The Retina Institute, 2201 S. Brentwood Blvd, St. Louis, MO, 63144, USA.
Washington University School of Medicine, St. Louis, MO, USA.
Graefes Arch Clin Exp Ophthalmol. 2021 Sep;259(9):2625-2632. doi: 10.1007/s00417-021-05135-x. Epub 2021 Mar 12.
Acute retinal artery occlusion (RAO) is an urgent ophthalmic condition often indicative of future ischemic pathology. Patients diagnosed at an outpatient retina clinic must present to an emergency department (ED) or primary care clinic to obtain a systemic workup. We review the overall compliance and suspected delay in completing the required testing.
Retrospective cohort study METHODS: Patients presenting with a symptomatic RAO from June 2009 to January 2019 at a vitreoretinal practice (The Retina Institute, St. Louis, MO) were included. Documentation of carotid vasculature and echocardiographic imaging was requested from the patient's primary care physician (PCP), cardiologist, or neurologist. Time to workup (TTW) from RAO diagnosis to receiving appropriate workup and site of workup (ED vs. outpatient setting) were recorded.
One hundred forty-seven patients were included. A total of 132 (89.8%) patients were documented as having completed at least one type of cardiovascular or carotid imaging. Seventy-seven patients (52.3%) were documented to have completed both carotid and echocardiographic imaging. Following RAO diagnosis, 97 (66.0%) patients were referred to an outpatient facility while 35 (23.8%) were evaluated at an ED. Mean TTW through an ED setting vs. outpatient was 2.20 days (1.10 STDM, range 0-29) vs.13.6 days (2.23 STDM, range 0-149) respectively (p=0.003).
Our study gives objective data to the delay suspected in referring patients with acute symptomatic RAO for outpatient workup. We recommend all outpatient ophthalmology and retina practices establish a relationship with a comprehensive or primary stroke center to facilitate urgent testing through an emergency department.
急性视网膜动脉阻塞（RAO）是一种紧急的眼科病症，通常预示着未来的缺血性病理。在门诊视网膜诊所被诊断出的患者必须前往急诊部（ED）或初级保健诊所进行系统检查。我们回顾了总体合规性和疑似延迟完成所需检查的情况。
回顾性队列研究
纳入 2009 年 6 月至 2019 年 1 月在玻璃体视网膜实践（圣路易斯视网膜研究所，密苏里州）就诊的有症状 RAO 患者。向患者的初级保健医生（PCP）、心脏病专家或神经科医生请求进行颈动脉血管造影和超声心动图成像。从 RAO 诊断到接受适当检查的检查时间（TTW）和检查地点（ED 与门诊）被记录。
共纳入 147 例患者。共有 132 例（89.8%）患者被记录完成了至少一种心血管或颈动脉成像。77 例（52.3%）患者被记录完成了颈动脉和超声心动图成像。RAO 诊断后，97 例（66.0%）患者被转诊至门诊医疗机构，35 例（23.8%）在 ED 接受评估。通过 ED 就诊的平均 TTW 为 2.20 天（1.10 STDM，范围 0-29），而通过门诊就诊的平均 TTW 为 13.6 天（2.23 STDM，范围 0-149）（p=0.003）。
我们的研究为疑似延迟转诊急性症状性 RAO 患者进行门诊检查提供了客观数据。我们建议所有门诊眼科和视网膜诊所与综合或初级卒中中心建立关系，以通过急诊部促进紧急检查。
