Department of Neurological Surgery, Wake Forest Baptist Health, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA.
Division of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, NC, USA.
J Stroke Cerebrovasc Dis. 2021 Feb;30(2):105531. doi: 10.1016/j.jstrokecerebrovasdis.2020.105531. Epub 2020 Dec 10.
Acute central retinal artery occlusion (CRAO) is an ophthalmologic emergency that often results in permanent vision loss. Over 25% are associated with acute cerebral ischemia. In the absence of existing Level I treatment options, this study aims to examine institutional practice patterns and review the literature to develop a formalized approach to the treatment of CRAO in the era of ischemic stroke protocols.
This is a retrospective review of institutional practices in the workup and treatment of patients diagnosed with acute non-arteritic (NA) CRAO at a single center from January 2017 to August 2020.
Of 91 patients managed for acute NA-CRAO, 62.6% were male and average age was 66.4 years. Only 20.9% of patients presented within 4 h of symptom onset. 12.1% of patients had evidence of acute stroke on MRI, and 27.5% had ipsilateral internal carotid artery stenosis >50%. Half (52.7%) did not receive any acute treatment for CRAO, excluding antiplatelet/anticoagulation. 48.5% of patients undergoing acute medical treatment had improved visual acuity compared to 29.4% without treatment (p=0.14).
There is a lack of clear protocol for the management of NA-CRAO. While not reaching statistical significance, our experience mirrors the literature with patients undergoing medical treatment demonstrating improved visual acuity over those without treatment. Given the presence of acute ischemic stroke, carotid disease, and/or stroke risk factors in over 25% of patients with CRAO, multidisciplinary involvement and modern stroke algorithms should be considered for this disease.
急性中央视网膜动脉阻塞（CRAO）是一种眼科急症，常导致永久性视力丧失。超过 25%的患者与急性脑缺血有关。在缺乏现有一级治疗方案的情况下，本研究旨在检查机构的实践模式，并回顾文献，以制定在缺血性卒中方案时代治疗 CRAO 的规范化方法。
这是对一家中心 2017 年 1 月至 2020 年 8 月期间诊断为急性非动脉炎性（NA）CRAO 的患者进行的回顾性研究，旨在检查机构在对这些患者进行检查和治疗时的实践模式。
在 91 例接受急性非动脉炎性 CRAO 治疗的患者中，62.6%为男性，平均年龄为 66.4 岁。只有 20.9%的患者在症状发作后 4 小时内就诊。12.1%的患者 MRI 显示有急性卒中证据，27.5%的患者同侧颈内动脉狭窄>50%。有一半（52.7%）患者未接受任何急性 CRAO 治疗，不包括抗血小板/抗凝治疗。与未接受治疗的患者（29.4%）相比，接受急性药物治疗的 48.5%的患者视力有所改善（p=0.14）。
目前对于非动脉炎性 CRAO 的管理缺乏明确的方案。虽然没有达到统计学意义，但我们的经验与文献中的经验相似，即接受药物治疗的患者视力改善优于未接受治疗的患者。鉴于超过 25%的 CRAO 患者存在急性缺血性卒中、颈动脉疾病和/或卒中危险因素，应考虑多学科参与和现代卒中算法来治疗这种疾病。
