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PRESENCE OF EMBOLIC SOURCE IN CENTRAL RETINAL ARTERY OCCLUSION PREDICTS FAVORABLE OUTCOME
Abstract
Background and Aims
Although thromboembolism is the most common cause of central retinal artery occlusion (CRAO), 38~50% remain unknown etiology, suggesting that they could have a different pathomechanism. Little is known about functional outcomes according to the etiologies. Here, we investigated the visual outcome of the CRAO with and without the presence of embolic source.
Methods
Patients with CRAO within 7 days of symptom onset between 2000 and 2021 were reviewed retrospectively. Initial VA (visual acuity), 1-month VA, use of thrombolytics, onset-to-visit time, comorbidities, and brain images were reviewed. CRAO with embolic source was defined when evidence of cardioembolism, large artery atherosclerosis, diseases causing hypercoagulability, or carotid dissection. CRAO without embolic source was defined when there was no evidence of embolic source or the presence of vasculitis. Improvement of VA was defined by ∆ logarithm of the minimum angle of resolution (LogMAR) ≤ -0.3 at 1 month.
Results
Of 114 patients, the median onset-to-visit time was 24h [IQR 8.4–72]. VA was improved in 38.6% (initial and 1-month LogMAR, 2.2 ± 0.5 vs. 2.0 ± 0.6, n=44). Embolic sources were identified in 63 (55.3%) patients, and they were more commonly associated with VA improvement than no improvement (70.5% vs. 55.3%, P=0.017). In a multivariable logistic regression analysis, CRAO with embolic source independently predicted VA improvement (OR 2.52, 95% CI 1.04–6.09), while intraarterial thrombolysis did not.
Conclusions
CRAO with the presence of an embolic source was closely related to the functional improvement of VA. This finding might be linked to the difference in etiological mechanisms of CRAO.