June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Incidence of Total Blindness After Central Retinal Artery Occlusion with Ocular Neovascularization
Author Affiliations & Notes
  • Harshvardhan Chawla
    Ophthalmology, Louisiana State University, New Orleans, Louisiana, United States
  • Hayley J. Redrick
    Ophthalmology, Louisiana State University, New Orleans, Louisiana, United States
  • Joshua T. Pannell
    Ophthalmology, Louisiana State University, New Orleans, Louisiana, United States
  • D. Anthony Mazzulla
    Ophthalmology, Ochsner Medical Center, Jefferson, Louisiana, United States
  • Joseph D. Benevento
    Ophthalmology, Ochsner Medical Center, Jefferson, Louisiana, United States
  • Sidharth Puri
    Ophthalmology, Ochsner Medical Center, Jefferson, Louisiana, United States
  • Footnotes
    Commercial Relationships   Harshvardhan Chawla None; Hayley Redrick None; Joshua Pannell None; D. Mazzulla None; Joseph Benevento None; Sidharth Puri None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 1771. doi:
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      Harshvardhan Chawla, Hayley J. Redrick, Joshua T. Pannell, D. Anthony Mazzulla, Joseph D. Benevento, Sidharth Puri; Incidence of Total Blindness After Central Retinal Artery Occlusion with Ocular Neovascularization. Invest. Ophthalmol. Vis. Sci. 2023;64(8):1771.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : While the incidence and risk factors of ocular neovascularization (ONV) following central retinal artery occlusion (CRAO) have previously been described, visual prognostic data associated with this secondary complication is lacking. The aim of this retrospective cohort study was to determine the time-based incidence of total blindness following post-CRAO ONV. This was defined as a best-corrected visual acuity (BCVA) of no light perception (NLP).

Methods : We queried the institutional electronic medical record using ICD-10 codes to identify patients with CRAO between January 2012 and December 2022. Subjects with secondary ONV were identified via chart review. Data collected included demographics, medical comorbidities, clinical presentation, medical/surgical management, and BCVA values. Patients with possible alternative etiologies of ONV (Figure 1) and/or prior panretinal photocoagulation (PRP) or anti-vascular endothelial growth factor (VEGF) therapy were excluded. Kaplan-Meier reverse survival analysis was performed with total blindness as the outcome of interest.

Results : Of 369 patients with confirmed CRAO, 33 with post-CRAO ONV met final inclusion criteria (Figure 1) with a mean follow-up of 22.0 ± 26.3 months. ONV management included PRP (69.7%), glaucoma drainage implant surgery or transscleral cyclophotocoagulation (30.3%), and intravitreal anti-VEGF therapy with Bevacizumab 1.25 mg (mean 2.6 ± 5.7 injections per patient). Total blindness occurred in 42.4% of subjects, at a mean of 11.9 ± 16.7 months from ONV onset. Sixty percent of patients who underwent glaucoma surgery ultimately reached NLP status. Kaplan-Meier analysis demonstrated total blindness rates of 30.2%, 46.1%, and 85.0% at 1, 2, and 5 years, respectively (Figure 2).

Conclusions : CRAO is known to cause irreversible severe vision loss. However, secondary ONV is associated with a significant incidence of progression to total blindness within 5 years of onset. Patients should be counseled about the importance of follow-up adherence following CRAO, with regular gonioscopy and aggressive early intervention for secondary ONV upon detection.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

 

Figure 1: Subject Selection Flowchart

CRAO, central retinal artery occlusion; ONV, ocular neovascularization.

Figure 1: Subject Selection Flowchart

CRAO, central retinal artery occlusion; ONV, ocular neovascularization.

 

Figure 2: Time-Based Incidence of No Light Perception Status

Total blindness was defined as a best-corrected visual acuity of no light perception.

Figure 2: Time-Based Incidence of No Light Perception Status

Total blindness was defined as a best-corrected visual acuity of no light perception.

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