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K.D. Gan, E. Weis, M. Muratoglu, S. Flynn, I. MacDonald; Modifiable Atherosclerotic Risk Factors in Patients With Arterial and Venous Ocular Strokes . Invest. Ophthalmol. Vis. Sci. 2005;46(13):3288.
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Purpose: The atherosclerotic risk profile of patients suffering from an acute vascular occlusion of the visual system is not well studied. We are the first to employ comprehensive, systematic, and modern ophthalmological and neurological examination to describe the atherosclerotic risk profile of these 'ocular stroke' patients, and subdivide these risk factors according to stroke type. Methods: Patients diagnosed with an ocular stroke were enrolled prospectively and underwent both a complete ophthalmological assessment by an ophthalmologist, and also a systematic atherosclerotic work–up by a stroke neurologist. Results: 211 patients were enrolled in the study. There were 63 branch retinal vein occlusions, 41 central retinal vein occlusions, 36 branch retinal artery occlusions, 17 central retinal artery occlusions, 27 non–arteritic anterior ischemic optic neuropathies (NA–AION), 10 asymptomatic retinal emboli, 9 amaurosis fugax, 6 cranial nerve palsies, and 2 hemiretinal vein occlusions. Of all the patients: 73% were hypertensive, 70% were hyperlipidemic, 23% were diabetic, and 22% were smokers. 100% of the patients required some change in their current atherosclerotic risk management. Of the venous occlusion patients: 75% were hypertensive, 70% were hyperlipidemic, 20% were diabetic, and 18% were smokers. 2% qualified for endarterectomy following carotid Doppler examination. Of the arterial occlusion patients: 76% were hypertensive, 63% were hyperlipidemic, 24% were diabetic, and 28% were smokers. 10% qualified for endarterectomy following carotid Doppler examination. Of the NA–AION patients: 67% were hypertensive, 96% were hyperlipidemic, 22% were diabetic, 19% were smokers. 0% qualified for endarterectomy following carotid Doppler examination. Conclusions: The importance of working–up and carefully managing ocular stroke patients is evident in that 100% of patients had modifiable atherosclerotic risk factors that were either under–managed or not managed at all. Retinal venous occlusions are significantly more common than retinal arterial occlusions. However, carotid artery disease is much more common in retinal arterial occlusion patients. Patients with NA–AION had a significantly higher rate of hyperlipidemia, but were much less likely to have carotid artery disease. This suggests that atherosclerotic work–up and management of patients should be tailored according to the type of ocular stroke.
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