Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA.
Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
J Stroke Cerebrovasc Dis. 2024 Sep;33(9):107895. doi: 10.1016/j.jstrokecerebrovasdis.2024.107895. Epub 2024 Jul 28.
Visual outcomes of acute central and branch retinal artery occlusions (CRAO/BRAO) are poor and acute treatment options are limited by delayed diagnosis. In the hyper-acute setting, the ocular fundus may appear "normal", making recognition challenging, but is facilitated by retinal optical coherence tomography (OCT), which is seldom available in emergency departments (ED). We evaluated the use of non-mydriatic ocular fundus photographs (NMFP) combined with OCT to facilitate ultra-rapid remote diagnosis and stroke alert for patients with acute vision loss presenting to the ED.
Prospective evaluation of all CRAO/BRAO between 06/06/2023-06/06/2024 who had NMFP-OCT in our general ED affiliated with a stroke center.
Over 1 year, 22 patients were diagnosed with CRAO, 4 with BRAO. Five patients presented within 4.5 hours of vision loss onset, 6 within 4.5 to ≤12 hours and 15 within >12 to 24 hours. On average, NMFP-OCT was performed within 141 minutes of presentation to the ED (range 27- 422 minutes). Diagnosis of acute RAO was made remotely with NMFP-OCT within 4.5 hours in 4 patients, 2 of whom received intravenous thrombolysis. Of the 9 patients with NMFP-OCT within 12 hours of symptom onset, 5 patients had subtle retinal whitening on color fundus photograph, but all had OCT inner retinal hyper-reflectivity/edema.
Implementation of NMFP-OCT in a general ED enables rapid remote diagnosis of CRAO/BRAO and facilitates initiation of an eye stroke protocol in acute patients. OCT complements color fundus photography and provides greater diagnostic accuracy in hyperacute cases with near-normal appearing ocular fundi.
急性中央和分支视网膜动脉阻塞（CRAO/BRAO）的视觉预后较差，急性治疗选择受到延迟诊断的限制。在超急性期，眼底可能看起来“正常”，难以识别，但视网膜光相干断层扫描（OCT）有助于识别，而眼科急症病房（ED）通常无法提供 OCT。我们评估了非散瞳眼底照相（NMFP）结合 OCT 在 ED 就诊的急性视力丧失患者中进行超快速远程诊断和卒中预警的应用。
前瞻性评估 2023 年 6 月 6 日至 2024 年 6 月 6 日期间在我们附属卒中中心的普通 ED 就诊的所有 CRAO/BRAO 患者，这些患者均行 NMFP-OCT。
在 1 年期间，诊断为 CRAO 的患者 22 例，BRAO 患者 4 例。5 例患者在视力丧失发作后 4.5 小时内就诊，6 例在 4.5 至≤12 小时内就诊，15 例在>12 至 24 小时内就诊。NMFP-OCT 平均在 ED 就诊后 141 分钟内完成（范围 27-422 分钟）。在 4 例患者中，通过 NMFP-OCT 在 4.5 小时内远程诊断出急性 RAO，其中 2 例接受了静脉溶栓治疗。在症状发作后 12 小时内行 NMFP-OCT 的 9 例患者中，5 例眼底彩照有轻微视网膜变白，但所有患者均有 OCT 内层视网膜高反射/水肿。
在普通 ED 中实施 NMFP-OCT 能够快速远程诊断 CRAO/BRAO，并有助于在急性患者中启动眼卒中方案。OCT 补充了眼底彩照，在眼底看似正常的超急性期病例中提供了更高的诊断准确性。
