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R. M. Feist, A. L. Dahl, R. S. Vail, T. O. Persaud, J. O. Mason, III; Short Term Survivorship and Incidence of New Cerebrovascular Events Following Retinal Artery Occlusion With or Without Visible Emboli in 81 Consecutive Patients. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5208. doi: https://doi.org/.
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This study attempts to review the short term survivorship and assess the risk of subsequent cerebrovascular events in all patients presenting with ophthalmoscopic evidence of retinal artery occlusions, whether or not there is a visible embolus. Much of the most recently published data on mortality and morbidity centers on patients with visible emboli.
Internal chart review of a single institution from 1996-2006 was performed. Diagnoses of central or branch retinal artery occlusion had been made by fundus exam and/or fluorescein angiography. Information on subsequent mortality or cerebrovascular events was ascertained from patients’ medical records after obtaining proper informed consent. Mortalities were confirmed by search of the Social Security Death Index or by contacting patients’ next of kin.
Eighty-one patients with central (n=47) or branch (n=34) retinal artery occlusion from 1996-2006 were identified. Emboli were seen in 48% of cases. The mean age at diagnosis of artery occlusion was 66 (range 41-89 years old). The mean time of follow up was 3.15 years. During this time period seven patients (8.6%) expired from all causes. There were four patients (4.9%) who suffered a new cerebrovascular event (non-fatal).
The presence of a retinal artery occlusion is believed to be associated with an increased mortality over the ensuing decade. Previous research has focused on central retinal artery occlusions with ophthalmoscopic evidence of an embolus. In central retinal artery occlusions, as many as 80% may not have ophthalmoscopic evidence of an embolus. Mortality rates drawn only from the subset with emboli may not be applicable to all patients with artery occlusions. As some artery occlusions may be related to inflammation, vasculitis, vasospasm or hypotension rather than embolus, these may portend a different prognosis. Similarly, subsequent morbidities, such as stroke, may have a different likelihood in the presence or absence of embolus. Therefore, artery occlusions without emboli may evoke a systemic workup with attention to these factors rather than to embolic sources alone.
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