Abstract
Objective
A central retinal artery occlusion (CRAO) represents a form of ocular stroke with
poor visual prognosis. CRAO shares a common pathophysiology with cerebral ischemic
stroke but presents unique diagnostic and management challenges leading to variability
in clinical practice. This study aims to assess the presentation, treatment, and outcomes
of CRAO at a tertiary care centre in Canada over 2 years and elucidate potential areas
for improvement in the care of these patients.
Methods
Single-institution retrospective review including 27 patients diagnosed with CRAO
from March 2018 to March 2020 in Edmonton, Alberta.
Results
Most patients with CRAO presented to eye care providers (14 of 27); others presented
to the emergency department (10 of 27) or family physicians (2 of 27). Three patients
(11.1%) presented within 4.5 hours of symptom onset. At presentation, 81% of patients
had visual acuity of 20/400 or worse in the affected eye. No patients received thrombolysis.
The majority of CRAO cases had a nonarteritic etiology (92.6%). All patients had at
least one pre-existing vascular risk factor. Forty-eight percent of patients received
escalated medical therapy. Ipsilateral carotid stenosis was identified in 5 patients
(18.5%); 3 patients required carotid endarterectomy. Two patients were diagnosed with
atrial fibrillation. Two patients experienced symptomatic cerebral ischemia within
6 weeks of CRAO.
Conclusions
The majority of patients with CRAO presented to eye care providers, and few present
within the potential window for thrombolysis of 4.5 hours, highlighting the need for
public awareness strategies. Our cohort highlights the significant rate of systemic
comorbidity that exists in these patients.
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Article Info
Publication History
Published online: March 17, 2022
Accepted:
February 19,
2022
Received in revised form:
January 30,
2022
Received:
December 13,
2021
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
