous year, 661/922 (71.7%) evaluated these patients more than 4 hours after the onset of vision loss. Optometrists who diagnosed a CRAO or branch retinal artery occlusion referred patients to an emergency department (ED) affiliated with a certified stroke center (844/1,917, 44.0%), an outpatient ophthalmology clinic (764/1,917, 39.9%), an ED without a stroke center (250/1,917, 13.0%), an outpatient neurology clinic (20/1,917, 1.0%), or other (39/1,917, 2.0%); most (22/39, 56.4%) who responded "other" would refer to a primary care physician. Optometrists are likely the first providers to evaluate patients with acute vision loss, including from a retinal artery occlusion. However, only 6.1% of optometrists responded to our survey despite 2 reminder emails, likely reflecting the lack of exposure to acute retinal artery occlusions, and a potential lack of interest of optometrists in participating in research. Of the optometrists who reported evaluating a CRAO in the previous year, less than 29% saw the patient within 4 hours of vision loss. In addition, a large portion of optometrists are referring acute CRAO patients to outpatient ophthalmology clinics, delaying appropriate acute management. Therefore, it is imperative that optometrists and ophthalmologists are educated to view acute retinal arterial ischemia as an acute stroke and urgently refer these patients to an ED affiliated with a stroke center. The delay in patient presentation and these referral patterns make future clinical trials for acute CRAO challenging.