Interventions for acute non-arteritic central retinal artery occlusion

Lin, John C.; Song, Sophia; Ng, Sueko M; Greenberg, Paul B.

doi:10.1002/14651858.cd001989.pub3

Cited by 11 publications

(11 citation statements)

References 80 publications

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“…Numerous approaches have been attempted with the goal of dislodging emboli and enhancing retinal blood flow through various procedures, such as ocular massage, intraocular pressure reduction, isovolemic hemodilution, anticoagulation, and intraarterial fibrinolysis. These interventions have yielded poor visual outcomes ( 44 , 45 ). Conversely, a strict management of cardiovascular risk factors is encouraged to manage CRVO ( 41 ), and there is no standard of treatment for Purtscher’s retinopathy ( 35 ).…”

Section: Discussionmentioning

confidence: 99%

Ophthalmic vascular manifestations in eosinophil-associated diseases: a comprehensive analysis of 57 patients from the CEREO and EESG networks and a literature review

Chapuis,

Bousquet,

Viallard

et al. 2024

Front. Immunol.

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IntroductionEosinophils have widespread procoagulant effects. In daily practice, eosinophil-related cardiovascular toxicity consists of endomyocardial damage, eosinophilic vasculitis and arterial or venous thrombosis. Here we aim to report on the clinical features and treatment outcomes of patients with unexplained ophthalmic vascular manifestations and eosinophilia.MethodsWe conducted a retrospective, multicenter, observational study and a literature review of patients with eosinophilia (≥0.5 x109/L) and concomitant ophthalmic vascular manifestations independent of the underlying eosinophilic disease but with no alternative cause for ophthalmic manifestations. ResultsFifty-seven patients were included (20 from the observational study and 37 from the literature review). Ophthalmic vascular features were the initial manifestation of eosinophil-related disease in 34 (59%) patients and consisted of 29 central retinal artery occlusions, six branch retinal artery occlusions, five central retinal vein occlusions, two branch retinal vein occlusions, seven retinal vasculitides, two retinal vasospasms, 12 Purtscher’s retinopathies, 13 anterior ischemic optic neuropathies and two posterior ischemic optic neuropathies. The median [IQR] absolute eosinophil count at onset of ophthalmic vascular manifestations was 3.5 [1.7-7.8] x109/L. Underlying eosinophil-related diseases included eosinophilic granulomatosis with polyangiitis (n=32), clonal hypereosinophilic syndrome (HES) (n=1), idiopathic HES (n=13), lymphocytic HES (n=2), adverse drug reactions (n=3), parasitosis (n=2), polyarteritis nodosa (n=1), IgG4-related disease (n=1), eosinophilic fasciitis (n=1) and primary sclerosing cholangitis (n=1). Other extra-ophthalmologic arterial or venous thromboses related to eosinophilia were reported in four (7%) and nine (16%) patients, respectively. Visual prognosis was poor: only eight (10%) patients achieved full recovery of ophthalmologic symptoms. After a median follow-up of 10.5 [1-18] months, one patient (3%) had a recurrence of an ophthalmic vascular manifestation, and three patients (10%) had a recurrence of other vascular symptoms (deep vein thrombosis in two and pulmonary embolism in one patient). At the time of recurrence, absolute eosinophil counts were above 0.5 x109/L in all cases (n=4). DiscussionThis study broadens the spectrum of vascular manifestations associated with hypereosinophilia by adding ophthalmic vascular manifestations. In patients with ophthalmological vascular manifestations and hypereosinophilia, aggressive treatment of the underlying pathology (and normalization of blood count) should be implemented.

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Section: Discussionmentioning

confidence: 99%

Ophthalmic vascular manifestations in eosinophil-associated diseases: a comprehensive analysis of 57 patients from the CEREO and EESG networks and a literature review

Chapuis,

Bousquet,

Viallard

et al. 2024

Front. Immunol.

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“…Identifying biomarkers for CRAO is important in stratifying patients to determine who would benefit from possible interventions. 34 The detection of fluid on OCT has become easier with newer technology allowing higher-resolution scans and rapid acquisition. 35 Fluid leakage in eyes with acute CRAO and AION likely represents a feature of neuronal damage with blood-retinal barrier breakdown and understanding the implications of fluid accumulation and its distribution might help in understanding the extent of damage and in counseling the patients about their visual prognosis.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Distribution of Macular Fluid with Central Retinal Artery Occlusion and Anterior Ischemic Optic Neuropathy

Fouad,

Hamza,

Wessam

2024

OPTH

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Purpose To examine the prevalence and distribution of fluid within a cohort of eyes with acute central retinal artery occlusion (CRAO) and non-arteritic anterior ischemic optic neuropathy (AION) using optical coherence tomography (OCT). Methods A retrospective analysis of patient records and OCT imaging. Patients presenting with acute CRAO or AION who had available macular OCT imaging and no co-morbidities known to cause macular fluid were included in the analysis. Baseline characteristics, visual acuity (VA), and fluid presence and distribution among the retinal layers were recorded. Results In the 16 eyes with acute CRAO, fluid was noted in 5 eyes (31%), which was mainly subretinal (3 eyes) or intraretinal located within the outer retinal layers (3 eyes). Only one eye had inner retinal cysts. Of the 11 eyes with acute AION, fluid was present in 8 eyes (73%). Subretinal fluid was noted in 4 eyes and extended to the foveal area in 3 of them, and outer retinal versus inner retinal cysts were noted in 6 versus 3 eyes, respectively. None of the eyes showed hard exudate deposition. In the small subset of eyes with CRAO and macular fluid that were followed-up, VA improved, while in eyes with AION, VA remained stable. Conclusion Macular fluid on OCT is not an uncommon feature of acute CRAO and AION and is mainly distributed within the outer retinal layers or subretinal space. Fluid is an understudied feature of retinal and optic nerve head infarction and may have a role in predicting neuronal damage extent and visual outcome.

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“…7 We avoided comparing the visual outcome of patients who received thrombolytics to those with non-thrombolytic therapies because of the large diversity of conservative management and the high heterogeneity among these studies. 11,14 The result of meta-regression models suggested that multiple factors can influence the outcome of patients. To better explore this effect, we studied the IPD, and we observed the predictive value of admission VA, having at least 2 weeks intervals before the final VA assessment, and a shorter time frame between the visual loss to thrombolysis for an improved outcome.…”

Section: Discussionmentioning

confidence: 99%

“…9,10 Only six randomized controlled trials including 223 acute non-arteritic CRAO (naCRAO) patients were reported so far to compare various proposed interventions, and meta-analysis could not be conducted due to study heterogeneity. 11 Previous systematic reviews and meta-analyses appraising the visual recovery rates after thrombolysis in CRAO included observational studies and case series to try to derive a conclusion. [12][13][14][15] They compared the visual recovery rate among CRAO patients treated with thrombolysis versus non-thrombolytic therapies.…”

Section: Introductionmentioning

confidence: 99%

Thrombolysis for central retinal artery occlusion: An individual participant-level meta-analysis

Shahjouei

Guo

Dumitrascu

2023

International Journal of Stroke

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Background: Whether thrombolysis improves outcome in non-arteritic central retinal artery occlusion (naCRAO) is uncertain. We aimed to evaluate the rate of visual recovery after intra-venous (IVT) or intra-arterial (IAT) administration of tissue plasminogen activator (tPA) or urokinase (UK) among patients with naCRAO and explore the parameters affecting the final visual acuity (VA). Aim: We systematically searched 6 databases. Logarithm of the Minimum Angle of Resolution (logMAR) and VA of ≥20/100 was used to quantify visual recovery. To explore the role of other factors on visual recovery, we defined two models for studies with aggregated data (AD, designs 1 and 2) and 16 models for individual participant data (IPD, models 1-16). Summary of Review: We included data from 771 patients out of 72 publications in nine languages. Visual improvement for ≥0.3 logMAR was reported in 74.3% of patients who received IVT-tPA within 4.5 hours (CI: 60.9%-86.0%; unadjusted rate: 73.2%) and 60.0% of those who received IAT-tPA within 24 hours (CI: 49.1%-70.5%; unadjusted rate: 59.6%). VA of ≥20/100 was observed among 39.0% of patients after IVT-tPA within 4.5h and 21.9% of those with IAT-tPA within 24 hours. IPD models highlighted the association between improved visual outcomes and VA at presentation, at least two weeks follow-up before reporting the final VA, antiplatelet therapy, and shorter symptom onset to thrombolysis window. Conclusions: Early thrombolytic therapy with tPA is associated with enhanced visual recovery in naCRAO. Future studies should refine the optimum time window for thrombolysis in naCRAO.

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Interventions for acute non-arteritic central retinal artery occlusion

Cited by 11 publications

References 80 publications

Ophthalmic vascular manifestations in eosinophil-associated diseases: a comprehensive analysis of 57 patients from the CEREO and EESG networks and a literature review

Ophthalmic vascular manifestations in eosinophil-associated diseases: a comprehensive analysis of 57 patients from the CEREO and EESG networks and a literature review

Prevalence and Distribution of Macular Fluid with Central Retinal Artery Occlusion and Anterior Ischemic Optic Neuropathy

Thrombolysis for central retinal artery occlusion: An individual participant-level meta-analysis

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