Risks of stroke and myocardial infarction after retinal artery occlusion and their time dependence: a systematic review and meta-analysis.

BACKGROUND

Retinal artery occlusion (RAO) is an ophthalmic emergency that may signal underlying cardiovascular disease. Both stroke and myocardial infarction (MI) share pathophysiological mechanisms and risk factors with RAO. This systematic review aimed to assess the risks of stroke and MI following the onset of RAO, with a focus on their time-dependent changes.

METHODS

PubMed, Embase, and Web of Science were searched for articles reporting  incidence of stroke and MI after RAO. Newcastle-Ottawa Scale was employed to evaluate the quality of study. Pooled relative risks for stroke and MI risks following RAO were calculated by random-effects models, and the time-dependent change of these risks was analyzed.

RESULTS

Twelve studies involving 319 748 people were included. Pooled analysis showed that RAO was associated with a significantly increased risk of stroke (RR = 3.64, 95% CI: 2.53-5.25, p < 0.0001), particularly within the first month after RAO. MI risk showed an upward trend (RR = 1.38, 95% CI: 0.80-2.40, p = 0.2478), but did not reach statistical significance. Time-stratified analyses revealed the highest incidence of stroke and MI within 30 days post-RAO.

CONCLUSION

RAO is strongly associated with an elevated short-term risk of stroke, underscoring the need for prompt cerebrovascular evaluation and monitoring within the first month. Although the association between RAO and MI was less conclusive, cardiovascular assessment remains warranted. These findings highlight RAO as an important marker of systemic vascular disease requiring timely intervention.