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. 2022 Apr;36(4):835-843.
doi: 10.1038/s41433-021-01546-6. Epub 2021 Apr 28.

The association of stroke with central and branch retinal arterial occlusion

Drew Scoles  1 , Brendan McGeehan  2 , Brian L VanderBeek  3   4   5
Affiliations

The association of stroke with central and branch retinal arterial occlusion

Drew Scoles et al. Eye (Lond). 2022 Apr.

Abstract

Objectives: To determine the near-term risk of stroke following a retinal artery occlusion (RAO).

Methods: The risk of stroke was assessed in two manners; with a self-controlled case series (SCCS) and a propensity score (PS) matched cohort study using a US medical claims database. The date of RAO diagnosis was assigned as the index date. In the SCCS, incidence of stroke was compared in 30- and 7-day periods pre- and post-index date. In PS analysis, matched cohorts were created from patients with RAO or hip fracture. Cox proportional hazard regression assessed the hazard for stroke. Patients were censored at 1 year, upon leaving the insurance plan or if they had a qualifying event for the comparison group.

Results: The SCCS included 16,193 patients with RAO. The incidence rate ratio (IRR) of new stroke in the month after RAO was increased compared to all periods >2 months before and all months after the index date (IRRs: 1.68-6.40, p < 0.012). Risk was increased in the week immediately following the index date compared to most weeks starting 2 weeks prior to and all weeks immediately after the index date (IRRs: 1.93-29.00, p < 0.026). The PS study analysed 18,213 propensity-matched patients with RAO vs. hip fracture. The HR for having a stroke after RAO compared to a hip fracture was elevated in all analyses (All RAO HR: 2.97, 95% CI: 2.71-3.26, p < 0.001; CRAO HR: 3.24, 95% CI: 2.83-3.70, p < 0.001; BRAO HR: 2.76, 95% CI: 2.43-3.13, p < 0.001).

Conclusions: The highest risk for stroke occurs in the days following a CRAO or BRAO, supporting guidelines suggesting immediate referral to a stroke centre upon diagnosis.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Numbers excluded at each step and final inclusion counts for both the self-controlled case series and the cohort analyses.
*Denotes those patients that did not have enough time in the insurance plan for inclusion. †Denotes patients excluded for missing gender or having a diagnosis of an ‘unspecified’ retinal artery obstruction that did not delineate between a central or branch occlusion.
Fig. 2
Fig. 2
Number of strokes in each month before and after the index date.
Fig. 3
Fig. 3
Number of strokes in each week before and after the index date.
See this image and copyright information in PMC

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References

    1. Brown GC. Systemic associations of retinal arterial obstructive disease. Int Ophthalmol Clin. 1991;31:1–14. doi: 10.1097/00004397-199103130-00003. - DOI - PubMed
    1. Park SJ, Choi NK, Seo KH, Park KH, Woo SJ. Nationwide incidence of clinically diagnosed central retinal artery occlusion in Korea, 2008 to 2011. Ophthalmology. 2014;121:1933–8. doi: 10.1016/j.ophtha.2014.04.029. - DOI - PubMed
    1. Leavitt JA, Larson TA, Hodge DO, Gullerud RE. The incidence of central retinal artery occlusion in Olmsted County, Minnesota. Am J Ophthalmol. 2011;152:820–3. doi: 10.1016/j.ajo.2011.05.005. - DOI - PMC - PubMed
    1. Hayreh SS, Podhajsky PA, Zimmerman MB. Retinal artery occlusion: associated systemic and ophthalmic abnormalities. Ophthalmology. 2009;116:1928–36. doi: 10.1016/j.ophtha.2009.03.006. - DOI - PMC - PubMed
    1. Recchia FM, Brown GC. Systemic disorders associated with retinal vascular occlusion. Curr Opin Ophthalmol. 2000;11:462–7. doi: 10.1097/00055735-200012000-00013. - DOI - PubMed