Retinal Artery Occlusion In Patient Research Articles

Plasma Proteomics to Identify Drug Targets and Potential Drugs for Retinal Artery Occlusion: An Integrated Analysis in the UK Biobank.

Retinal artery occlusion (RAO), which is positively correlated with acute ischemic stroke (IS) and results in severe visual impairment, lacks effective intervention drugs. This study aims to perform integrated analysis using UK Biobank plasma proteome data of RAO and IS to identify potential targets and preventive drugs. A total of 7191 participants (22 RAO patients, 1457 IS patients, 8 individuals with both RAO and IS, and 5704 healthy age-gender-matched controls) were included in this study. Unique 1461 protein expression profiles of RAO, IS, and the combined data set, extracted from UK Biobank Plasma proteomics projects, were analyzed using both differential expression analysis and elastic network regression (Enet) methods to identify shared key proteins. Subsequent analyses, including single cell type expression assessment, pathway enrichment, and druggability analysis, were conducted for verifying shared key proteins and discovery of new drugs. Five proteins were found to be shared among the samples, with all of them showing upregulation. Notably, adhesion G-protein coupled receptor G1 (ADGRG1) exhibited high expression in glial cells of the brain and eye tissues. Gene set enrichment analysis revealed pathways associated with lipid metabolism and vascular regulation and inflammation. Druggability analysis unveiled 15 drug candidates targeting ADGRG1, which demonstrated protective effects against RAO, especially troglitazone (-8.5 kcal/mol). Our study identified novel risk proteins and therapeutic drugs associated with the rare disease RAO, providing valuable insights into potential intervention strategies.

Efficacy and safety of hyperbaric oxygen therapy monitored by fluorescein angiography in patients with retinal artery occlusion

AimsTo assess the efficacy and safety of a standardised hyperbaric oxygen therapy protocol (HBOT) monitored by fluorescein angiography (FA) in patients with retinal artery occlusion (RAO).MethodsIt is a prospective, non-comparative,...

Circulating serum fibroblast growth factor 21 as risk and prognostic biomarker of retinal artery occlusion

To evaluate the predictive and prognostic value of fibroblast growth factor 21 (FGF21) levels in retinal artery occlusion (RAO) patients. In this case–control study, serum FGF21 levels were detected by using the ELISA method. Multivariable logistic regression analyses were performed to evaluate the significance of FGF21 in assessing the risk of developing RAO and its impact on vision and concurrent ischemic stroke. Compared with control group, serum FGF21 levels were significantly higher (median [IQR] = 230.90[167.40,332.20] pg/ml) in RAO patients. Multivariate logistic regression analysis showed that elevated serum FGF21 levels were associated with a higher risk of RAO occurrence (P = 0.025, OR [95%CI] = 9.672 [2.573, 36.359]) after adjustment for multiple confounding factors. Higher serum FGF21 levels were negatively associated with visual acuity improvement (P = 0.029, OR [95%CI] = 0.466[0.235, 0.925]) and positively correlated with concurrent ischemic stroke (P = 0.04, OR [95% CI] = 1.944[1.029, 3.672]) in RAO patients. Elevated serum FGF21 levels could promote the development of RAO and indicate worse visual prognosis and increase the risk of concurrent ischemic stroke, which might help clinicians early diagnose and treat RAO patients.

Increased Risk of New-Onset Parkinson's Disease Following a Diagnosis of Retinal Vascular Occlusion: A 14-Year Cohort Study.

Although the role of the vascular component in the pathophysiology of Parkinson's disease is widely accepted and retinal vascular abnormalities are commonly observed in Parkinson's disease patients, evidence connecting retinal vascular disorders with the risk of developing Parkinson's disease is limited. We aimed to investigate the association between retinal vascular occlusion (RVO) and the risk of developing Parkinson's disease in people over 60 years using a nationwide cohort. From the 14-year South Korean National Health Insurance Service-Senior cohort, 11210 incident RVO patients and 11210 propensity scores, risk-matched controls were included. The incidence of Parkinson's disease was estimated with a Poisson regression. A Cox proportional hazards regression model was used to investigate the associations between RVO and the risk of Parkinson's disease. The incidence of Parkinson's disease was 664.4 cases per 100000 person-years (95% confidence interval [CI], 599.7-736.0) in the RVO cohort. Individuals with RVO had an increased incidence of Parkinson's disease (hazard ratio [HR], 1.28; 95% CI: 1.10-1.49). Increased PD risk was predominantly observed in retinal artery occlusion patients (HR, 1.53; 95% CI: 1.11-2.12), male patients (HR, 1.67; 95% CI: 1.29-2.17), and 5 years after diagnosis (HR, 1.46; 95% CI: 1.10-1.93). Our findings suggest that a common pathophysiological pathway, such as vasculature changes, may exist between RVO and Parkinson's disease. RVO may be one of the risk factors associated with future development of Parkinson's disease. The nature of this association warrants further investigation.

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.

Analysis of the Association between Retinal Artery Occlusion and Acute Ischaemic Stroke/ST-Elevation Myocardial Infarction and Risk Factors in Hungarian Patients.

Background and Objectives: We aimed to analyse data on retinal artery occlusion (RAO) patients to explore correlations with acute ischaemic stroke (AIS), ST-elevation myocardial infarction (STEMI), and cardio/cerebrovascular comorbidities. Patients and Methods: Our retrospective cohort study included 169 RAO and 169 age- and gender-matched control patients. We examined the association of AIS, STEMI, and related comorbidities such as hypertension (HT), type 1 and type 2 diabetes (T1DM and T2DM, respectively), hyperlipidaemia, and ischaemic heart disease (IHD) with RAO. We also recorded atrial fibrillation in our RAO patients. Results: Our results demonstrated that RAO patients developed both AIS and STEMI at a significantly higher rate compared to controls (p < 0.001 for both). We also found that RAO patients had a significantly higher prevalence of HT and hyperlipidaemia (p1 = 0.005, p2 < 0.001) compared to controls. Multiple risk factors together significantly increased the odds of developing AIS and STEMI. Conclusions: Our results suggest that through identifying and treating the risk factors for RAO patients, we can reduce the risk of AIS, STEMI, and RAO of the fellow eye. Considering that ophthalmologists are often the first detectors of these cardiovascularly burdened patients, collaboration with colleagues from internal medicine, cardiology, and neurology is essential to achieve secondary prevention.

Sex differences in major adverse cardiovascular and cerebrovascular event risk among central retinal artery occlusion patients

To estimate the association between central retinal artery occlusion (CRAO) and major adverse cardiovascular and cerebrovascular events (MACCE), including their clinical characteristics, blood markers, and the contribution of CRAO to MACCE, as well as to assess any sex differences. This retrospective cohort study included continuous new-onset CRAO patients and 1:4 controls during the same period. Correlations of CRAO with the incidence of MACCE during follow-up and the sex-related differences were studied. One hundred and twenty-four CRAO patients and four hundred and ninety-six controls were enrolled. Neutrophil-to-lymphocyte ratio (NLR, P = 0.014) and high-sensitivity C-reactive protein (hs-CRP, P = 0.038) were tended to be higher in CRAO patients. After the follow-up period, 78 patients experienced MACCE. Multivariate Cox regression analysis showed that CRAO was a predictor of the occurrence of MACCE (HR 2.321, 95% CI 1.439–3.744, P = 0.001). Sex subgroups indicated that age, diabetes, current smoking, CRAO, NLR and hs-CRP increased the risk factor of MACCE in males (All P < 0.05) and CRAO, NLR, low-density lipoprotein cholesterol (LDL-C) and hs-CRP were independent influencing factors for females (All P < 0.05). New-onset CRAO significantly increases the probability of MACCE and is associated with a poor prognosis. The sex-related differences suggested that effective prevention of the occurrence of MACCE in high-risk patients requires that attention be given to individualized risk factors corresponding to sexes.

Optical coherence tomography angiography features of retinal artery occlusion before and after intra‐arterial thrombolysis

AbstractBackgroundTo evaluate the ability of optical coherence tomography angiography (OCTA) to quantitatively assess the effectiveness of intra‐arterial thrombolysis (IAT) surgery for the treatment of retinal artery occlusion (RAO).MethodsThis was a prospective observational study. Patients diagnosed with RAO who received IAT were enrolled. All participants underwent comprehensive ophthalmologic examinations and OCTA scans. The best‐corrected visual acuity (BCVA), vascular densities (VDs) of the superficial capillary plexus (SCP), deep capillary plexus (DCP), radial peripapillary capillaries, and central retinal thickness (CRT) were recorded. The above parameters were compared between RAO eyes and the fellow healthy eyes before and after IAT. Correlations between the BCVA and OCTA parameters in RAO eyes were calculated.ResultsThirty‐four eyes from 34 consecutive RAO patients with a mean age of 51.0 ± 12.9 years were enrolled. There was a considerable decrease of VDs in the SCP, DCP, and radial peripapillary capillaries in all RAO eyes (all p &lt; 0.001). Compared with contralateral normal eyes, CRT was significantly increased in RAO eyes (p &lt; 0.001). The SCP and DCP VDs were significantly improved after IAT surgery (p = 0.010 and 0.014, respectively). BCVA in logMAR unit was negatively correlated with the DCP VD (r = −0.664, p = 0.010) and positively correlated with CRT (r = 0.597, p = 0.024) after surgery, but not significantly correlated with VDs or CRT before surgery.ConclusionMacular and peripapillary VDs of the retina detected by OCTA were greatly decreased in RAO eyes and improved after IAT treatment. OCTA is capable of quantifying VDs in separate retinal layers non‐invasively, conveniently, efficiently, and precisely.

ApoB, non-HDL-C, and LDL-C Are More Prominent in Retinal Artery Occlusion Compared to Retinal Vein Occlusion

ABSTRACT Purpose To evaluate and compare the blood lipid profile in retinal artery occlusion (RAO) and retinal vein occlusion (RVO). Methods We included 82 RAO patients and 95 RVO patients in this retrospective case–control study. Controls were matched to RAO or RVO patients at a 1:1 ratio, respectively. Associated lipid variates were analyzed in multivariable logistic regression models. Results LDL-C (OR = 1.69), non-HDL-C (OR = 1.87), and ApoB (OR = 11.72) individually significantly increased the risk of RAO. ApoA1 was associated with RVO (OR = 0.02), and with 75.8% sensitivity and 67.4% specificity. TG (OR = 1.61), LDL-C (OR = 1.69), non-HDL-C (OR = 1.91), and ApoB (OR = 12.12) each significantly increased the risk of RAO when compared with RVO. Conclusions ApoB, non-HDL-C, and LDL-C may be potential biomarkers in RAO patients. Low ApoA1 is an independent risk factor for the development of RVO.

Abstract WP43: Characteristics And Management Of Hospitalized Retinal Artery Occlusion Patients In The Era Of Updated Guidelines: A Population-based Study

Background: Retinal artery occlusion (RAO) is a stroke equivalent that causes significant morbidity. There has been growing emphasis on urgent in-hospital evaluation of these patients, both to facilitate potential thrombolytic therapy and expedite workup; however, little is known regarding its effect on systems of care. We thus examined presenting characteristics and management of hospitalized RAO patients using the Greater Cincinnati Northern Kentucky Stroke Study (GCNKSS). Methods: The GCNKSS is a population-based study of stroke in a 5-county region with a population of 1.3 million representative of the USA in terms of Black race, income, and education. All cases of RAO among Black individuals from July 2019-December 2020 and among White individuals from 2020 were chart abstracted using ICD codes. All cases underwent physician adjudication. Demographic and clinical data were recorded. Results: We identified 57 hospitalizations with acute RAO among 55 patients. Characteristics of their hospitalization and demographics are shown (Table). Notably, 19% (11/57) of patients presented in a thrombolytic window of ≤3.5 and average time from symptom onset to evaluation was 17 hours. Most patients initially interacted with a subspecialist (53%) and presented to the ED in delayed fashion. One patient received thrombolytic therapy, four (7%) patients underwent carotid revascularization, and no patients had newly identified atrial fibrillation, cardiac thrombus, or endocarditis. Discussion: Our population-based study found only a minority of patients presented within a thrombolytic window, suggesting that systems of care need to promote more rapid evaluation of these patients. Very few patients received select intervention, but the high impact of carotid revascularization may warrant urgent evaluation of even low risk patients. Further study of long-term outcomes in this patient population is called for.

Quantitative Wide-Field Swept-Source Optical Coherence Tomography Angiography and Visual Outcomes in RAO.

Retinal artery occlusion (RAO) is an ophthalmic emergency that can lead to poor visual outcomes and is associated with an increased risk of stroke and cardiovascular events. Wide-field swept-source OCT-A (WF SS-OCTA) can provide quick and non-invasive angiographic information with a wide field of view. Here, we looked for associations between OCT-A vascular imaging metrics and vision in RAO patients. Patients with diagnoses of central (CRAO) or branched retinal artery occlusion (BRAO) were included. 6mm × 6mm Angio and 15mm × 15mm AngioPlex Montage OCT-A images were obtained for both eyes in each patient using Zeiss Plex Elite 9000 WF SS-OCTA device. Each 6mm × 6mm image was divided into nine Early Treatment Diabetic Retinopathy Study (ETDRS) subfields. Non-perfusion area (NPA) was manually measured using 15mm × 15mm images. A linear regression model was utilized to identify correlation between imaging metrics and vision. P-values less than 0.05 were considered as statistically significant. Twenty-five subjects were included. For RAO eyes, there was a statistically significant inverse correlation between retinal thickness as well as superficial capillary plexus (SCP) vessel density (VD) and vision. An inverse correlation was found between deep capillary plexus (DCP) VD and vision without statistical significance. There was a positive correlation between choroidal thickness as well as choroidal volume and vision without statistical significance. No significant correlation was found between the metrics and vision in contralateral eyes. For NPA and vision, no significant correlation was identified. This is the first study to investigate the utility of WF SS-OCTA in RAO and to demonstrate correlations between retinal vascular imaging metrics and visual outcomes. The results of this study provide a basis to understand the structural changes involved in vision in RAO and may guide management of RAO and prevention of cerebral stroke and cardiovascular accidents.

Retinal Vein Occlusion Treated with QIAPI 1™: Report of a Case

Acute retinal vascular occlusions are frequent causes of visual impairment. Although both retinal artery occlusions and retinal vein occlusions are associated with increased age and cardiovascular risk factors, their pathophysiology, systemic implications, and management differ substantially. Retinal vascular events are perceived to be related to various cardiovascular complications. There is a positive association of retinal vascular events to mortality, stroke, and myocardial infarction. Retinal artery occlusion (RAO) and retinal vein occlusion (RVO) is associated with a higher risk of stroke. Given that RAO and RVO patients would generally present to ophthalmologists, their high cardiovascular risk should include a referral for cardiovascular assessment as part of their management protocol. This article reports the remarkable effects on tissues affected by retinal vascular events, when by pharmacological means, we restore the surprising ability to take energy directly from light, through the dissociation of water, as it happens in plants.

A STUDY OF FEQUENCIES OF CRAO CASES IN POST COVID 19 RHINO ORBITAL MUCOR MYCOSIS

Introduction: Mucormycosis is a life-threatening fungal infection that occurs in patients who are immune compromised because of diabetic ketoacidosis, neutropenia and/or organ transplantation. In pandemic of COVID 19 an unusual epidemic of rhino-orbital-cerebral mucormycosis was observed affecting post COVID patients mainly. Covid 19 causes endothelial dysfunction due to inflammatory induced homeostasis and a pro coagulant state with multi-organ involvement[1].All these inflammatory and hypercoaguble states are established risk factors for retinal artery occlusion. Direct invasion of vessels by fungal hyphae leading to widespread occlusive vasculitis and thrombosis can also lead to complications like Central Retinal Artery Occlusion in patients of mucormycosis. Aim: To report a series of CRAO cases in Post Covid Rhino-orbito cerebral mucormycosis patients and describe clinical profile and outcome. Methodology: In a cross sectional study all adult patients at SDU medical college from 1st April to 31st August 2021 diagnosed as Rhino-orbital-cerebral Mucormycosis were included. Epidemiological data of all cases and relevant history were noted. Detailed history regarding COVID hospitalization and treatment received were noted. Detailed ocular examination including fundus examination was done.Primary outcome measure was CRAO. Results: A total of 34 patients were included in study out of which 26.47% were females and 73.52% were males. CRAO was observed in a total of 10 patients (27.02) out of which 9(90%) were males and 1(10%) was female. Conclusion: Association of invasive mucormycosis with COVID-19 is dangerous and has serious consequences. Detailed ophthalmological surveillance in such patients is mandatory to avoid sight threatening complications.

The Association between Elevated Hematocrit and Retinal Artery Occlusion in Adult Patients.

Retinal artery occlusion (RAO) is most commonly caused by embolism. Evidence showed that hematocrit (Hct) levels are often associated with embolic events. In this study, we aim to investigate the relationship between Hct levels and RAO. This retrospective study enrolled RAO patients between January 2011 and March 2020, who were 1:4 matched by age, gender, index date, and relevant comorbidities with the non-RAO group. Patient characteristics and laboratory data were collected. Univariate conditional logistic regression was applied by estimating crude matched odds ratios to determine the relevant factors for the occurrence of RAO. Furthermore, a narrative review of the relevant study was conducted to explore the association between Hct levels and embolism. Between January 2011 to March 2020, 82 RAO patients and 328 non-RAO patients matched with age, gender, index date, comorbidities of hypertension, diabetes mellitus, dyslipidemia, chronic kidney disease, stroke, and atrial fibrillation were enrolled after excluding ineligible individuals. Conditional logistic regression analysis showed that Hct level ≥ 40% was associated with developing RAO. A forest plot showed a trend of a non-linear dose-response association between Hct levels and ischemic vascular events in male patients. Hct levels ≥ 40% in patients older than 65 years with at least six comorbidities could be associated with RAO. We suggest that older patients who have multiple comorbidities, combined with elevated Hct levels, should be informed of the possible occurrence of RAO.

The Impact of the Initial Admission Department on the Management and Prognosis of Retinal Artery Occlusion.

Retinal artery occlusion (RAO) is an emergency condition in both neurology and ophthalmology departments. However, RAO's management and visual outcome in different initial departments remain unclear. Therefore, we aimed to investigate the impact of the initial department on the management and prognosis of RAO. Consecutive cases of RAO between January 2011 and December 2021 were retrospectively analyzed. The neurology and ophthalmology departments compared the baseline characteristics, relevant evaluation, and treatment. The primary outcome was the visual recovery rate. The secondary outcomes were newly diagnosed cardiovascular factors, concurrent stroke and new-onset cardiovascular events. A total of 74 RAO patients were included. The median age was 54 years, and 67.6% were male. 42 (56.8%) patients were admitted to the neurology department and 32 (43.2%) to the ophthalmology department. The visual recovery rate was higher in the neurology department than in the ophthalmology department, although the difference did not reach statistical significance (27.8 vs. 12.5%, p = 0.120). Risk factor evaluation and secondary prevention were taken more frequently in the neurology department (p < 0.001). Cardiovascular risk factors and concurrent stroke were all discovered in the neurology department. However, the incidence of new-onset cardiovascular events was similar between the two departments. The study demonstrated that the visual prognosis of RAO was devastating regardless of the neurology and ophthalmology department. Given the admission delay, inadequate management, and high risk of cardiovascular risk factors and stroke, stroke centers should be recommended as initial admission departments for RAO patients.

Evaluation of Risk Scores as Predictive Tools for Stroke in Patients with Retinal Artery Occlusion: A Danish Nationwide Cohort Study.

Purpose We investigated the 1-year risk of stroke in patients with retinal artery occlusion and evaluated the predictive and discriminating abilities of contemporary risk stratification models for embolic stroke. Methods This register-based cohort study included 7,906 patients with retinal artery occlusion from Danish nationwide patient registries between 1995 and 2018. The study population was stratified according to the number of points obtained in the stroke risk scores: the CHA 2 DS 2 -VASc score and the ESSEN Stroke Risk score. The 1-year risk of stroke within strata was evaluated and compared using the cox proportional hazards model. Furthermore, the discrimination of the risk scores as predictive tools for stroke risk assessment was investigated using C-statistics, Brier score, and the index of prediction accuracy. Results The stroke event rate in patients with retinal artery occlusion increased as the score increased for both risk scores, ranging from 3.62 (95% confidence interval [CI]: 2.46-5.31) per 100 person-years to 13.25 (95% CI: 11.78--14.89) per 100-person-years for increasing levels of the CHA 2 DS 2 -VASc score and from 3.97 (95% CI: 2.97-5.32) per 100 person-years to 16.43 (95% CI: 14.01-19.27) per 100 person-years for increasing levels of the ESSEN Stroke Risk score. Using a risk score of 0 as a reference, the difference was statistically significant for retinal artery occlusion patients with a CHA 2 DS 2 -VASc score of 2 or above and for all levels of the ESSEN Stroke Risk score. The C-statistics for the risk scores was 61% (95% CI: 58%-63%) and 62% (95% CI: 59-64%) for the CHA 2 DS 2 -VASc score and ESSEN Stroke Risk score, respectively. Conclusion The results suggested that the use of the CHA 2 DS 2 -VASc score and the ESSEN Stroke Risk score was applicable for risk stratification of stroke in patients with retinal artery occlusion, but discrimination was poor due to low specificity.

Retinal Artery Occlusion and Associated Risk of Cerebrovascular Disease Related Hospitalization: A National Inpatient Study.

ObjectivesTo evaluate the demographic and comorbid risk factors for cerebrovascular disease (CVD) hospitalization in patients with retinal artery occlusion (RAO) and study the impact on hospitalization outcomes.MethodsWe conducted a retrospective cross-sectional study using the Nationwide Inpatient Sample (NIS, 2019). We included 62,255 adults (age 18-65 years) with the primary diagnosis of CVD. The study sample was divided by the co-diagnosis of RAO (N=1,700). A logistic regression model was used to evaluate the odds ratio (OR) of association for risk factors leading to CVD hospitalization in patients with RAO, with the non-RAO cohort as the reference category.ResultsThe majority of the CVD patients with RAO were elderly (51-65 years, 68%), females (54%), and whites (47%). Yet, demographics did not significantly impact the association with CVD hospitalization between RAO and non-RAO patients. There was a significant difference in the geographic distribution of CVD hospitalizations with RAO, with the highest prevalence in the East North Central Atlantic (21%) and South Atlantic (18%) regions, and the lowest in the Mountain (4%) and East South Central (4%) regions. Comorbid diabetes with complications (69%), and complicated hypertension (55%) were most prevalent in patients with RAO thereby increasing the risk for CVD hospitalization by 7.8 (95% CI 6.9-8.8) and 1.8 times (95% CI 1.6-1.9), respectively. Patients with RAO and having major severity of illness were at increased risk of CVD hospitalization (OR 2.8, 95% CI 1.9-3.9). Patients with RAO had a significant difference in adverse disposition, including transfer to the skilled nursing facility (SNF)/intermediate care facility (ICF) (32% vs. 24%) and requiring home health care (16% vs. 11%) compared to non-RAO patients.ConclusionThe prevalence of RAO in CVD hospitalization was 2.7%, and demographics did not have any impact on the increasing risk of CVD. Comorbid diabetes (by 685%) and hypertension (by 78%) potentially increase the risk of CVD hospitalization in patients with RAO. These patients have a major severity of illness, leading to an adverse disposition. This calls for a collaborative care model to improve the quality of life in these at-risk patients with RAO.

Establishment of the reproducible branch retinal artery occlusion mouse model and intravital longitudinal imaging of the retinal CX3CR1-GFP+ cells after spontaneous arterial recanalization.

Animal models of retinal artery occlusion (RAO) have been widely used in many studies. However, most of these studies prefer using a central retinal artery occlusion (CRAO) which is a typical global ischemia model of the retina, due to the technical limitation of producing single vessel targeted modeling with real-time imaging. A focal ischemia model, such as branch retinal artery occlusion (BRAO), is also needed for explaining interactions, including the immunological reaction between the ischemic retina and adjacent healthy retina. Accordingly, a relevant model for clinical RAO patients has been demanded to understand the pathophysiology of the RAO disease. Herein, we establish a convenient BRAO mouse model to research the focal reaction of the retina. As a photo-thrombotic agent, Rose bengal was intravenously injected into 7 week-old transgenic mice (CX3CR1-GFP) for making embolism occlusion, which causes pathology similarly to clinical cases. In an optimized condition, a 561 nm laser (13.1 mw) was projected to a targeted vessel to induce photo-thrombosis for 27 s by custom-built retinal confocal microscopy. Compared to previous BRAO models, the procedures of thrombosis generation were naturally and minimal invasively generated with real-time retinal imaging. In addition, by utilizing the self-remission characteristics of Rose bengal thrombus, a reflow of the BRAO with immunological reactions of the CX3CR1-GFP+ inflammatory cells such as the retinal microglia and monocytes was monitored and analyzed. In this models, reperfusion began on day 3 after modeling. Simultaneously, the activation of CX3CR1-GFP+ inflammatory cells, including the increase of activation marker and morphologic change, was confirmed by immunohistochemical (IHC) staining and quantitative real-time PCR. CD86 and Nox2 were prominently expressed on day 3 after the modeling. At day 7, blood flow was almost restored in the large vessels. CX3CR1-GFP+ populations in both superficial and deep layers of the retina also increased around even in the BRAO peri-ischemic area. In summary, this study successfully establishes a reproducible BRAO modeling method with convenient capabilities of easily controllable time points and selection of a specific single vessel. It can be a useful tool to analyze the behavior of inflammatory cell after spontaneous arterial recanalization in BRAO and further investigate the pathophysiology of BRAO.

Nationwide trends in emergency department utilisation for acute retinal ischaemia in the USA, 2011–2018

BackgroundGuidelines recommend urgent evaluation for transient monocular vision loss (TMVL) and retinal artery occlusion (RAO), but emergency department (ED) utilisation for these conditions is unknown.MethodsWe performed a retrospective longitudinal cross-sectional...

Relationship between atrial fibrillation and retinal artery occlusion: what we know now and how we can use it in clinical practice?

Atrial fibrillation (AF) is the most common heart rhythm disorder that constitutes the cause of ischemic stroke. Retinal artery occlusion (RAO), believed to be the equivalent of ischaemic stroke, is one of the causes of sudden vision loss that is related to an increased risk of cardiovascular events. The relationship between AF and ischaemic stroke is well known. Gaining knowledge about the relationship between AF and RAO seems essential. Is the presence of AF associated with the risk of RAO? What impact does RAO have on the prognosis of patients with AF? Should patients with RAO be examined for AF? What treatment should be introduced in RAO patients recently diagnosed with AF? Knowing the answers to these questions appears to be essential in daily clinical practice. A literature review on the relationship between RAO and AF is presented.