Elsevier

Ophthalmology

Volume 116, Issue 10, October 2009, Pages 1928-1936
Ophthalmology

Original article
Retinal Artery Occlusion: Associated Systemic and Ophthalmic Abnormalities

https://doi.org/10.1016/j.ophtha.2009.03.006Get rights and content

Objective

To investigate systematically the various associated systemic and ophthalmic abnormalities in different types of retinal artery occlusion (RAO).

Participants

We included 439 consecutive untreated patients (499 eyes) with RAO first seen in our clinic from 1973 to 2000.

Methods

At first visit, all patients underwent detailed ophthalmic and medical history, and comprehensive ophthalmic evaluation. Visual evaluation was done by recording visual acuity, using the Snellen visual acuity chart, and visual fields with a Goldmann perimeter. Initially they also had carotid Doppler/angiography and echocardiography. The same ophthalmic evaluation was performed at each follow-up visit.

Main Outcome Measures

Demographic features, associated systemic and ophthalmic abnormalities, and sources of emboli in various types of RAO.

Results

We classified RAO into central (CRAO) and branch (BRAO) artery occlusion. In both nonarteritic (NA) CRAO and BRAO, the prevalence of diabetes mellitus, arterial hypertension, ischemic heart disease, and cerebrovascular accidents were significantly higher compared with the prevalence of these conditions in the matched US population (all P<0.0001). Smoking prevalence, compared with the US population, was significantly higher for males (P = 0.001) with NA-CRAO and for women with BRAO (P = 0.02). Ipsilateral internal carotid artery had ≥50% stenosis in 31% of NA-CRAO patients and 30% of BRAO, and plaques in 71% of NA-CRAO and 66% of BRAO. An abnormal echocardiogram with an embolic source was seen in 52% of NA-CRAO and 42% of BRAO. Neovascular glaucoma developed in only 2.5% of NA-CRAO eyes.

Conclusions

This study showed that, in CRAO as well as BRAO, the prevalence of various cardiovascular diseases and smoking was significantly higher compared with the prevalence of these conditions in the matched US population. Embolism is the most common cause of CRAO and BRAO; plaque in the carotid artery is usually the source of embolism and less commonly the aortic and/or mitral valve. The presence of plaques in the carotid artery is generally of much greater importance than the degree of stenosis in the artery. Contrary to the prevalent misconception, we found no cause-and-effect relationship between CRAO and neovascular glaucoma.

Financial Disclosure(s)

The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Section snippets

Materials and Methods

We conducted this study in patients with CRAO and with BRAO seen in our Ocular Vascular Clinic, a Tertiary Care referral center at the University of Iowa Hospitals & Clinics, as a part of National Institute of Health–funded (RO1) prospective studies on ocular vascular occlusive disorders, approved by the Institutional Review Board. The study consists of a cohort of 439 patients (499 eyes), with CRAO in 249 patients (289 eyes) and BRAO in 190 patients (210 eyes), seen consecutively from 1973 to

Central Retinal Artery Occlusion

There were 234 NA-CRAO patients (271 eyes), 37 (16%) with bilateral involvement. More than half of the 271 eyes had NA-CRAO alone (156 eyes), with the rest having other types of CRAO (Table 1). The demographic characteristics of these patients are listed in Table 3. Development of CRAO was discovered at waking in 29.5% (80 eyes). In this cohort of CRAO patients, the natural history of visual outcome3 and fundus findings4 are described in detail elsewhere.

Branch Retinal Artery Occlusion

There were 141 patients (160 eyes) with

Discussion

There is a large volume of literature dealing with various aspects of RAO, including visual outcome, sources of retinal emboli, systemic diseases, hematologic abnormalities, and other risk factors associated with RAO.

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    Manuscript no. 2008-1536.

    Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article.

    Supported by grant EY-1151 from the National Institutes of Health.

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