Central retinal artery occlusion: Presentation and management at a Canadian academic health sciences centre

Theme: Neuro-ophthalmology
What: Neuro-ophthalmology
Part of: Neuro-ophthalmology II / Neuro-ophtalmolgie II
When: 6/1/2024, 02:00 PM - 03:30 PM
Where: Room | Salle 714 B

Abstract

Purpose

Guidelines for the management of central retinal artery occlusion (CRAO) are evolving. Data from American and European centres have outlined practice patterns for CRAO in those regions. Canadian data are lacking but are needed to inform discussions about a national strategy for this condition. Our objective was to describe CRAO presentation and management at one of Canada’s largest academic health sciences centres.

Study design

Institutional case series

Methods

We performed a retrospective analysis of consecutive patients with CRAO presenting to The Ottawa Hospital between 1-June-2019 and 31-May-2023. Patients with remotely diagnosed CRAO were excluded. Study outcomes included demographics, presentation pathways, workup, interventions, and referrals. The institutional review board approved the study protocol. 

Results

Seventy-six patients were included. The median (interquartile range [IQR]) age was 68.1 (61.4-81.8) years and 46 (60.5%) were male.

The most common site of presentation was an emergency department for 47 (61.8%). The median (IQR) time from vision loss to presentation was 15.0 (3.5-48.0) hours. Twenty-two (28.9%) presented within 4.5 hours. The median (IQR) door-to-ophthalmology time was 12.0 (4.6-22.6) hours.

Neurovascular imaging was obtained for 73 (96.1%) patients. Among patients presenting within 48 hours, median (IQR) door-to-imaging time was 6.1 (3.6-9.1) hours. A targeted history/physical for giant cell arteritis (GCA) was documented for 66 (86.8%) and GCA serology was obtained for 58 (76.3%). Temporal artery biopsy was performed for 19 (25.0%) and GCA was ultimately diagnosed in 6 (7.9%).

No patient received thrombolysis. Four (5.3%) received putative conservative therapy for CRAO (ocular massage and/or intra-ocular pressure lowering therapy). Empiric glucocorticoid therapy for GCA was initiated for 17 (22.5%).

Sixty-four patients were eligible for anti-platelet therapy (APT) escalation. Of those, escalation to single APT occurred for 16 (25.0%) and to dual APT for 29 (45.3%). Anti-platelet loading dose was administered to 19 (42.2%) of those 45 patients.

Sixty-four (91.4%) of 70 patients with non-arteritic CRAO were referred for secondary stroke prevention. Referral for ocular follow up was made for 60 (78.9%) patients in the entire cohort.

Conclusion

We found that patients seek care urgently following CRAO, and generally receive appropriate stroke care. Work is called for to reduce delays to ophthalmological consultation, to optimize screening for GCA, to clarify best practice for APT, and to promote secondary prevention referrals. Despite growing evidence for efficacy of thrombolysis in CRAO, our hospital system, one of the largest in Canada, has not yet adopted this within its institutional scope.

Presenter(s)

Presenting Author: Matthew Quinn

Additional Author(s):

Danah Albreiki, The Ottawa Hospital

Danny Lelli, The Ottawa Hospital

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