Atrial fibrillation in retinal vascular occlusion disease and non-arteritic anterior ischemic optic neuropathy

Abstract

BackgroundPatients with retinal vascular occlusion disease have an increased risk for ischemic stroke and share some risk factors with cerebrovascular disease. The purpose of this study was to analyze the prevalence of atrial fibrillation (AF) in subjects with retinal vascular occlusive disease and anterior ischemic optic neuropathy and to compare these data to an ischemic stroke group.MethodsProspective, observational single-center trial. Subjects with retinal artery occlusion (RAO), retinal vein occlusion (RVO) and anterior ischemic optic neuropathy (AION) were included. Patients with ischemic stroke (IS) from a previous observational trial were used as control. Investigation included 7-day Holter ECG, echocardiography, duplex ultrasonography of the carotid arteries, and 24-hour blood pressure monitoring. Further vascular risk factors were documented.ResultsDuring the 1-year study period, 101 patients were recruited. The control group with ischemic stroke consisted of 272 subjects. At inclusion, the prevalence of AF was 12% (RAO), 10.2% (RVO), 11.1% (NAION) and 15.8% (IS). The final prevalence after Holter ECG rose to 16% (RAO), 18.4% (RVO), 14.8% (NAION) and 26.5% (IS). No significant difference was measured between groups.ConclusionsWe detected a similar prevalence of AF in all groups. RVO patients tended to exhibit a higher AF detection rate and lower number needed to screen than RAO and NAION. The detection of AF rose considerably via Holter ECG. As a consequence, we recommend prolonged ECG monitoring in patients with acute ophthalmic vascular diseases.

Risk of incident atrial fibrillation in patients presenting with retinal artery or vein occlusion: a nationwide cohort study

“…The association of AF and RAO is not investigated to the same extent as the association of AF and ischemic stroke. Whereas one study found a similar detection rate of AF in RAO patients AF (12.5% of patients using 24-h ECG (at least)), other studies indicate that AF is more common in patients with ischemic stroke and find a higher number needed to screen in patients with RAO than in patients with ischemic stroke [ 14 , 37 , 38 ]. Patients with AF have a higher ratio of hemispheric to retinal occlusions compared to patients with AF, which may indicate that other embolic sources than the atria such as a carotid stenosis play a larger role in RAO patients.…”

“…This study substantiates the importance of a careful work-up required in patients with retinal vascular occlusion, which is in accordance with other studies. [ 37 , 45 ] Detection of AF leads to indication for oral anticoagulation (in the presence of at least one CHA 2 DS 2 -VASc point) to efficiently reduce risk of ischemic stroke. [ 46 , 47 ] Further studies are needed to estimate the effect of oral anticoagulation on the risk of RAO.…”

Standard Diffusion-weighted MRI for the Diagnosis of Central Retinal Artery Occlusion

“…Frequent ophthalmoscopic findings include retinal edema, attenuation or segmentation of retinal arterioles and visible retinal artery emboli [2]. Similar to ischemic stroke, CRAO is mainly caused by emboli originating from large artery atherosclerosis [3][4][5] or car-K dioembolism [6,7], although a wider etiologic spectrum needs to be considered [8][9][10][11][12][13][14].…”

Akute okuläre Ischämien – was ist wichtig in der internistischen Diagnostik?

“…1). Die Untersuchung ist einfach durchführbar und sollte mittels hochfrequentem Linearschallkopf erfolgen (7)(8)(9)(10)(11)(12)(13)(14)(15). In Neurologie, Notfall-und Intensivmedizin wird die transorbitale Sonografie zunehmend eingesetzt, unter anderem für die Abklärung eines erhöhten intrakraniellen Drucks [10].…”