Hoyek Sandra, Yuan Melissa, Bejjani Romy, Zacks David N, Miller Joan W, Vavvas Demetrios G, Patel Nimesh A
From the Department of Ophthalmology, Massachusetts Eye and Ear (S.H., M.Y., R.B., J.W.M., D.G.V., and N.A.P.), Harvard Medical School, Boston, Massachusetts, USA.
Department of Ophthalmology, Kellogg Eye Center (D.N.Z.), University of Michigan Medical School, Ann Arbor, Michigan, USA.
Am J Ophthalmol. 2025 Feb;270:35-51. doi: 10.1016/j.ajo.2024.10.004. Epub 2024 Oct 15.
To characterize a large modern cohort of patients with central retinal artery occlusion (CRAO) by describing presenting features and outcomes relating to manually segmented optical coherence tomography (OCT) features, angiographic reperfusion, and visual recovery.
Retrospective clinical cohort study.
Patients with CRAO (ICD-10: H34.1) initially presenting to a tertiary referral center between January 2017 and December 2021 were included. Demographics, eye exam findings, fundus photographs, OCT, and fluorescein angiography were analyzed. Main outcome measures included total and inner retinal thickness on macular OCT, reperfusion, visual outcomes, and development of neovascularization.
A total of 145 eyes of 144 patients with mean age at of 69.4 ± 13.6 years were included. The mean time to presentation was 1.6 ± 4.2 days, with 19% examined within 4.5 hours and 26% within 6 hours of vision loss. 19% had cilioretinal artery (CLRA) sparing. Mean initial visual acuity (VA) was 1.68 ± 1.10 Logarithm of the Minimum Angle of Resolution (LogMAR) (CLRA sparing) compared to 2.53 ± 0.58 LogMAR (non-CLRA sparing), P < .001. 32% had elevated inflammatory makers. Out of 47 eyes with final fluorescein angiography, one-third showed some reperfusion. Final vision was 1.40 ± 1.16 LogMAR (CLRA sparing) compared to 2.46 ± 0.81 (non-CLRA sparing), P < .001. A third of patients improved in VA in both groups, 27% of patients gained more than 2 lines of vision in the CLRA-sparing group and 36% in the non-CLRA-sparing group. 17% improved to better than 20/200 in CLRA-sparing and 4% in non-CLRA sparing. Overall, 11% developed neovascularization all in non-CLRA sparing. In a multiple linear regression, VA at presentation was associated with regaining vision of 2 lines or more (OR = 2.603, P = .007). OCT showed progressive thinning over time, reaching lowest measurements at 6 months, and stabilizing thereafter.
In this modern cohort of acute CRAO patients, presentation to a tertiary facility within 12 hours of symptoms was seen in almost half of the patients. Final VA improved in almost a third of the patients, however, vision better than the legal blindness limit was rare (∼5%). Interestingly, a third of patients had some mild elevation of systemic inflammatory markers. Better VA at presentation was associated with visual gain, while baseline OCT values had poor correlation with final outcome.
通过描述与手动分割光学相干断层扫描（OCT）特征、血管造影再灌注和视力恢复相关的临床表现及结果，对一大组现代视网膜中央动脉阻塞（CRAO）患者进行特征分析。
回顾性临床队列研究。
纳入2017年1月至2021年12月期间最初就诊于三级转诊中心的CRAO（国际疾病分类第十版：H34.1）患者。分析人口统计学资料、眼部检查结果、眼底照片、OCT和荧光素血管造影。主要观察指标包括黄斑OCT上的视网膜总厚度和内层视网膜厚度、再灌注情况、视力结果以及新生血管的形成。
共纳入144例患者的145只眼，平均年龄为69.4±13.6岁。平均就诊时间为1.6±4.2天，19%的患者在视力丧失后4.5小时内接受检查，26%在6小时内接受检查。19%的患者睫状视网膜动脉（CLRA）未受累。平均初始视力（VA）在CLRA未受累组为1.68±1.10最小分辨角对数（LogMAR），而在非CLRA未受累组为2.53±0.58 LogMAR，P<.001。32%的患者炎症指标升高。在47只接受最终荧光素血管造影的眼中，三分之一显示有一定程度的再灌注。最终视力在CLRA未受累组为1.40±1.16 LogMAR，在非CLRA未受累组为2.46±0.81 LogMAR，P<.001。两组中三分之一的患者视力有所改善，CLRA未受累组27%的患者视力提高超过2行，非CLRA未受累组为36%。CLRA未受累组17%的患者视力改善至优于20/200，非CLRA未受累组为4%。总体而言，11%的患者出现新生血管，均发生在非CLRA未受累组。在多元线性回归分析中，就诊时的视力与视力恢复2行或更多相关（比值比=2.603，P=.007）。OCT显示随着时间推移视网膜逐渐变薄，在6个月时达到最低测量值，此后趋于稳定。
在这个现代急性CRAO患者队列中，近一半的患者在症状出现后12小时内就诊于三级医疗机构。近三分之一的患者最终视力有所改善，然而，视力优于法定失明限度的情况很少见（约5%）。有趣的是，三分之一的患者全身炎症指标有轻度升高。就诊时较好的视力与视力提高相关，而基线OCT值与最终结果的相关性较差。
