• Neuro-Ophthalmology/Orbit

    This retrospective study assessed cases of acute vascular ischemic events occurring in patients with central retinal artery occlusion (CRAO).

    Study design

    Researchers identified 17,117 patients in the National Inpatient Sample (NIS) who were diagnosed with CRAO in the United States between 2003 and 2014. The primary outcome was incidence of in-hospital acute vascular ischemic events.

    Outcomes

    The incidence of in-hospital stroke and acute myocardial infarction were 12.9% and 3.7%, respectively. The incidence of stroke increased during the study period, almost doubling to 15.3% in 2014 in comparison to 7.7% in 2003. The combined risk of in-hospital stroke, transient ischemic attack, acute myocardial infarction or mortality was 19%.

    Female sex, hypertension, carotid artery stenosis, aortic valve disease, smoking and alcohol dependence or abuse were positive predictors of in-hospital stroke.

    Limitations

    The study lacked a control group and did not consider long-term outcomes after discharge, though it was potentially outside of the scope of this study. There was also a possibility of misdiagnosis based on ICD-9 codes, although the large sample size may have mitigated this risk.

    Clinical significance

    This is the largest study of CRAO patients to date and suggests a significant burden of acute vascular ischemic events and mortality. These findings validate CRAO as an important clinical marker for future vascular ischemic events, including stroke and acute myocardial infarction.