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Kadam Y, Das AV, Narayanan R, Balakrishnan N, Telukunta P, Takkar B. Profile and outcomes of retinal artery occlusion: The underrealized need to expedite presentation. Indian J Ophthalmol 2025; 73:S72-S77. [PMID: 39723868 PMCID: PMC11834905 DOI: 10.4103/ijo.ijo_1686_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 09/21/2024] [Accepted: 10/03/2024] [Indexed: 12/28/2024] Open
Abstract
PURPOSE To evaluate the clinical profile of retinal artery occlusion (RAO) and impact of presentation on visual outcomes. DESIGN A retrospective analysis of case files of 3070 patients with RAO was performed using electronic medical records. METHODS Demographic data were analyzed using descriptive statistics. The differential distribution of risk factors of RAO with age was studied. Time to presentation and treatment effects were assessed using multivariate regression. Interaction plots were drawn to assess the impact of risk factors on outcomes. RESULTS Central RAO was the most common type (n = 2443, 77.11%), followed by branch RAO (n = 500, 15.78%), while combined retinal vascular occlusion and cilio-RAO were rare. Most of the patients (71.40%) were male and had unilateral (96.81%) affliction. Almost half presented within the fifth (24.85%) and sixth (21.4%) decades of life. Hyperhomocysteinemia had a higher association (1.95, P = 0.0019) with younger patients (<40 years), while hypertension (3.64, P < 0.001), diabetes mellitus (DM; 4.18, P < 0.001), and coronary artery disease (CAD) (4.26, P = 0.002) were significantly commoner in older patients. CAD (5.1%) and cerebrovascular disease (0.6%) were detected after ocular presentation in some patients. Embolus, though detected rarely (1%), was associated (60%) with serious systemic disorders. Early presentation (<6 h) was associated with better visual outcomes (mean log of minimum angle of resolution 1.8 ± 1.3 vs. 2.1 ± 1.3, P = 0.032). Neovascular glaucoma (2.14% overall) was twice more common in DM (P < 0.0004) and led to further vision loss. Visual improvement occurred in 10% of patients over follow-up. CONCLUSION RAO occurs slightly earlier compared to coronary and cerebrovascular disorders and can precede their detection. Associated risk factors vary with the age of presentation. Presentation within 6 h needs facilitation for better outcomes and management.
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Affiliation(s)
- Yogita Kadam
- Department of Eyesmart EMR and AEye, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
- Indian Health Outcomes, Public Health, and Economics Research Center, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Anthony V Das
- Department of Eyesmart EMR and AEye, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
- Indian Health Outcomes, Public Health, and Economics Research Center, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Raja Narayanan
- Indian Health Outcomes, Public Health, and Economics Research Center, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
- Anant Bajaj Retina Institute, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Neelima Balakrishnan
- Indian Health Outcomes, Public Health, and Economics Research Center, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Praneet Telukunta
- Anant Bajaj Retina Institute, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Brijesh Takkar
- Indian Health Outcomes, Public Health, and Economics Research Center, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
- Anant Bajaj Retina Institute, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
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Yu HJ, Choi S, Guiseppi R, Banaee T. Retinal Artery Occlusion: A Review of Current Management Practices. J Ophthalmic Vis Res 2024; 19:488-507. [PMID: 39917461 PMCID: PMC11795002 DOI: 10.18502/jovr.v19i4.16559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Accepted: 09/02/2024] [Indexed: 02/09/2025] Open
Abstract
Retinal artery occlusion (RAO) is a well-characterized ischemic ophthalmic event that may result in sudden and devastating vision loss. The etiology of RAO may vary including both arteritic and non-arteritic causes and the location of the lesion can extend from the ophthalmic artery to the branches of the central retinal artery. Given this variable causes of RAO, the clinical presentation and extent of vision loss may also differ from case to case, necessitating a prompt and thorough evaluation, including a full stroke work up. While there is currently no widely accepted standard for the treatment of RAO, there are several proposed methods that have been or are currently being investigated through retrospective studies and prospective trials. The current article aims to provide a review of the pathophysiology, clinical presentation, and management of RAO in addition to presenting a systematic review of recently published studies on treatment options for RAO.
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Affiliation(s)
- Hannah J. Yu
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Sophia Choi
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Rodney Guiseppi
- Department of Ophthalmology and Visual Sciences, University of Texas. Medical Branch, Galveston, Texas, USA
| | - Touka Banaee
- Department of Ophthalmology and Visual Sciences, University of Texas. Medical Branch, Galveston, Texas, USA
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Liu T, Lu Q, Liu Z, Lin X, Peng L, Lu X, Guo W, Liu P, Zhang N, Wu S. Causal association of type 2 diabetes with central retinal artery occlusion: a Mendelian randomization study. Front Endocrinol (Lausanne) 2024; 15:1379549. [PMID: 39175569 PMCID: PMC11338930 DOI: 10.3389/fendo.2024.1379549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 07/25/2024] [Indexed: 08/24/2024] Open
Abstract
Background Central retinal artery occlusion (CRAO) is a medical condition characterized by sudden blockage of the central retinal artery, which leads to a significant and often irreversible loss of vision. Observational studies have indicated that diabetes mellitus is a risk factor for CRAO; however, there is no research on the causal relationship between diabetes mellitus, particularly type 2 diabetes, and CRAO. This study aimed to perform Mendelian randomization (MR) analysis to clarify the causal relationship between type 2 diabetes and CRAO. Methods Genetic variants associated with type 2 diabetes were selected from two different datasets. A recent genome-wide association study of CRAO conducted using the FinnGen database was used as the outcome data. A two-sample MR was performed to evaluate the causal relationship between type 2 diabetes and CRAO. Inverse variance weighting was the primary method, and MR-Egger, maximum likelihood, and median weighting were used as complementary methods. A multivariate MR (MVMR) analysis was performed to further evaluate the robustness of the results. Cochran's Q test, MR-Egger intercept test, and MR-PRESSO global test were used for the sensitivity analyses. Results Genetically predicted type 2 diabetes was causally associated with CRAO(odds ratio [OR] =2.108, 95% confidence interval [CI]: 1.221-3.638, P=7.423×10-3), which was consistent with the results from the validation dataset (OR=1.398, 95%CI: 1.015-1.925, P=0.040). The MVMR analysis suggested that type 2 diabetes may be an independent risk factor for CRAO (adjusted OR=1.696; 95%CI=1.150-2.500; P=7.655×10-3), which was assumed by the validation dataset (adjusted OR=1.356; 95%CI=1.015-1.812; P=0.039). Conclusion Our results show that genetically predicted type 2 diabetes may be causally associated with CRAO in European populations. This suggests that preventing and controlling type 2 diabetes may reduce the risk of CRAO.
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Affiliation(s)
- Tong Liu
- Department of Neurology & Neuro-ophthalmology, The First Hospital of Xi’an (The First Affiliated Hospital of Northwestern University), Xi’an, China
- Xi’an Key Laboratory for Innovation and Translation of Neuroimmunological Diseases, Xi’an, China
| | - Qingli Lu
- Department of Neurology & Neuro-ophthalmology, The First Hospital of Xi’an (The First Affiliated Hospital of Northwestern University), Xi’an, China
- Xi’an Key Laboratory for Innovation and Translation of Neuroimmunological Diseases, Xi’an, China
| | - Zhongzhong Liu
- Department of Neurology & Neuro-ophthalmology, The First Hospital of Xi’an (The First Affiliated Hospital of Northwestern University), Xi’an, China
- Xi’an Key Laboratory for Innovation and Translation of Neuroimmunological Diseases, Xi’an, China
| | - Xuemei Lin
- Department of Neurology & Neuro-ophthalmology, The First Hospital of Xi’an (The First Affiliated Hospital of Northwestern University), Xi’an, China
- Xi’an Key Laboratory for Innovation and Translation of Neuroimmunological Diseases, Xi’an, China
| | - Linna Peng
- Department of Neurology & Neuro-ophthalmology, The First Hospital of Xi’an (The First Affiliated Hospital of Northwestern University), Xi’an, China
- Xi’an Key Laboratory for Innovation and Translation of Neuroimmunological Diseases, Xi’an, China
| | - Xiping Lu
- Department of Neurology & Neuro-ophthalmology, The First Hospital of Xi’an (The First Affiliated Hospital of Northwestern University), Xi’an, China
- Xi’an Key Laboratory for Innovation and Translation of Neuroimmunological Diseases, Xi’an, China
| | - Weiyan Guo
- Xi’an Key Laboratory for Innovation and Translation of Neuroimmunological Diseases, Xi’an, China
| | - Pei Liu
- Department of Neurology & Neuro-ophthalmology, The First Hospital of Xi’an (The First Affiliated Hospital of Northwestern University), Xi’an, China
- Xi’an Key Laboratory for Innovation and Translation of Neuroimmunological Diseases, Xi’an, China
| | - Na Zhang
- Department of Neurology & Neuro-ophthalmology, The First Hospital of Xi’an (The First Affiliated Hospital of Northwestern University), Xi’an, China
- Xi’an Key Laboratory for Innovation and Translation of Neuroimmunological Diseases, Xi’an, China
| | - Songdi Wu
- Department of Neurology & Neuro-ophthalmology, The First Hospital of Xi’an (The First Affiliated Hospital of Northwestern University), Xi’an, China
- Xi’an Key Laboratory for Innovation and Translation of Neuroimmunological Diseases, Xi’an, China
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Chen C, Singh G, Madike R, Cugati S. Central retinal artery occlusion: a stroke of the eye. Eye (Lond) 2024; 38:2319-2326. [PMID: 38548943 PMCID: PMC11306586 DOI: 10.1038/s41433-024-03029-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/13/2024] [Accepted: 03/08/2024] [Indexed: 08/09/2024] Open
Abstract
Central retinal artery occlusion (CRAO), like a stroke in the brain, is a critical eye condition that requiring urgent medical attention. Patients with CRAO present with acute loss of vision and the visual prognosis is poor with low chance of spontaneous visual recovery. Moreover, the risk of developing ischaemic heart disease and cerebral stroke is increased due to the presence of underlying atherosclerotic risk factors. Currently, there is no officially recommended treatment for CRAO. This review will describe the anatomy, pathophysiology, clinical features of CRAO, as well as exploring existing and potential future approaches for managing the condition.
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Affiliation(s)
- Celia Chen
- Department of Ophthalmology, Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia.
| | - Gurfarmaan Singh
- The University of Adelaide School of Medicine, Adelaide, South Australia, Australia
- Department of Ophthalmology, Modbury Hospital, Adelaide, South Australia, Australia
| | - Reema Madike
- The University of Adelaide School of Medicine, Adelaide, South Australia, Australia
| | - Sudha Cugati
- The University of Adelaide School of Medicine, Adelaide, South Australia, Australia
- Department of Ophthalmology, Modbury Hospital, Adelaide, South Australia, Australia
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Lixi F, Fazzini L, Cannas C, Montisci R, Giannaccare G. Ocular Manifestations and Complications of Patent Foramen Ovale: A Narrative Review. J Pers Med 2024; 14:695. [PMID: 39063949 PMCID: PMC11278285 DOI: 10.3390/jpm14070695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 06/19/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024] Open
Abstract
Patent foramen ovale (PFO) is a prevalent congenital cardiac anomaly associated with a persistent opening between the atrial septum, allowing communication between the left and right atria. Despite often being asymptomatic, PFO can lead to various clinical presentations, including cryptogenic stroke and other embolic events. Transient visual disturbances, alterations in the visual field, migraine with aura, impaired eye movement and endogenous eye infections may prompt patients to seek ophthalmological consultation. Understanding these diverse clinical scenarios is crucial for early detection, appropriate management and mitigating the morbidity burden associated with PFO. This narrative review aims at examining the spectrum of clinical presentations of ocular pictures associated with PFO. The pathophysiology, diagnosis and treatment methods for PFO will be described, emphasizing the importance of a multidisciplinary approach involving ophthalmologists, cardiologists, neurologists and imaging specialists. In the future, prospective studies and clinical trials are warranted to provide further insights into the preventive role and optimal therapeutic strategies for managing PFO-related ocular complications, ultimately guiding clinical decision making and optimizing patient care.
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Affiliation(s)
- Filippo Lixi
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (F.L.); (C.C.)
| | - Luca Fazzini
- Clinical Cardiology Unit, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (L.F.); (R.M.)
| | - Claudia Cannas
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (F.L.); (C.C.)
| | - Roberta Montisci
- Clinical Cardiology Unit, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (L.F.); (R.M.)
| | - Giuseppe Giannaccare
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (F.L.); (C.C.)
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Maache S, Laaroussi H, Soulo N, Nouioura G, Boucetta N, Bouslamti M, Saghrouchni H, A Bin Jardan Y, Ibenmoussa S, Bourhia M, Lyoussi B, Elarabi I. The antioxidant, antidiabetic, and antihyperlipidemic effects of the polyphenolic extract from Salvia blancoana subsp. mesatlantica on induced diabetes in rats. BIORESOUR BIOPROCESS 2024; 11:62. [PMID: 38926327 PMCID: PMC11208370 DOI: 10.1186/s40643-024-00769-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 05/06/2024] [Indexed: 06/28/2024] Open
Abstract
Currently, several studies have demonstrated the benefits of medicinal plants in managing type 2 diabetes. In this work, we evaluated the beneficial effects of the polyphenolic extract (PESB) from Salvia blancoana subsp. mesatlantica in the management of hypercaloric-feeding and small-dose alloxan-brought type 2 diabetes in rats. We analyzed the chemical constituents of the extract, including flavones and flavonols content, to understand its biological action. The antioxidant activities were evaluated by total antioxidant action, scavenging effect of the free radical DPPH, and reducing power. The obtained results showed that the value of TFC was estimated at 31.90 ± 0.34 mgEQ/g in the PESB extract. The total antioxidant capacity was estimated at 593.51 ± 4.09 mg (EAA)/g, the value of DPPH IC50 was 7.3 ± 0.00 μg/mL, and the value of EC50 of reducing power was estimated at 6.43 ± 0.01 μg/mL. In total, 14 phenolic compounds were identified and the naringin was the most dominant (63.19%) while the vanillin was the less recorded (0.10%). Serum glucose decreased significantly (p < 0.05) in rats given PESB (100 mg/kg) after four weeks. Glibenclamide (GLB) and PESB reduced HbA1c and increased plasma insulin in diabetic rats, restoring HOMA-β and HOMA-IR levels to near-normal. Additionally, diabetic rats treated with GLB or PESB showed statistically equivalent results to those of non-diabetic rats regarding hepatic enzymes, renal and lipid markers, as well as cardiovascular indices. The weight loss was significantly lower in diabetic rats receiving a dose of PESB (100 mg/kg), and GLB compared to corresponding untreated diabetic rats (p < 0.01). PESB and GLB showed a prominent protective function in the pancreas, liver, and kidney tissues. This investigation demonstrates the capacity of extracts from leaves of S. blancoana subsp. mesatlantica to manage diabetes mellitus due to their richness in a wide range of bioactive compounds. Therefore, more investigations are required to estimate the safety of the plant use.
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Affiliation(s)
- Souad Maache
- Laboratory of Natural Substances, Pharmacology, Environment, Modeling, Health, and Quality of Life (SNAMOPEQ), Faculty of Sciences Dhar El Mahraz, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Hassan Laaroussi
- Laboratory of Natural Substances, Pharmacology, Environment, Modeling, Health, and Quality of Life (SNAMOPEQ), Faculty of Sciences Dhar El Mahraz, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Najoua Soulo
- Laboratory of Natural Substances, Pharmacology, Environment, Modeling, Health, and Quality of Life (SNAMOPEQ), Faculty of Sciences Dhar El Mahraz, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Ghizlane Nouioura
- Laboratory of Natural Substances, Pharmacology, Environment, Modeling, Health, and Quality of Life (SNAMOPEQ), Faculty of Sciences Dhar El Mahraz, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | | | - Mohammed Bouslamti
- Laboratory of Natural Substances, Pharmacology, Environment, Modeling, Health, and Quality of Life (SNAMOPEQ), Faculty of Sciences Dhar El Mahraz, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Hamza Saghrouchni
- Department of Biotechnology, Institute of Natural and Applied Sciences, Çukurova University, 01250, Balcalı, Adana, Türkiye.
| | - Yousef A Bin Jardan
- Department of Pharmaceutics, College of Pharmacy, King Saud University, P.O. Box 11451, Riyadh, Saudi Arabia
| | - Samir Ibenmoussa
- Laboratory of Therapeutic and Organic Chemistry, Faculty of Pharmacy, University of Montpellier, 34000, Montpellier, France
| | - Mohammed Bourhia
- Laboratory of Biotechnology and Natural Resources Valorization , Faculty of Sciences, Ibn Zohr University, 80060, Agadir, Morocco
- Laboratory of Chemistry-Biochemistry, Environment, Nutrition, and Health, Faculty of Medicine and Pharmacy, University Hassan II, B. P. 5696, Casablanca, Morocco
| | - Badiaa Lyoussi
- Laboratory of Natural Substances, Pharmacology, Environment, Modeling, Health, and Quality of Life (SNAMOPEQ), Faculty of Sciences Dhar El Mahraz, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Ilham Elarabi
- Laboratory of Natural Substances, Pharmacology, Environment, Modeling, Health, and Quality of Life (SNAMOPEQ), Faculty of Sciences Dhar El Mahraz, Sidi Mohamed Ben Abdellah University, Fez, Morocco
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Chen EJ, Mi FH. BRANCH RETINAL ARTERY OCCLUSION IN A YOUNG PATIENT AFTER RADIOTHERAPY FOR NASOPHARYNGEAL CARCINOMA BRANCH RETINAL ARTERY OCCLUSION AFTER RADIOTHERAPY. Retin Cases Brief Rep 2024; 18:189-193. [PMID: 36037265 DOI: 10.1097/icb.0000000000001345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE The aim of this study was to report a case of branch retinal artery occlusion in a young patient who received previous neck radiotherapy for nasopharyngeal carcinoma. METHODS The authors describe an interesting case of a branch retinal artery occlusion in a patient with previous neck radiotherapy for nasopharyngeal carcinoma 14 years ago. The patient was a 49-year-old man, who presented to the retina service in Tan Tock Seng Hospital. RESULTS Ultrasound of the carotid arteries revealed more than 50% bilateral common carotid arteries stenosis and 80-99% bilateral internal carotid artery stenosis. Magnetic resonance imaging of the brain showed presence of chronic infarcts. Screening for hypercoaguable states and cardioembolic causes were unremarkable. CONCLUSION Head and neck irradiation is a significant risk factor for developing carotid stenosis and its consequent complications such as retinal artery occlusions and cerebrovascular events.
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Affiliation(s)
- Elizabeth Jiahui Chen
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Fang Helen Mi
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore; and
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Balla S, Vajas A, Pásztor O, Rentka A, Lukucz B, Kasza M, Nagy A, Fodor M, Nagy V. Analysis of the Association between Retinal Artery Occlusion and Acute Ischaemic Stroke/ST-Elevation Myocardial Infarction and Risk Factors in Hungarian Patients. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1680. [PMID: 37763799 PMCID: PMC10534709 DOI: 10.3390/medicina59091680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/04/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: We aimed to analyse data on retinal artery occlusion (RAO) patients to explore correlations with acute ischaemic stroke (AIS), ST-elevation myocardial infarction (STEMI), and cardio/cerebrovascular comorbidities. Patients and Methods: Our retrospective cohort study included 169 RAO and 169 age- and gender-matched control patients. We examined the association of AIS, STEMI, and related comorbidities such as hypertension (HT), type 1 and type 2 diabetes (T1DM and T2DM, respectively), hyperlipidaemia, and ischaemic heart disease (IHD) with RAO. We also recorded atrial fibrillation in our RAO patients. Results: Our results demonstrated that RAO patients developed both AIS and STEMI at a significantly higher rate compared to controls (p < 0.001 for both). We also found that RAO patients had a significantly higher prevalence of HT and hyperlipidaemia (p1 = 0.005, p2 < 0.001) compared to controls. Multiple risk factors together significantly increased the odds of developing AIS and STEMI. Conclusions: Our results suggest that through identifying and treating the risk factors for RAO patients, we can reduce the risk of AIS, STEMI, and RAO of the fellow eye. Considering that ophthalmologists are often the first detectors of these cardiovascularly burdened patients, collaboration with colleagues from internal medicine, cardiology, and neurology is essential to achieve secondary prevention.
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Affiliation(s)
- Szabolcs Balla
- Department of Ophthalmology, University of Debrecen, 4032 Debrecen, Hungary (O.P.); (A.R.); (M.F.); (V.N.)
| | - Attila Vajas
- Department of Ophthalmology, University of Debrecen, 4032 Debrecen, Hungary (O.P.); (A.R.); (M.F.); (V.N.)
| | - Orsolya Pásztor
- Department of Ophthalmology, University of Debrecen, 4032 Debrecen, Hungary (O.P.); (A.R.); (M.F.); (V.N.)
| | - Anikó Rentka
- Department of Ophthalmology, University of Debrecen, 4032 Debrecen, Hungary (O.P.); (A.R.); (M.F.); (V.N.)
| | - Balázs Lukucz
- Department of Technology and Economics, University of Budapest, 1111 Budapest, Hungary;
| | - Márta Kasza
- Medical Centre, Hungarian Defence Forces, 1134 Budapest, Hungary;
| | - Attila Nagy
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary;
| | - Mariann Fodor
- Department of Ophthalmology, University of Debrecen, 4032 Debrecen, Hungary (O.P.); (A.R.); (M.F.); (V.N.)
| | - Valéria Nagy
- Department of Ophthalmology, University of Debrecen, 4032 Debrecen, Hungary (O.P.); (A.R.); (M.F.); (V.N.)
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Retinal Artery Occlusion as an Early Indicator of Macrovascular Complications in Diabetes. Am J Med 2023; 136:179-185. [PMID: 36170938 DOI: 10.1016/j.amjmed.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/13/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND A characteristic of the retinal circulation is that arterial occlusion is embolic or secondary to vasculitis but rarely or never due to in situ atherosclerosis. Therefore, retinal artery occlusion suggests the presence of cardiac or large-vessel disease outside the eye. This cohort study examined the general risk of macrovascular disease in individuals with diabetes, with or without retinal artery occlusion. METHODS We retrieved data on 992 subjects with incident retinal artery occlusion and preexisting diabetes, registered in Denmark between January 1, 2000, and December 31, 2018. Each retinal artery occlusion subject was matched for age, sex, and diabetes duration, with 5 control subjects with diabetes but without retinal artery occlusion. We performed survival analyses to compare the risk of extraocular macrovascular disease between the 2 groups in a 5-year follow-up. RESULTS After 1 year, the incidence of macrovascular disease in subjects with retinal artery occlusion was approximately 21 per 100 person-years (95% confidence interval [CI]: 18.11-24.29), compared to 6.25 per 100 patient-years (95% CI: 5.57-7.00) in those without retinal artery occlusion. After 5 years, the cumulative incidences of macrovascular disease were 51.2% (95% CI: 47.9-54.7%) and 29.4% (95% CI: 28.0-30.8%) in patients with diabetes with or without retinal artery occlusion, respectively. Hazard rate ratios were 3.36 (95% CI: 2.79-4.05) after 1 year and 2.27 (95% CI: 2.04-2.53) after 5 years. CONCLUSION Among individuals with diabetes, those diagnosed with retinal artery occlusion had a higher general risk of macrovascular complications for at least 5 years after the occlusion event compared with those without retinal artery occlusion.
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Abu Serhan H, Abdelaal A, Abuawwad MT, Taha MJJ, Irshaidat S, Abu Serhan L, Abu-Ismail L, Abu Salim QF, Abdelazeem B, Elnahry AG. Ocular Vascular Events following COVID-19 Vaccines: A Systematic Review. Vaccines (Basel) 2022; 10:2143. [PMID: 36560553 PMCID: PMC9786009 DOI: 10.3390/vaccines10122143] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/10/2022] [Accepted: 12/11/2022] [Indexed: 12/16/2022] Open
Abstract
The main aim of this study is to investigate the current evidence regarding the association between COVID-19 vaccination and ocular vascular events. The protocol is registered on PROSPERO (CRD42022358133). On 18 August 2022, an electronic search was conducted through five databases. All original articles reporting individuals who were vaccinated with COVID-19 vaccines and developed ophthalmic vascular events were included. The methodological quality of the included studies was assessed using the NIH tool. A total of 49 studies with 130 ocular vascular cases were included. Venous occlusive events were the most common events (54.3%), which mostly occurred following the first dose (46.2%) and within the first five days following vaccination (46.2%). Vascular events occurred more with the Pfizer and AstraZeneca vaccines (81.6%), and mostly presented unilaterally (73.8%). The most frequently reported treatment was intravitreal anti-VEGF (n = 39, 30.4%). The majority of patients (90.1%) demonstrated either improvement (p = 0.321) or persistence (p = 0.414) in the final BCVA. Ophthalmic vascular events are serious vision-threatening side effects that have been associated with COVID-19 vaccination. Clinicians should be aware of the possible association between COVID-19 vaccines and ocular vascular events to provide early diagnosis and treatment.
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Affiliation(s)
- Hashem Abu Serhan
- Department of Ophthalmology, Hamad Medical Corporations, Doha 3050, Qatar
- Tanta Research Team, El-Gharbia 31511, Egypt
| | - Abdelaziz Abdelaal
- Tanta Research Team, El-Gharbia 31511, Egypt
- Harvard Medical School, Postgraduate Medical Education, Boston, MA 02115, USA
- Doheny Eye Institute, University of California, Los Angeles, CA 94720, USA
| | - Mohammad T. Abuawwad
- Department of Clinical Medicine, Kasr Alainy Faculty of Medicine, Cairo University, Cairo 11562, Egypt
| | - Mohammad J. J. Taha
- Department of Clinical Medicine, Kasr Alainy Faculty of Medicine, Cairo University, Cairo 11562, Egypt
| | - Sara Irshaidat
- Department of Pediatrics, King Hussein Cancer Centre, Amman 11941, Jordan
| | - Leen Abu Serhan
- Faculty of Medicine, Hashemite University, Zarqa 13133, Jordan
| | - Luai Abu-Ismail
- Department of Ophthalmology, Islamic Hospital, Amman 11190, Jordan
| | | | - Basel Abdelazeem
- Tanta Research Team, El-Gharbia 31511, Egypt
- Department of Internal Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - Ayman G. Elnahry
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo 11591, Egypt
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
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Roy B, Runa SA. SARS-CoV-2 infection and diabetes: Pathophysiological mechanism of multi-system organ failure. World J Virol 2022; 11:252-274. [PMID: 36188734 PMCID: PMC9523319 DOI: 10.5501/wjv.v11.i5.252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/25/2022] [Accepted: 08/01/2022] [Indexed: 02/05/2023] Open
Abstract
Since the discovery of the coronavirus disease 2019 outbreak, a vast majority of studies have been carried out that confirmed the worst outcome of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in people with preexisting health conditions, including diabetes, obesity, hypertension, cancer, and cardiovascular diseases. Likewise, diabetes itself is one of the leading causes of global public health concerns that impose a heavy global burden on public health as well as socio-economic development. Both diabetes and SARS-CoV-2 infection have their independent ability to induce the pathogenesis and severity of multi-system organ failure, while the co-existence of these two culprits can accelerate the rate of disease progression and magnify the severity of the disease. However, the exact pathophysiology of multi-system organ failure in diabetic patients after SARS-CoV-2 infection is still obscure. This review summarized the organ-specific possible molecular mechanisms of SARS-CoV-2 and diabetes-induced pathophysiology of several diseases of multiple organs, including the lungs, heart, kidneys, brain, eyes, gastrointestinal system, and bones, and sub-sequent manifestation of multi-system organ failure.
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Affiliation(s)
- Bipradas Roy
- Department of Physiology, Wayne State University, Detroit, MI 48201, United States
- Division of Hypertension and Vascular Research, Department of Internal Medicine, Henry Ford Health System, Detroit, MI 48202, United States
| | - Sadia Afrin Runa
- Department of Biotechnology and Genetic Engineering, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj 8100, Bangladesh
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12
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Kaur M, Ahmed S, Younis H, Jaka S, . A, Canenguez Benitez JS, Roshan NS, Desai N. Retinal Artery Occlusion and Associated Risk of Cerebrovascular Disease Related Hospitalization: A National Inpatient Study. Cureus 2022; 14:e27354. [PMID: 36048422 PMCID: PMC9417324 DOI: 10.7759/cureus.27354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives To evaluate the demographic and comorbid risk factors for cerebrovascular disease (CVD) hospitalization in patients with retinal artery occlusion (RAO) and study the impact on hospitalization outcomes. Methods We conducted a retrospective cross-sectional study using the Nationwide Inpatient Sample (NIS, 2019). We included 62,255 adults (age 18-65 years) with the primary diagnosis of CVD. The study sample was divided by the co-diagnosis of RAO (N=1,700). A logistic regression model was used to evaluate the odds ratio (OR) of association for risk factors leading to CVD hospitalization in patients with RAO, with the non-RAO cohort as the reference category. Results The majority of the CVD patients with RAO were elderly (51-65 years, 68%), females (54%), and whites (47%). Yet, demographics did not significantly impact the association with CVD hospitalization between RAO and non-RAO patients. There was a significant difference in the geographic distribution of CVD hospitalizations with RAO, with the highest prevalence in the East North Central Atlantic (21%) and South Atlantic (18%) regions, and the lowest in the Mountain (4%) and East South Central (4%) regions. Comorbid diabetes with complications (69%), and complicated hypertension (55%) were most prevalent in patients with RAO thereby increasing the risk for CVD hospitalization by 7.8 (95% CI 6.9-8.8) and 1.8 times (95% CI 1.6-1.9), respectively. Patients with RAO and having major severity of illness were at increased risk of CVD hospitalization (OR 2.8, 95% CI 1.9-3.9). Patients with RAO had a significant difference in adverse disposition, including transfer to the skilled nursing facility (SNF)/intermediate care facility (ICF) (32% vs. 24%) and requiring home health care (16% vs. 11%) compared to non-RAO patients. Conclusion The prevalence of RAO in CVD hospitalization was 2.7%, and demographics did not have any impact on the increasing risk of CVD. Comorbid diabetes (by 685%) and hypertension (by 78%) potentially increase the risk of CVD hospitalization in patients with RAO. These patients have a major severity of illness, leading to an adverse disposition. This calls for a collaborative care model to improve the quality of life in these at-risk patients with RAO.
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Ørskov M, Vorum H, Larsen TB, Lip GYH, Bek T, Skjøth F. Similarities and differences in systemic risk factors for retinal artery occlusion and stroke: A nationwide case-control study. J Stroke Cerebrovasc Dis 2022; 31:106610. [PMID: 35777081 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106610] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/19/2022] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND Retinal artery occlusion (RAO) has been considered a stroke equivalent. This study compares risk factor profiles for thromboembolism among patients with RAO and stroke, respectively. METHODS This case-control study is based on 5683 RAO patients entered in the Danish National Patient Register between 1st of January 2000 and 31st of December 2018. Cases were matched on sex, year of birth, and age at event with 28,415 stroke patients. The Danish nationwide registries were used to collect information about age, sex, previous diagnoses, and drug prescriptions. Adjusted conditional logistic regression models were used to investigate the association between hypothesised risk factors and the patient outcome. RESULTS For atrial fibrillation, a substantially stronger association to stroke was found, with an odds ratio (OR) of 0.52 (95% CI: 0.47-0.58) when comparing RAO patients with stroke patients. RAO was stronger associated with arterial hypertension, peripheral artery disease, retinal vein occlusion, cataract, and glaucoma with OR's ranging from 1.21-11.70. The identified effect measures reached equivalence or was close to equivalence for diabetes, heart failure, ischemic heart disease, and renal disease. CONCLUSION The differences in risk factor profiles between RAO and stroke suggests differences in the pathophysiology of the two diseases. These variations in pathophysiologies between the two diseases may indicate that different interventions are needed to ensure the optimal long-term prognosis for the patients.
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Affiliation(s)
- Marie Ørskov
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Hobrovej 18-22, Aalborg DK-9000, Denmark; Department of Clinical Medicine, Aalborg Thrombosis Research Unit, Faculty of Health, Aalborg University, Aalborg, Denmark.
| | - Henrik Vorum
- Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark
| | - Torben Bjerregaard Larsen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Hobrovej 18-22, Aalborg DK-9000, Denmark; Department of Clinical Medicine, Aalborg Thrombosis Research Unit, Faculty of Health, Aalborg University, Aalborg, Denmark
| | - Gregory Y H Lip
- Department of Clinical Medicine, Aalborg Thrombosis Research Unit, Faculty of Health, Aalborg University, Aalborg, Denmark; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Flemming Skjøth
- Department of Clinical Medicine, Aalborg Thrombosis Research Unit, Faculty of Health, Aalborg University, Aalborg, Denmark; Unit for Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
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14
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Ørskov M, Vorum H, Larsen TB, Lip GYH, Bek T, Skjøth F. Clinical risk factors for retinal artery occlusions: a nationwide case-control study. Int Ophthalmol 2022; 42:2483-2491. [PMID: 35305540 DOI: 10.1007/s10792-022-02247-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/11/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE This study seeks to examine potential risk factors for the development of retinal artery occlusions (RAO). METHODS We used data obtained from Danish nationwide registries to evaluate potential risk factors for RAO present up to 5 years prior to the RAO diagnosis. The study included 5312 patients diagnosed with RAO registered in the Danish National Patient Register and 26,560 controls assessed from the general population matched on sex and age at index date. Adjusted conditional logistic regression was used to estimate the odds ratio of included risk factors for RAO diagnosis. We conducted supplementary analyses stratified on sex and age, and on RAO subtype. In addition, interaction analyses were performed between strata in the stratified analyses. RESULTS Risk factors associated with the development of RAO included diabetes, arterial hypertension, ischemic heart disease, peripheral artery disease, stroke, renal disease, cataract, and glaucoma, with ORs ranging from 1.33 to 4.94. Atrial fibrillation and sleep apnea yielded effect measures close to equivalence. The presence of a risk factor was generally associated with higher odds of RAO among the population ≤ 55 of age. Arterial hypertension was stronger associated with RAO in male patients than in female patients. The association with arterial hypertension was stronger for CRAO than for BRAO subtype. CONCLUSION The investigated risk factors suggest that atherosclerosis and conditions changing the intraocular pressure are involved in the pathophysiology of RAO.
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Affiliation(s)
- Marie Ørskov
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark.
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark.
| | - Henrik Vorum
- Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark
| | - Torben Bjerregaard Larsen
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
| | - Gregory Y H Lip
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, Aarhus N, Denmark
| | - Flemming Skjøth
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
- Unit for Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
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15
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Ikemura T, Nakamura N, Hayashi N. Impact of acute dynamic exercise on vascular stiffness in the retinal arteriole in healthy subjects. J Appl Physiol (1985) 2021; 132:459-468. [PMID: 34941440 DOI: 10.1152/japplphysiol.00507.2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Acute exercise can improve vascular stiffness in the conduit artery, but its effect on the retinal arterioles is unknown. The present study investigated the effects of acute dynamic exercise on retinal vascular stiffness. In experiment 1, we measured the cardio-ankle vascular index (CAVI), carotid artery intima-media thickness (carotid IMT), and retinal blood velocity by laser speckle flowgraphy in 28 healthy old and 28 young men (69 ± 3 and 23 ± 3 years, respectively). Pulse waveform variables, which were used as an index of retinal vascular stiffness, were assessed by retinal blood flow velocity profile analysis. In experiment 2, 18 healthy old and 18 young men (69 ± 3 and 23 ± 3 years, respectively) underwent assessment of pulse waveform variables after a 30-min bout of moderate cycling exercise at an intensity of 60% heart rate reserve. There was a significant difference in the baseline pulse waveform variables between the old and young groups. Pulse waveform variables in the retinal arteriole did not significantly change after acute dynamic exercise, whereas CAVI significantly decreased. These findings suggest that retinal vascular stiffness does not change by acute exercise. The effect of exercise on vascular stiffness in the retinal arterioles might be different from that in the conduit artery.
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Affiliation(s)
- Tsukasa Ikemura
- College of Liberal Arts and Science, Kitasato University, Kitazato, Minami-ku, Sagamihara, Kanagawa, Japan.,Faculty of Commerce, Yokohama College of Commerce, Higashiterao, Tsurumi, Yokohama, Kanagawa, Japan.,Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
| | - Nobuhiro Nakamura
- Faculty of Commerce, Yokohama College of Commerce, Higashiterao, Tsurumi, Yokohama, Kanagawa, Japan.,Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
| | - Naoyuki Hayashi
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan.,Institute for Liberal Arts, Tokyo Institute of Technology, Ookayama, Meguro, Tokyo, Japan
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Parmeggiani F. Are visual disturbances (excluding diabetic retinopathy) more common in geriatric DM patients? Are they risks factor for the progression of disability? JOURNAL OF GERONTOLOGY AND GERIATRICS 2021. [DOI: 10.36150/2499-6564-n452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Feldman-Billard S, Dupas B. Eye disorders other than diabetic retinopathy in patients with diabetes. DIABETES & METABOLISM 2021; 47:101279. [PMID: 34534696 DOI: 10.1016/j.diabet.2021.101279] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/18/2021] [Accepted: 08/29/2021] [Indexed: 10/20/2022]
Abstract
AIM While diabetic retinopathy is the most specific complication of chronic hyperglycaemia, numerous other ocular conditions also can involve the eyes of people with diabetes. Cataract, glaucoma, age-related macular degeneration, retinal vascular occlusion, and acute ischaemic optic neuropathy combine to impair vision in people with diabetes, especially when they are old. This report provides a critical analysis and an overview of the current knowledge of the main ocular disorders (excluding diabetic retinopathy) and their association in patients with diabetes. METHODS A literature search strategy was conducted for all English-language literature with a systematic review of key references until 2021. RESULTS Patients with diabetes have a high-to-moderate increased risk for most of the usual ocular disorders we reviewed with the exception of age-related macular degeneration. Exposure to chronic hyperglycaemia promotes the development of many eye disorders while acute glucose changes are involved in refractive disorders, diabetic papillopathy and acute cataract. CONCLUSION Diabetes, beyond diabetic retinopathy, increases the risk of numerous eye disorders leading to low vision with implications for daily diabetes management. Even in the absence of clearly demonstrated benefit from glucose control in all eye conditions, achieving good glycaemic control and adherence to diabetes treatment will likely help avoid an additional risk of visual impairment in people with diabetes. In perspective, interesting findings suggesting a preventive effect of metformin use on age-related macular degeneration occurrence justify further studies.
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Affiliation(s)
- Sylvie Feldman-Billard
- Service de Médecine Interne, CHNO des Quinze-Vingts, 28 rue de Charenton, 75571 Paris Cedex 12, France.
| | - Bénédicte Dupas
- Centre Ophtalmologique Sorbonne Saint-Michel, Paris, France; Service d'Ophtalmologie, Hôpital Lariboisière, Paris, France
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18
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Bourke C, Stephenson KAJ, Connell PP. Visual field loss in an elderly vasculopath: clinical significance of multimodal imaging. BMJ Case Rep 2021; 14:e245115. [PMID: 34493560 PMCID: PMC8424838 DOI: 10.1136/bcr-2021-245115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Christine Bourke
- Ophthalmology, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Paul P Connell
- Ophthalmology, Mater Misericordiae University Hospital, Dublin, Ireland
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Li Y, Hall NE, Pershing S, Hyman L, Haller JA, Lee AY, Lee CS, Chiang M, Lum F, Miller JW, Lorch A, Elze T. Age, Gender, and Laterality of Retinal Vascular Occlusion: A Retrospective Study from the IRIS® Registry. Ophthalmol Retina 2021; 6:161-171. [PMID: 33991710 DOI: 10.1016/j.oret.2021.05.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 04/17/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Retinal vascular occlusion is a leading cause of profound irreversible visual loss, but the understanding of the disease is insufficient. We systematically investigated the age, gender, and laterality at the onset of retinal artery occlusion (RAO) and retinal vein occlusion (RVO) in the Intelligent Research in Sight (IRIS®) Registry. DESIGN Retrospective registry cohort. PARTICIPANTS Patients with retinal vascular occlusion participating in the IRIS® Registry. METHODS Patients who received a diagnosis of retinal vascular occlusion between 2013 and 2017 were included. Those with unspecified gender or laterality were excluded when conducting the relevant analyses. Patients were categorized into RAO, with subtypes transient retinal artery occlusion (TRAO), partial retinal artery occlusion (PRAO), branch retinal artery occlusion (BRAO), and central retinal artery occlusion (CRAO), and into RVO, with subtypes venous engorgement (VE), branch retinal vein occlusion (BRVO), and central retinal vein occlusion (CRVO). Age was evaluated as a categorical variable (5-year increments). We investigated the association of age, gender, and laterality with the onset frequency of retinal vascular occlusion subtypes. MAIN OUTCOME MEASURES The frequency of onset of RAO and RVO subtypes by age, gender and laterality. RESULTS A total of 1 251 476 patients with retinal vascular occlusion were included, 23.8% of whom had RAO, whereas 76.2% had RVO. Of these, 1 248 656 and 798 089 patients were selected for analyses relevant to gender and laterality, respectively. The onset frequency of all subtypes increased with age. PRAO, BRAO, CRAO, and CRVO presented more frequently in men (53.5%, 51.3%, 52.6%, and 50.4%, respectively), whereas TRAO, VE, and BRVO presented more frequently in women (54.9%, 56.0%, and 54.5% respectively). All RAO subtypes and BRVO showed a right-eye onset preference (TRAO, 51.7%; PRAO, 54.4%; BRAO, 53.5%; CRAO, 53.4%; and BRVO, 51.0%), whereas VE and CRVO exhibited a left-eye onset preference (53.3% and 50.9%, respectively). CONCLUSIONS Although retinal vascular occlusion incidence increases with age regardless of subtypes, we found various subtype-specific disease-onset differences related to gender and, in particular, ocular laterality. These findings may improve understanding of the specific cause of retinal vascular occlusions of different subtypes and their relationships with structural and anatomic asymmetries of the vascular system.
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Affiliation(s)
- Yangjiani Li
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA; State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Nathan E Hall
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA; Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Suzann Pershing
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA; Department of Ophthalmology, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Leslie Hyman
- Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | | | - Aaron Y Lee
- eScience Institute, University of Washington, Seattle, Washington, USA; Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Cecilia S Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Michael Chiang
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Flora Lum
- American Academy of Ophthalmology, San Francisco, California, USA
| | - Joan W Miller
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Alice Lorch
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Tobias Elze
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA.
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20
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Malan L, Hamer M, von Känel R, Kotliar K, van Wyk RD, Lambert GW, Vilser W, Ziemssen T, Schlaich MP, Smith W, Magnusson M, Wentzel A, Myburgh CE, Steyn HS, Malan NT. Delayed retinal vein recovery responses indicate both non-adaptation to stress as well as increased risk for stroke: the SABPA study. Cardiovasc J Afr 2021; 32:5-16. [PMID: 33104153 PMCID: PMC8756074 DOI: 10.5830/cvja-2020-031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 08/07/2020] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Low or high sympatho-adrenal-medullary axis (SAM) and hypothalamic-pituitary-adrenal axis (HPA) dysregulation reflect chronic stress. Retinal vessel dynamics may relate to SAM, HPA activity and stroke risk. Our objectives were therefore to assess the relationships between retinal vessel, SAM and HPA responses, and to determine stroke risk. METHODS A prospective bi-ethnic gender cohort (n = 275, 45 ± 9 years) was included. Urine/serum/saliva samples for SAM [norepinephrine:creatinine ratio (u-NE)] and HPA [adrenocorticotrophic hormone (ACTH), cortisol] were obtained at baseline, three-year follow up and upon flicker light-induced provocation. Diastolic ocular perfusion pressure was measured as a marker of hypo-perfusion. Retinal arterial narrowing and venous widening calibres were quantified from digital images in the mydriatic eye. A validated stress and stroke risk score was applied. RESULTS An interaction term was fitted for venous dilation in u-NE tertiles (p ≤ 0.05) and not in u-NE median/quartiles/quintiles. Independent of race or gender, tertile 1 (low u-NE) had a 112% increase in u-NE, decreases in cortisol, and no changes in ACTH over three years (positive feedback). Tertile 3 (high u-NE) contradictorily had decreases in u-NE and cortisol, and increases in ACTH (negative feedback). In tertile 1, reduced arterial dilation, and faster arterial vasoconstriction and narrowing were related to higher SAM activity and hypo-perfusion (p ≤ 0.05), whereas delayed venous dilation, recovery and widening were related to cortisol hypo-secretion (p ≤ 0.05). In tertile 1, delayed venous recovery responses predicted stress and stroke risk [odds ratio 4.8 (1.2-19.6); p = 0.03]. These associations were not found in u-NE tertiles 2 and 3. CONCLUSIONS In response to low norepinephrine, a reflex increase in SAM activity occurred, enhancing arterial vasoconstriction and hypo-perfusion. Concomitant HPA dysregulation attenuated retinal vein vasoactivity and tone, reflecting delayed vein recovery responses and non-adaptation to stress. These constrained vein recovery responses are indicative of increased chronic stress and stroke risk.
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Affiliation(s)
- Leoné Malan
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.
| | - Mark Hamer
- Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London, United Kingdom
| | - Roland von Känel
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa; Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich 8091, Switzerland
| | - Konstantin Kotliar
- Department of Medical Engineering and Technomathematics, FH Aachen University of Applied Sciences, Jülich, Germany
| | | | - Gavin W Lambert
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn; Baker Heart & Diabetes Institute, Melbourne, Australia
| | | | - Tjalf Ziemssen
- Autonomic and Neuroendocrinological Laboratory Dresden, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, University Western Australia, Perth, Australia
| | - Wayne Smith
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa; Medical Research Council Research Unit: Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Martin Magnusson
- Department of Clinical Sciences, Malmö, Lund University; Wallenberg Centre for Molecular Medicine, Malmö, Lund University; Department of Cardiology, Malmö, Skåne University Hospital, Sweden
| | - Annemarie Wentzel
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - Carlien E Myburgh
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - Hendrik S Steyn
- Statistical Consultation Services, North-West University, Potchefstroom, South Africa
| | - Nico T Malan
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
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Chang YS, Ho CH, Chu CC, Wang JJ, Jan RL. Risk of retinal vein occlusion in patients with diabetes mellitus: A retrospective cohort study. Diabetes Res Clin Pract 2021; 171:108607. [PMID: 33310122 DOI: 10.1016/j.diabres.2020.108607] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 10/18/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
AIMS To investigate the risk of retinal vein occlusion (RVO) in new-onset diabetes mellitus (DM) patients. METHODS This nationwide, retrospective, matched cohort study included 240,761 DM patients registered between January 2003 and December 2005 in the Longitudinal Cohort of Diabetes Patients database. An age- and sex-matched control group comprising 240,761 non-DM patients (case: control = 1:1) was selected from the Taiwan Longitudinal Health Insurance Database 2000. Information for each patient from the index date until December 2013 was collected. The incidence and risk of RVO were compared between the two groups. Cox proportional hazard regression analysis was performed to calculate the adjusted hazard ratio (HR) for RVO after adjustment for potential confounders. The RVO cumulative incidence rate was obtained using Kaplan-Meier analysis. RESULTS During the follow-up period, 1,456 DM patients developed RVO (491, central retinal vein occlusion; 965, branch retinal vein occlusion). There was a significantly elevated risk of RVO in DM patients compared with the controls (incidence rate ratio = 1.91, 95% confidence interval [CI] = 1.75-2.08). Patients with DM showed significant risk of RVO after adjustment for potential confounders (hypertension, hyperlipidemia, congestive heart failure, coronary artery disease, and chronic renal disease) in the full cohort (adjusted HR = 1.76, 95% CI = 1.61-1.93). Additionally, patients with hypertension had a significantly higher risk of RVO than patients without hypertension after adjustment for other confounders in the cohort (adjusted HR = 1.50, 95% CI = 1.36-1.65). CONCLUSIONS We found that patients with DM have increased risks of RVO. In addition to blood pressure control, we recommend educating patients with DM about RVO, to prevent its subsequent occurrence.
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Affiliation(s)
- Yuh-Shin Chang
- Department of Ophthalmology, Chi Mei Medical Center, Tainan, Taiwan; Graduate Institute of Medical Sciences, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan; Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Chin-Chen Chu
- Department of Anesthesiology, Chi-Mei Medical Center, Tainan, Taiwan; Department of Recreation and Health-Care Management, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan; Department of Anesthesiology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Ren-Long Jan
- Graduate Institute of Medical Sciences, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan; Department of Pediatrics, Chi Mei Medical Center, Liouying, Tainan, Taiwan.
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Jan RL, Tai MC, Ho CH, Chu CC, Wang JJ, Tseng SH, Chang YS. Risk of recurrent corneal erosion in patients with diabetes mellitus in Taiwan: a population-based cohort study. BMJ Open 2020; 10:e035933. [PMID: 32565466 PMCID: PMC7311018 DOI: 10.1136/bmjopen-2019-035933] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To investigate the risk of recurrent corneal erosion (RCE) in patients with diabetes mellitus (DM). DESIGN, SETTING AND PARTICIPANTS This retrospective, nationwide, matched cohort study included 239 854 patients with DM recruited between 2003 and 2005 from the Longitudinal Cohort of Diabetes Patients database. The control group included the same number of age-matched and sex-matched patients without DM selected from the Taiwan Longitudinal Health Insurance Database, 2000. Data for each patient were collected from the index date until December 2013. MAIN OUTCOMES AND MEASURES The incidence and risk of RCE were compared between the two groups. Cox proportional hazards regression was used to calculate the HR for RCE after adjustment for potential confounders. The cumulative RCE incidence rate was calculated using Kaplan-Meier analysis. RESULTS In total, 1236 patients with DM and 884 controls developed RCE during the follow-up period, resulting in an incidence rate of RCE in patients with DM (5.87/10 000 person-years (PY)) higher than that in the controls (4.23/10 000 PY). After adjustment for potential confounders, including hypertension, hyperlipidaemia, chronic renal disease and keratoconjunctivitis sicca, patients with DM were 1.35 times (95% CI, 1.24 to 1.48) more likely to develop RCE than the total sample cohort. CONCLUSIONS DM increases the risk of RCE, which is an interdisciplinary issue. Therefore, close collaboration between endocrinologists and ophthalmologists is important in managing RCE following DM.
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Affiliation(s)
- Ren-Long Jan
- Department of Pediatrics, Chi Mei Medical Center, Liouying, Tainan, Taiwan
- Graduate Institute of Medical Science, College of Health Science, Chang Jung Christian University, Tainan, Taiwan
| | - Ming-Cheng Tai
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
- Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Chin-Chen Chu
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
- Department of Recreation and Health-Care Management, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Sung-Huei Tseng
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Ophthalmology, Chi Mei Medical Center, Tainan, Taiwan
| | - Yuh-Shin Chang
- Graduate Institute of Medical Science, College of Health Science, Chang Jung Christian University, Tainan, Taiwan
- Department of Ophthalmology, Chi Mei Medical Center, Tainan, Taiwan
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Risk of Corneal Ulcer in Patients with Diabetes Mellitus: A Retrospective Large-Scale Cohort Study. Sci Rep 2020; 10:7388. [PMID: 32355281 PMCID: PMC7193550 DOI: 10.1038/s41598-020-64489-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/16/2020] [Indexed: 11/13/2022] Open
Abstract
This nationwide, retrospective, matched cohort study was designed to investigate the risk of corneal ulcer in patients with diabetes mellitus (DM). It included 238,701 patients with DM, recruited between 2003 and 2005 from the Longitudinal Cohort of Diabetes Patients database. The control group included the same number of age- and sex-matched non-DM patients selected from the Taiwan Longitudinal Health Insurance Database, 2000. The data of each patient were collected from the index date until December 2013. The incidence of corneal ulcer was compared between the two groups. In total, 2,549 patients with DM and 1,988 controls developed corneal ulcer during the follow-up period, resulting in an incidence rate for corneal ulcers that was 1.27 times (95% confidence interval [CI] = 1.20–1.35; P < 0.001) higher in patients with DM than in controls. After adjustment for potential confounders, including hyperlipidemia, hypertension, congestive heart failure, coronary artery disease, and chronic renal disease, patients with DM were 1.31 times (95% CI, 1.24–1.40; P < 0.05) more likely than the cohort to develop corneal ulcers. In conclusion, this study shows that DM increases the risk of corneal ulcer. Therefore, close collaboration between ophthalmologists and endocrinologists is important to ensure timely ophthalmology visits.
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Xiao YY, Wei WB, Wang YX, Lu AD, Chen SH, Song L, Wu SL. Correlation of the history of stroke and the retinal artery occlusion: a nested case-control study. Int J Ophthalmol 2020; 13:431-437. [PMID: 32309180 DOI: 10.18240/ijo.2020.03.10] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 01/08/2020] [Indexed: 12/17/2022] Open
Abstract
AIM To analyze the systemic factors including stroke history related to the retinal artery occlusion (RAO). METHODS Patients with an exact diagnosis of RAO in the medical database of the Kailuan Corporation were identified as the case group. Five patients without RAO were added for each case from the Kailuan Study and matched for sex and age (age±2) as the control group. The Kailuan Study is a general population-based cohort study in northern China, in which a total of 101 510 individuals (81 110 men) aged 18-98y were recruited to participate in the study. And the participants were bi-annually re-examined. The database of both groups was from Kailuan study of 2010 cohort. All the information, including the demographic characteristics, lifestyle behaviors, medical comorbidities, medical history, family medical history, drug usage, anthropometric measurements, blood pressure measurement, blood sample laboratory assessment, urine tests, and other physical examinations were all collected. A retrospective nested case-control method was used for this study. Conditional multivariate logistic regression was used to analyze the risk factors with SPSS 13.0 software and SAS 9.3 software. RESULTS A total of 45 patients were included as the case group, and the control group included 225 patients. In the case group, 28 patients (62.2%) had a central retinal artery occlusion (CRAO), and 17 patients (37.8%) had a branch retinal artery occlusion (BRAO). A total of 18 patients (40.0%) had a stroke before the RAO (mean 4.04±3.88y before the RAO), and 31 patients (81.6%) had infarctions or malacia identified by the cranial computed tomography (CT) scans. The basal ganglia and centrum semiovale were the most frequently involved regions. Plaques in the common carotid artery were present in 32 patients (88.9%). Conditional multivariate logistic regression analysis showed that the RAO was found to be associated with the history of stroke (P=0.0023, OR=28.794; 95%CI: 3.322-249.586). CONCLUSION A history of stroke can significantly increase the incidence of RAO. Exists of plaque in the carotid artery is mean more than its severe stenosis for RAO.
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Affiliation(s)
- Yue-Yan Xiao
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Wen-Bin Wei
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Ya-Xing Wang
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Ai-Dong Lu
- Department of Ophthalmology, Kailuan General Hospital, Tangshan 063000, Hebei Province, China
| | - Shuo-Hua Chen
- Department of Cardiology, Kailuan General Hospital, Tangshan 063000, Hebei Province, China
| | - Lu Song
- Department of Cardiology, Kailuan General Hospital, Tangshan 063000, Hebei Province, China
| | - Shou-Ling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan 063000, Hebei Province, China
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Schorr EM, Rossi KC, Stein LK, Park BL, Tuhrim S, Dhamoon MS. Characteristics and Outcomes of Retinal Artery Occlusion: Nationally Representative Data. Stroke 2020; 51:800-807. [PMID: 31951154 DOI: 10.1161/strokeaha.119.027034] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- There are few large studies examining comorbidities, outcomes, and acute interventions for patients with retinal artery occlusion (RAO). RAO shares pathophysiology with acute ischemic stroke (AIS); direct comparison may inform emergent treatment, evaluation, and secondary prevention. Methods- The National Readmissions Database contains data on ≈50% of US hospitalizations from 2013 to 2015. We used International Classification of Diseases, Ninth Revision, codes to identify and compare index RAO and AIS admissions, comorbidities, and interventions and Clinical Comorbidity Software codes to identify readmissions causes, using survey-weighted methods when possible. Cumulative risk of all-cause readmission after RAO ≤1 year was estimated by Kaplan-Meier analysis. Results- Among 4871 RAO and 1 239 963 AIS admissions, patients with RAO were less likely (P<0.0001) than patients with AIS to have diabetes mellitus (RAO, 24.3% versus AIS, 36.8%), congestive heart failure (9.1% versus 14.8%), atrial fibrillation (15.5% versus 25.2%), or hypertension (62.2% versus 67.6%) but more likely to have valvular disease (13.3% versus 10.5%) and tobacco usage (38.6% versus 32.9%). In RAO admissions, thrombolysis was administered in 2.9% (5.8% in central RAO subgroup, versus 8.0% of AIS), therapeutic anterior chamber paracentesis in 1.0%, thrombectomy in none; 1.4% received carotid endarterectomy during index admission, 1.6% within 30 days. Nearly 1 in 10 patients with RAO were readmitted within 30 days and were more than twice as likely as patients with AIS to be readmitted for dysrhythmia or endocarditis. Readmission for stroke after RAO was the highest within the first 150 days after index admission, and risk was higher in central RAO than in branch RAO. Conclusions- Patients with RAO had high prevalence of many stroke risk factors, particularly valvular disease and smoking, which can be addressed to minimize subsequent risk. Despite less baseline atrial fibrillation, RAO patients were more likely to be readmitted for atrial fibrillation/dysrhythmias. A variety of interventions was administered. AIS risk is the highest shortly after RAO, emphasizing the importance of urgent, thorough neurovascular evaluation.
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Affiliation(s)
- Emily M Schorr
- From the Department of Neurology (E.M.S., L.K.S., S.T., M.S.D.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kyle C Rossi
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (K.C.R.)
| | - Laura K Stein
- From the Department of Neurology (E.M.S., L.K.S., S.T., M.S.D.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Brian L Park
- Department of Pediatrics (B.L.P.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Stanley Tuhrim
- From the Department of Neurology (E.M.S., L.K.S., S.T., M.S.D.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mandip S Dhamoon
- From the Department of Neurology (E.M.S., L.K.S., S.T., M.S.D.), Icahn School of Medicine at Mount Sinai, New York, NY
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