Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48105, USA.
Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
Graefes Arch Clin Exp Ophthalmol. 2024 Nov;262(11):3577-3587. doi: 10.1007/s00417-024-06527-5. Epub 2024 Jun 7.
To understand the etiology, work-up, and secondary systemic and ocular events of retinal artery occlusion (RAO) in young patients (≤ 45 years old) without typical cardiovascular risk factors.
Retrospective longitudinal case series of 18 young patients with RAO and without typical cardiovascular risk factors evaluated at the University of Michigan Medicine Health System between the year 2000 and 2022. Laboratory and imaging studies performed at the time of RAO diagnosis, along with systemic and ocular events during follow-up, were recorded. These data were combined with data from a literature review of 74 similar patients experiencing a RAO.
Fifteen (83%) of patients were female and 10 (56%) suffered a branch retinal artery occlusion (BRAO). 56% of patients had one risk factor associated with cryptogenic stroke, most commonly a migraine history (33%). The most frequent etiology of RAO was vasculitis (28%), followed by idiopathic (22%) and patent foramen ovale (PFO, 17%). Three out of four patients with idiopathic RAOs developed new migraines around the time of RAO diagnosis, whereas none of the patients with a clear etiology had new onset migraines (n = 14). No patients suffered a stroke or myocardial infarction (MI) in the follow-up period (average 3.6 years ± 3.2 years). Two patients (11%) suffered a repeat RAO, both of whom were diagnosed with a vasculitis. Patients with isolated retinal vasculitis required repeat fluorescein angiograms for up to 2 years after the initial event to definitively identify the vasculitic etiology of the RAO. When our data are pooled with similarly healthy patients from previously published RAO series, structural/functional cardiac abnormalities and vasculitides are the most common identifiable etiologies for RAOs in this group.
The most common identifiable etiologies of RAO in young patients with low cardiovascular risk are structural/functional cardiac abnormalities and vasculitides, with a small range of additional causes/associations accounting for remaining cases. We suggest a focused work-up algorithm to rapidly identify etiologies in this group while minimizing unnecessary testing. The long-term risk of systemic or ocular secondary events in these patients is low regardless of the etiology of their RAO.
了解无典型心血管危险因素的年轻患者（≤ 45 岁）视网膜动脉阻塞（RAO）的病因、检查及继发的系统性和眼部事件。
对 2000 年至 2022 年期间在密歇根大学医学健康系统接受治疗的 18 例无典型心血管危险因素的年轻 RAO 患者进行回顾性纵向病例系列研究。记录 RAO 诊断时进行的实验室和影像学研究，以及随访期间的系统性和眼部事件。这些数据与文献复习中 74 例 RAO 患者的数据相结合。
15 例（83%）患者为女性，10 例（56%）为分支视网膜动脉阻塞（BRAO）。56%的患者有 1 个与隐源性卒中相关的危险因素，最常见的是偏头痛病史（33%）。RAO 的最常见病因是血管炎（28%），其次是特发性（22%）和卵圆孔未闭（PFO，17%）。4 例特发性 RAO 中有 3 例在 RAO 诊断时出现新发偏头痛，而无明确病因的患者无一例新发偏头痛（n=14）。在随访期间，无患者发生卒中或心肌梗死（MI）（平均随访 3.6 年±3.2 年）。2 例（11%）患者发生复发性 RAO，均诊断为血管炎。单纯视网膜血管炎患者需要在最初事件后长达 2 年重复进行荧光素血管造影，以明确 RAO 的血管炎病因。将我们的数据与之前发表的 RAO 系列中同样健康的患者数据汇总后，结构性/功能性心脏异常和血管炎是该组 RAO 最常见的可识别病因。
低心血管风险的年轻患者 RAO 最常见的可识别病因是结构性/功能性心脏异常和血管炎，极少数其他病因/关联占其余病例。我们建议采用一种针对性的检查方案，在尽量减少不必要检查的同时快速确定病因。无论 RAO 的病因如何，这些患者发生系统性或眼部继发性事件的长期风险均较低。
