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Jeannine K. Giacovelli, Arash Mozayan, Umar Mian; Retinal artery occlusions, Hollenhorst plaques and cerebrovascular events and mortality in the Bronx. Invest. Ophthalmol. Vis. Sci. 2012;53(14):988.
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Central retinal artery occlusions (CRAO), branch retinal artery occlusions (BRAO) and Hollenhorst plaques (HHP) are regarded as predictors of atherosclerosis, and may place patients at higher risk for cerebrovascular compromise and death. The purpose of this study is to examine the association between CRAO, BRAO and HHP and the risk of cerebrovascular events and death in an ethnically diverse population in the Bronx.
Outpatients with a diagnosis of CRAO, BRAO or HHP were identified in a retrospective review of the Montefiore Medical Center Eye Clinic’s electronic and paper charts from January 2001 through January 2011. ICD-9 diagnosis codes for CRAO (362.31), BRAO (362.32) and HHP (362.33) were used to determine our patient population. Medical records were reviewed to gather demographic and clinical data. A matched control group was created for each diagnosis to assess the risk of mortality and cerebrovascular events in patients with CRAO, BRAO and HHP, using a log-rank Mantel-Haenszel test from our institutional research software Clinical Looking Glass. Patients with a diagnosis of CRAO, BRAO or HHP were excluded from the control groups.
The study yielded 159 patients with CRAO (41% men, 59%women), 284 with BRAO (42% men, 58% women) and 85 with HHP (33% men, 67% women) with a median age of 66, 70 and 65 respectively. Atherosclerotic risk factors in the CRAO population included hypertension (67%), hyperlipidemia (50%), and diabetes (43%). The BRAO risk factors included hypertension (76%), hyperlipidemia (52%) and diabetes (51%). The HHP risk factors included hypertension (75%), hyperlipidemia (70%) and diabetes (62%). Mortality was statistically significantly higher in the CRAO (27%, p=0.01) and BRAO groups (33%, p=3.77e-6) when compared to their respective control groups, but the HHP group did not reach statistical significance (20%, p=0.6). The rate of cerebrovascular events was significantly higher in the CRAO (9%, p=0.01) and BRAO groups (12%, p=0.03) when compared to their respective control groups, but the HHP group did not reach statistical significance (7%, p=0.27).
The presence of a CRAO or BRAO is associated with a higher rate of cerebrovascular events and death, whereas the finding of HHP does not appear to increase the risk of either. These results suggest that an evaluation, including cost-utility analysis, of current clinical practice following the identification of Hollenhorst plaques may be warranted.
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