Vascular risk factors for central retinal artery occlusion.

PURPOSE: To determine the proportion of patients presenting with thromboembolic central retinal artery occlusion (CRAO) who had undiagnosed vascular risk factors amenable to modification. METHODS: A retrospective audit of consecutive patients with non-arteritic/thromboembolic CRAO presenting between 1997 and 2008 in a single tertiary teaching hospital. RESULTS: Thirty-three patients with non-arteritic CRAO were identified. Twenty-one patients (64%) had at least one new vascular risk factor found after the retinal occlusive event, with hyperlipidemia being the most common undiagnosed vascular risk factor at the time of the sentinel CRAO event (36%). Nine patients (27%) had newly diagnosed hypertension or previous diagnosis of hypertension but not optimally controlled. To better control their vascular risk factors 18 patients (54%) were given a new or altered medication. Nine patients had more than 50% of ipsilateral carotid stenosis ; six of these proceeded with carotid endarterectomy or stenting. One patient had significant new echocardiogram finding. Systemic ischaemic event post CRAO occurred in two patients with stroke and acute coronary syndrome. CONCLUSIONS: Patients presenting with CRAO often have a previously undiagnosed vascular risk factor that may be amenable to medical or surgical treatment. As this population is at a high risk of secondary ischaemic events, risk factor modification is prudent.

Central retinal artery occlusion: timing and mode of presentation.

BACKGROUND AND PURPOSE: Central retinal artery occlusion (CRAO) is a sudden, frequently irreversible, monocular vision loss, analogous to acute cerebral ischaemia. Thrombolysis may improve visual outcomes, but it is unclear what the acceptable timing of administration should be. We aim to ascertain, through audit, the timing and mode of presentation of individuals with potentially thrombolysable CRAOs. METHODS: A retrospective audit of patients with acute thromboembolic CRAO. RESULTS: Thirty-one patients were identified. Mean time from onset of vision loss to presentation was 31 +/- 65 h. Eighteen patients (58%) presented within 20 h of vision loss, and the majority presented first to a general practitioner. Fifteen patients (48%) were reviewed by an in-hospital ophthalmologist within 20 h of vision loss. The mean delay from the referring source to assessment by an in-hospital ophthalmologist was 5.2 h (median 3.3 h, range 50 min to 24 h). This delay was, on average, shorter for patients referred directly to an ophthalmology clinic. CONCLUSIONS: Just under half (48%) of our cohort of CRAO patients were reviewed by an in-hospital ophthalmologist within the 20-h therapeutic time window for thrombolytic therapy and thus could qualify for inclusion in a randomized controlled trial according to EAGLE inclusion criteria. If thrombolysis is proven to be a feasible and safe treatment in CRAO then public awareness should be raised of the symptoms and an efficient direct referral pathway to an in-hospital ophthalmologist established to aid treatment delivery.

Prevalence of exfoliation syndrome in central Sri Lanka: the Kandy Eye Study.

AIMS: To report the prevalence and correlates of exfoliation syndrome (XFS) in central, rural Sri Lanka. METHODS: A population-based, cross-sectional ophthalmic survey of inhabitants 40 years of age and over from villages in the Kandy District was conducted. Selection was randomised using a cluster sampling process. 1721 eligible participants were identified, 1375 participated. A detailed ophthalmic history and examination including ocular biometry was made of each participant. RESULTS: The prevalence of XFS was estimated to be 1.1% (95% CI 0.5 to 1.5%; 22 eyes). XFS was bilateral in eight subjects, unilateral in six subjects. Univariate analysis demonstrated a significant association between XFS and increasing age (p<0.001), increasing intraocular pressure (odds ratio 1.2; 95% CI 1.09 to 1.27; p<0.001), nuclear cataracts (odds ratio 1.92; 95% CI 1.47 to 2.51; p<0.001), visual impairment (odds ratio 9.72; 95% CI 3.01 to 31.44; p<0.001) and a history of hypertension (odds ratio 3.89; 95% CI 1.14 to 13.16; p = 0.030). CONCLUSION: XFS in this Sri Lankan population was associated with advanced age, raised intraocular pressure, nuclear cataracts, hypertension and visual impairment.