Katriel E Lee1, Christine Tschoe2, Stephanie A Coffman3, Carol Kittel4, Patrick A Brown5, Quang Vu6, Kyle M Fargen7, Bartlett H Hayes8, Stacey Q Wolfe9. 1. Department of Neurological Surgery, Wake Forest Baptist Health, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA. Electronic address: kalee@wakehealth.edu. 2. Department of Neurological Surgery, Wake Forest Baptist Health, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA. Electronic address: ctschoe@gmail.com. 3. Department of Neurological Surgery, Wake Forest Baptist Health, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA. Electronic address: scoffman@wakehealth.edu. 4. Division of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, NC, USA. Electronic address: c.kittel@wakehealth.edu. 5. Department of Radiology, Wake Forest Baptist Health, Winston-Salem, NC, USA. Electronic address: Patrick.A.Brown@wakehealth.edu. 6. Department of Neurology, Wake Forest Baptist Health, Winston-Salem, NC, USA. Electronic address: qvu@wakehealth.edu. 7. Department of Neurological Surgery, Wake Forest Baptist Health, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA. Electronic address: kfargen@wakehealth.edu. 8. Department of Ophthalmology, Wake Forest Baptist Health, Winston-Salem, NC, USA. Electronic address: bhhayes@wakehealth.edu. 9. Department of Neurological Surgery, Wake Forest Baptist Health, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA. Electronic address: sqwolfe@wakehealth.edu.
Abstract
OBJECTIVES: Acute central retinal artery occlusion (CRAO) is an ophthalmologic emergency that often results in permanent vision loss. Over 25% are associated with acute cerebral ischemia. In the absence of existing Level I treatment options, this study aims to examine institutional practice patterns and review the literature to develop a formalized approach to the treatment of CRAO in the era of ischemic stroke protocols. MATERIALS AND METHODS: This is a retrospective review of institutional practices in the workup and treatment of patients diagnosed with acute non-arteritic (NA) CRAO at a single center from January 2017 to August 2020. RESULTS: Of 91 patients managed for acute NA-CRAO, 62.6% were male and average age was 66.4 years. Only 20.9% of patients presented within 4 h of symptom onset. 12.1% of patients had evidence of acute stroke on MRI, and 27.5% had ipsilateral internal carotid artery stenosis >50%. Half (52.7%) did not receive any acute treatment for CRAO, excluding antiplatelet/anticoagulation. 48.5% of patients undergoing acute medical treatment had improved visual acuity compared to 29.4% without treatment (p=0.14). CONCLUSIONS: There is a lack of clear protocol for the management of NA-CRAO. While not reaching statistical significance, our experience mirrors the literature with patients undergoing medical treatment demonstrating improved visual acuity over those without treatment. Given the presence of acute ischemic stroke, carotid disease, and/or stroke risk factors in over 25% of patients with CRAO, multidisciplinary involvement and modern stroke algorithms should be considered for this disease.
OBJECTIVES:Acute central retinal artery occlusion (CRAO) is an ophthalmologic emergency that often results in permanent vision loss. Over 25% are associated with acute cerebral ischemia. In the absence of existing Level I treatment options, this study aims to examine institutional practice patterns and review the literature to develop a formalized approach to the treatment of CRAO in the era of ischemic stroke protocols. MATERIALS AND METHODS: This is a retrospective review of institutional practices in the workup and treatment of patients diagnosed with acute non-arteritic (NA) CRAO at a single center from January 2017 to August 2020. RESULTS: Of 91 patients managed for acute NA-CRAO, 62.6% were male and average age was 66.4 years. Only 20.9% of patients presented within 4 h of symptom onset. 12.1% of patients had evidence of acute stroke on MRI, and 27.5% had ipsilateral internal carotid artery stenosis >50%. Half (52.7%) did not receive any acute treatment for CRAO, excluding antiplatelet/anticoagulation. 48.5% of patients undergoing acute medical treatment had improved visual acuity compared to 29.4% without treatment (p=0.14). CONCLUSIONS: There is a lack of clear protocol for the management of NA-CRAO. While not reaching statistical significance, our experience mirrors the literature with patients undergoing medical treatment demonstrating improved visual acuity over those without treatment. Given the presence of acute ischemic stroke, carotid disease, and/or stroke risk factors in over 25% of patients with CRAO, multidisciplinary involvement and modern stroke algorithms should be considered for this disease.
Authors: Nicolas Feltgen; Jan Liman; Maximilian Schultheiss; Martin S Spitzer; Amelie Pielen; Sven Poli Journal: Ophthalmologe Date: 2021-08-04 Impact factor: 1.059