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Visual Outcomes of Central Retinal Artery Occlusion
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersPURPOSE
To assess visual acuity (VA) outcomes in a large cohort of patients diagnosed with nonarteritic central retinal artery occlusion (CRAO), and to ascertain whether time from symptom onset to presentation, presenting VA, or conservative treatment delivery (anterior chamber paracentesis, ocular massage, intraocular pressure lowering drugs, hyperventilation, or some combination of those) impacted ultimate VA outcomes.
DESIGN
Retrospective cohort study.
SUBJECTS
The study included 794 patients who presented with CRAO between 2011 and 2020. Within this cohort, 484 individuals presented within 30 days of symptom onset and had comprehensive documentation regarding the details of their presentation, management, and follow-up ≥ 90 days postdiagnosis.
METHODS
Retrospective chart review was conducted for all patients with a diagnosis of CRAO initially identified via International Classification of Diseases coding, followed by confirmation of diagnosis by 2 retina specialists. Cases of arteritic CRAO were excluded.
MAIN OUTCOME MEASURES
Visual acuity recovery, defined as improvement from ≤ 20/200 or worse at presentation to ≥ 20/100 ≥ 90 days after diagnosis.
RESULTS
Of the 794 identified patients, 712 (89.7%) presented with VA of ≤ 20/200. Similarly, 447 (92.4%) of the 484-patient subset that presented within 30 days and had comprehensive documentation presented with VA ≤ 20/200. Of the 441 of those patients with documented follow-up, 380 (86.2%) remained at that level. Of the 244 patients who presented within 4.5 hours of symptom onset, 227 (93%) presented ≤ 20/200 and 201 (92.6%) of the 217 of those with follow-up data did not improve beyond that threshold. There was no significant difference (P < 0.05) in final VA between patients presenting before versus after 4.5 hours from time of vision loss. There was also no significant difference (P < 0.05) in VA outcomes between patients who did or did not receive conservative treatment.
CONCLUSIONS
This large retrospective study further highlights the poor visual prognosis for patients with CRAO. Earlier time to presentation did not seem to impact final VA outcome, nor did conservative treatment efforts. Efficacious evidence-based treatment options are needed for this patient population.
FINANCIAL DISCLOSURE(S)
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Additional Info
Disclosure statements are available on the authors' profiles:
Central Retinal Artery Occlusion: Visual Outcomes from a Large Northern California Cohort
Ophthalmol Retina 2024 Jun 01;8(6)566-570, R Shah, X Zheng, AP Patel, MT Bhatti, A Gilbert, RA VoraFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Shah and co-authors conducted a large retrospective cohort study that analyzed the natural evolution of nonarteritic central retinal artery occlusion (CRAO) after traditional treatment. Through a chart review, the authors of this article have drawn a meaningful summary of data for a better understanding of the prognosis and potential interventions for patients with CRAO. In this study, the vision outcomes in patients with CRAO were poor, regardless of the type of traditional treatments received or the timing of starting traditional intervention (before or after 4.5 hours from the time of vision loss).
The naturally poor prognosis for patients with CRAO has urgently prompted us to explore new thrombolytic therapies. The American Heart Association has released a scientific statement endorsing the use of intravenous tissue plasminogen activator in the treatment of CRAOs. Recently, a study regarding the use of a remote consult platform and intra-arterial tissue plasminogen activator therapy has shed new light on an efficient thrombolytic approach for treating acute CRAO.1 Therefore, a randomized controlled clinical trial evaluating different thrombolytic regimens, including remote consult platforms, should soon be on the horizon.
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