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Presence of Embolic Source and Outcome in Central Retinal Artery Occlusion
Dong-Wan Kang1, Keun-Hwa Jung2, Wookjin Yang1
1From the Department of Neurology (D.-W.K., K.-H.J., W.Y., Y.K., M.C., J.H., M.T.P., E.-J.L., H.-Y.J., J.-M.K., S.-B.K., S.-H.L.), Seoul National University Hospital & Seoul National University College of Medicine; Headquarters for Public Health Care (D.-W.K.), Seoul National University Bundang Hospital, Seongnam; Department of Ophthalmology (H.M.K.), Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Clinical Neurosciences (M.T.P.), University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines; and Korean Cerebrovascular Research Institute (J.-M.K., S.-H.L.), Seoul, South Korea.
Insights
Identifying an embolic source in central retinal artery occlusion (CRAO) is linked to better visual outcomes. Patients with CRAO and an embolic source (CRAO-E+) showed improved vision more frequently.
Area of Science:
- Ophthalmology
- Neurology
- Vascular Medicine
Background:
- The cause of central retinal artery occlusion (CRAO) remains unknown in about half of cases, indicating diverse underlying mechanisms.
- Understanding how different etiologies of CRAO impact patient outcomes is crucial for effective treatment strategies.
Purpose of the Study:
- To determine if the presence of an embolic source influences the visual outcome in patients with central retinal artery occlusion (CRAO).
Main Methods:
- Retrospective analysis of 114 CRAO patients within 7 days of symptom onset.
- Etiology categorized as CRAO with (CRAO-E+) or without (CRAO-E-) an embolic source.
- Visual acuity and brain imaging were reviewed; visual improvement defined as a ≥0.3 decrease in logMAR at 1 month.
Main Results:
- Visual improvement occurred in 40.4% of patients.
- Embolic sources were identified in 55.3% of cases.
- CRAO-E+ independently predicted visual improvement (OR 3.00, p=0.025).
Conclusions:
- Central retinal artery occlusion with an embolic source (CRAO-E+) is associated with a better visual prognosis.
- CRAO-E+ may have a higher likelihood of recanalization compared to CRAO-E-.
Objectives:
The etiology of central retinal artery occlusion (CRAO) is unclear in approximately 50% of patients, suggesting pathomechanical heterogeneity; moreover, little is known about outcomes according to etiology. This study investigated whether the presence of an embolic source affects outcome in CRAO.
Methods:
CRAO patients within 7 days of symptom onset were retrospectively enrolled. Clinical parameters, including initial and 1-month visual acuity, CRAO subtype, and brain images, were reviewed. CRAO etiology was categorized as CRAO with or without an embolic source (CRAO-E+ and CRAO-E-). Visual improvement was defined as a decrease in logarithm of the minimum angle of resolution ≥0.3 at 1 month.
Results:
A total of 114 patients with CRAO were included. Visual improvement was noted in 40.4% of patients. Embolic sources were identified in 55.3% of patients, and visual improvement group rather than no improvement group was more commonly associated with the presence of an embolic source. In multivariable logistic regression analysis, CRAO-E+ independently predicted visual improvement (odds ratio 3.00, 95% CI 1.15-7.81, p = 0.025).
Discussion:
CRAO-E+ was found to be associated with a better outcome. CRAO-E+ may be more prone to recanalization than that CRAO-E-.
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