Risk factors for central retinal artery occlusion in young patients

The acute irreversible loss of vision associated with central retinal artery occlusion (CRAO) can be devastating, especially in young patients. literature has revealed potential risk factors, including hypercoagulability, trauma, sickle cell disorders, cardiac valvular disease, carotid stenosis, use oral contraceptives, pregnancy, collagen vascular increased intraocular pressure, optic nerve drusen, congenital prepapillary arterial loop, intravenous drug abuse, migraine, vasculitis, and perioperative factors patients CRAO.1Brown GC Magargal LE Shields JA Goldberg RE Walsh PN Retinal obstruction children adults.Ophthalmology. 1981; 88: 18-25Abstract Full Text PDF PubMed Scopus (203) Google Scholar, 2Xia T Zarbin MA Bhagat N patients: a 6-year review.J Vitreoret Dis. 2019; 3: 63-68Crossref 3Ratra D Dhupper M. occlusions the young: systemic associations Indian population.Indian J Ophthalmol. 2012; 60: 95-100Crossref (26) Scholar This retrospective case-control study aims to evaluate ocular comorbidities CRAO was performed using data from 2002–2014 National Inpatient Sample (NIS) Database.4HCUP Nationwide (NIS)Healthcare Cost Utilization Project (HCUP). Agency for Healthcare Research Quality, Rockville, MD2011Google Scholar,5HCUP MD2012Google Cases included 522 (weighted) hospitalized adults between ages 20 45 years an admitting diagnosis CRAO, controls, matched by age sex, were 5430 individuals who did not have any occlusion. average subjects non-CRAO cohorts 37.3 37.4 years, respectively (p = 0.800). Men constituted 58.4% 56.6% cohorts, 0.400). ethnic background cases versus controls White participants 42.1% 55.9% < 0.001), Black 28.1% 8.2% Hispanic 4.5% 25.6% Asian/Pacific Islander 4.7% 2.0% Native American 0% 6.9% 0.001). A higher prevalence certain noted compared (Table 1); these hypertension 41.4% 23.3%, tobacco 32.3% 23.7%, hyperlipidemia 21.0 9.2, disease 9.6 2.2, migraine 6.7 2.7. Carotid history cerebral stroke, atherosclerosis, aortic disease/aneurysm significantly more prevalent cases. Acute thromboembolic events reported during hospitalization Deep Vein Thrombosis or Pulmonary Embolism (4.7%), ischemic stroke (4.0%), Transient Ischemic Attack (1.1%). Furthermore, 9.6% underwent angiography, 29.1% echocardiography. No endarterectomy, no in-hospital deaths reported. length varied (3.45 days vs 4.29 days; p significant difference found hospital cost per day ($9964 $9283; 0.083).Table 1Comparison without CRAOVariableControls (n 5430)Cases 522)pCount%Count%AgeAverage (y)37.3037.380.800Age group (y)0.56620–29105519.409618.4030–45437580.6042681.60Sex0.400Men317258.4029556.60Women225841.6022743.40EthnicityWhite303355.9022042.10<0.001Black4448.2014728.10<0.001Hispanic139125.60244.50<0.001Asian/Pacific Islander1082.00254.70<0.001Native American3776.9000.00<0.001Other50.10303.90<0.001Systemic comorbiditiesAortic dissection aneurysm50.10101.90<0.001Atherosclerosis320.60101.900.001Atrial fibrillation/flutter1152.1051.000.072Carotid dissection50.1000.000.488Carotid stenosis50.10305.80<0.001Cocaine use1011.9050.900.137Bleeding diathesis1993.70203.900.814Congestive heart failure891.60142.800.076DVT/PE (history)1572.90254.700.017Diabetes chronic complications1623.00142.800.719Diabetes complications5299.70295.600.002Intravenous use1102.0050.900.094Hyperlipidemia5019.2010921.00<0.001Primary hypercoagulable state190.30254.90<0.001Hypertension126723.3021441.40<0.001Leukemia631.2000.000.013Non-Hodgkin lymphoma290.5000.000.094Migraine1492.70356.70<0.001Obesity4989.206011.500.072Pregnancy140.3000.000.245Pseudotumour cerebri100.2000.000.326Rheumatoid arthritis/collagen diseases711.3040.900.299Sickle trait430.8091.800.029Stroke (history)430.80193.70<0.001Syphilis100.2091.80<0.001Systemic vasculitides00.0050.90<0.001Tobacco use128823.7016932.30<0.001Cardiac valve disease1202.20509.60<0.001Glaucoma NVG40.10101.80<0.001In-hospital complicationsDVT/PE (acute)2113.90254.700.317Myocardial infarction (acute)430.8000.000.041Ischemic stroke50.10214.00<0.001Hemorrhagic stroke100.2000.000.326Transient attack190.4061.100.007Systemic venous thrombosis521.00132.500.001In-hospital proceduresCerebral angiography440.80509.60<0.001Carotid ultrasound00.00152.80<0.001Echocardiography480.9015229.10<0.001MedicationAnticoagulation1222.30305.70<0.001Antiplatelet140.3000.000.245Aspirin591.1040.800.495Hospital courseMean stay (days)4.293.45<0.001Mean (dollars)928399640.083Died hospitalization190.4000.000.176DVT Thrombosis. PE Embolism. Open table new tab DVT Comorbidities that vasculitides (Odds Ratio (OR) 164.68), stenosis (OR 61.66), glaucoma 26.48), state 14.82), syphilis 5.40), 3.36), 3.14), 1.97) 2).Table 2Results regression analysisVariableUnivariablepMultivariablep*Bonferroni correction: 0.003.Age (y)20–291.00Ref1.00Ref30–451.06 (0.84–1.34)0.597——SexWomen1.00RefMen1.08 (0.90–1.29)0.413——EthnicityWhite1.00RefBlack4.39 (3.54–5.44)<0.0013.56 (2.77–4.56)<0.001Hispanic0.14 (0.09–0.21)<0.0010.23 (0.15–0.36)<0.001Asian/Pacific Islander2.47 (1.58–3.86)<0.0012.86 (1.78–4.59)<0.001Native American0.01 (0.00–0.21)<0.0010.02 (0.00–0.35)0.007Other40.93 (15.55–107.71)<0.00150.67 (18.96–135.4)<0.001Systemic aneurysm19.92 (6.75–58.81)<0.0014.55 (1.07–19.41)0.041Atherosclerosis3.38 (1.65–6.91)<0.0013.06 (1.20–7.76)0.019Atrial fibrillation flutter0.49 (0.21–1.16)0.106——Carotid dissection0.96 (0.04–23.12)0.980——Carotid stenosis62.86 (24.76–159.61)<0.00161.66 (23.83–159.54)<0.001Bleeding diathesis1.10 (0.70–1.75)0.678——Congestive failure1.76 (1.00–3.07)0.0481.19 (0.64–2.19)0.584DVT/PE (history)1.68 (1.09–2.59)0.0190.65 (0.36–1.17)0.147Diabetes complications0.96 (0.56–1.64)0.870——Diabetes complications0.56 (0.38–0.82)0.0030.44 (0.29–0.69)<0.001Intravenous use0.47 (0.19–1.17)0.104——Hyperlipidemia2.61 (2.08–3.29)<0.0011.37 (1.02–1.84)0.035Primary state14.5 (7.94–26.47)<0.00114.82 (6.52–33.71)<0.001Hypertension2.32 (1.93–2.79)<0.0011.97 (1.58–2.46)<0.001Leukemia0.08 (0.00–1.34)0.079——Non-Hodgkin lymphoma0.17 (0.01–2.97)0.227——Migraine infarction2.56 (1.75–3.74)<0.0013.14 (2.04–4.82)<0.001Obesity1.30 (0.97–1.72)0.075——Peripheral disease2.97 (1.80–4.89)<0.0010.42 (0.18–0.99)0.048Pregnancy0.36 (0.02–6.59)0.488——Pseudotumour cerebri0.50 (0.03–9.92)0.652——Rheumatoid arthritis0.72 (0.29–1.82)0.492——Sickle trait2.35 (1.16–4.75)0.0180.35 (0.13–0.97)0.044Stroke (history)4.87 (2.83–8.38)<0.0012.20 (1.11–4.34)0.024Syphilis10.24 (4.16–25.17)<0.0015.40 (1.89–15.45)0.002Systemic vasculitides108.98 (4.45–2666.38)0.04164.68 (5.60–4846.00)0.003Tobacco use1.54 (1.27–1.87)<0.0011.21 (0.97–1.52)0.088Cardiac disease4.73 (3.36–6.66)<0.0013.36 (2.19–5.16)<0.001Glaucoma (includes neovascular glaucoma)23.27 (7.35–73.66)<0.00126.48 (7.95–88.19)<0.001DVT Bonferroni 0.003. Recent evidence suggests cerebrovascular accidents may occur within month up 25% cases; Heart Association Academy Ophthalmology recommend that, irrespective age, all should undergo urgent work-up.6Flaxel CJ Adelman RA Bailey ST et al.Retinal Ophthalmic Artery Occlusions Preferred Practice Pattern.Ophthalmology. 2020; 127: P259-P287Abstract (29) showed myriad conditions are adults. Because present uses national database, it is nature, one cannot determine causality. accuracy analysis depends on health care providers coding diagnoses. These limitations unique this database study. Additionally, although control sex ethnicity, which introduce variation; however, variation likely modest unlikely affect analysis, includes ethnicity. Lastly, because inpatients, there requiring multiple hospitalizations than what would seen outpatients. Marco A. reports personal fees Genentech/Roche, Novartis Pharma AG, Iveric Bio, Perfuse Therapeutics, Selphagy/Life Biosciences, Frequency Chengdu Kanghong Biotech, cofounder NVasc. other authors financial disclosures.