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Central Retinal Artery Occlusion at a Canadian Academic Center

Published online by Cambridge University Press:  18 February 2025

Matthew P. Quinn Open the ORCID record for Matthew P. Quinn [Opens in a new window] ,
Victoria Liu ,
Danah Albreiki  and
Daniel A. Lelli
Matthew P. Quinn*
Affiliation:
Department of Ophthalmology, University of Ottawa Eye Institute, The Ottawa Hospital, Ottawa, Canada
Victoria Liu
Affiliation:
Department of Ophthalmology, University of Ottawa Eye Institute, The Ottawa Hospital, Ottawa, Canada
Danah Albreiki
Affiliation:
Department of Ophthalmology, University of Ottawa Eye Institute, The Ottawa Hospital, Ottawa, Canada
Daniel A. Lelli
Affiliation:
Division of Neurology, Department of Internal Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Canada
*
Corresponding author: Matthew Quinn; Email: [email protected]
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Abstract

Background:

Central retinal artery occlusion (CRAO) is a retinal stroke with poor visual prognosis and frequent association with life-threatening conditions. Clinical guidelines and treatment options are in evolution, and Canadian data regarding CRAO are limited.

Methods:

Patients with CRAO between June 1, 2019, and May 31, 2023, were included. The medical chart was reviewed for demographics, presentation factors, investigations, interventions, secondary prevention referrals and outcomes.

Results:

Seventy-six patients were included. Median age was 68.1 (61.4–81.8) years, and 60.5% were male. The site of presentation was an emergency department in 61.8%. The median (interquartile range [IQR]) time from vision loss to presentation was 15.0 (3.5–48.0) hours; 28.9% presented within 4.5 hours. The median (IQR) time for ophthalmological consultation was 12.0 (4.6–22.6) hours. No patient was treated with thrombolysis. Referral for neurovascular secondary prevention occurred for 92.1%; however, referral for ocular follow-up was omitted in 21.1%. Among patients with non-arteritic CRAO, 25.7% had symptomatic carotid stenosis, and 10.5% had a cardioembolic source. Giant cell arteritis was diagnosed in 8.1% of patients over age 50. Functional visual recovery occurred for 10.5% of patients.

Conclusions:

In this series, patients often presented within hours of CRAO and usually to an emergency department; however, no patient was treated with thrombolysis. As in other centers, delay in ophthalmological consultation and the lack of a defined CRAO treatment pathway are barriers. Patients with CRAO frequently have high-risk underlying pathology and generally do not experience meaningful improvement in vision. There is an unmet need for Canadian guidelines to standardize multidisciplinary care for CRAO.

Résumé

RÉSUMÉ

Étude sur l’occlusion de l’artère rétinienne centrale dans un centre hospitalier universitaire au Canada

Contexte:

L’occlusion de l’artère rétinienne centrale (OARC) est, en fait, un accident vasculaire rétinien qui comporte un pronostic visuel sombre et qui est souvent associé à des affections potentiellement mortelles. Les lignes directrices de pratique clinique et les différentes possibilités de traitement sont en évolution et il existe peu de données sur l’OARC au Canada.

Méthode:

Ont été inclus dans l’étude des patients qui ont subi une OARC entre le 1er juin 2019 et le 31 mai 2023. Les dossiers médicaux ont été examinés aux fins de collecte de données démographiques ainsi que de renseignements sur les facteurs de consultation, les examens, les interventions, les consultations en prévention secondaire et les résultats.

Résultats:

Au total,76 patients ont participé à l’étude, dont 60,5 % étaient des hommes; l’âge médian était de 68,1 ans (61,4-81,8 ans). Dans 61,8 % des cas, le lieu de consultation était un service des urgences. Le temps médian (écart interquartile [EI]) écoulé entre la perte de vision et la consultation était de 15,0 heures (3,5-48,0), et il était de 4,5 heures dans 28,9 % des cas. Quant au temps médian (EI) écoulé avant la consultation en ophtalmologie, il était de 12,0 heures (4,6-22,6). Aucun patient n’a été soumis à un traitement thrombolytique. Dans 92,1 % des cas, il y a eu une consultation en prévention secondaire neurovasculaire, mais il n’y a pas eu de suivi en ophtalmologie dans 21,1 % des cas. Parmi les patients ayant subi une OARC d’origine non artéritique, 25,7 % présentaient une sténose carotidienne symptomatique et 10,5 % avaient des troubles cardioemboliques. Un diagnostic d’artérite à cellules géantes a été posé chez 8,1 % des patients de plus de 50 ans. Enfin, 10,5 % des patients ont connu une récupération visuelle fonctionnelle.

Conclusion:

D’après la série de cas, les patients consultent souvent dans les heures suivant l’OARC et habituellement dans un service des urgences. Toutefois, aucun patient n’a été soumis à un traitement thrombolytique. Comme dans d’autres établissements, le retard de consultation en ophtalmologie et le manque d’un cheminement thérapeutique établi des OARC constituent des obstacles à la prestation de soins. Dans bien des cas, les patients touchés par une OARC ont un risque élevé d’affections sous-jacentes et ils ne connaissent généralement pas une amélioration importante de la vision. Bref, les lignes directrices visant à uniformiser le traitement pluridisciplinaire des OARC au Canada souffrent de lacunes.

Keywords

acute retinal ischemiacentral retinal artery occlusionneuro-ophthalmologypractice patternsstroke
Type
Original Article
Information
Canadian Journal of Neurological Sciences , First View , pp. 1 - 7
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation

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