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Risk of acute stroke in patients with retinal artery occlusion: a systematic review and meta-analysis

Risk of acute stroke in patients with retinal artery occlusion: a systematic review and meta-analysis
Risk of acute stroke in patients with retinal artery occlusion: a systematic review and meta-analysis
Objective

To estimate the incidence of acute cerebral ischaemia detected by magnetic resonance imaging (MRI) in acute central retinal artery occlusion (CRAO), branch retinal artery occlusion (BRAO) and transient monocular vision loss (TMVL).

Methods

Studies reporting the incidence of acute cerebral ischaemia, detected by MRI, within 7 days from diagnosis of acute CRAO, BRAO and TMVL up to January 2019 were systematically searched for on Pubmed, Medline and Cochrane Library. Meta-analysis was performed using random effects model. The primary outcome was the pooled estimate of incidence of acute cerebral ischaemia in CRAO, BRAO and TMVL cohorts including both neurologically symptomatic and asymptomatic patients, expressed as a proportion along with 95% confidence intervals (CIs). The pooled estimate of incidence of asymptomatic acute cerebral ischaemia represented a secondary outcome measure.

Results

For the primary outcome, the pooled proportion of acute cerebral ischaemia was 0.30 (CI 0.24–0.36) in the CRAO cohort, and 0.25 (CI 0.16–0.37) in the BRAO cohort, without statistical heterogeneity. The rate of acute cerebral ischaemia was 11.8% in the TMVL cohort. For the secondary outcome, the pooled proportion of asymptomatic acute cerebral ischaemia was 0.22 (CI 0.16–0.28) in the CRAO cohort, 0.29 (CI 0.20–0.41) in the BRAO cohort and 0.08 (CI 0.05–0.15) in the TMVL cohort, with no statistical heterogeneity.

Conclusions

30% of patients with acute CRAO and 25% of patients with acute BRAO presented an acute cerebral ischaemia on MRI. Such high rates support a care pathway of prompt referral of such patients for neurological evaluation and brain imaging.
0950-222X
Fallico, Matteo
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Lotery, Andrew
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Longo, Antonio
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Avitabile, Teresio
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Bonfiglio, Vincenza
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Russo, Andrea
91268f7c-8791-4fbf-8be6-36428cb66a4c
Murabito, Paolo
69031744-3edf-43b2-85ba-198b1410600e
Palmucci, Stefano
ae59b4f8-7eb0-4a4d-983d-2973503e7e2a
Pulvirenti, Alfredo
614a209d-f746-4ef6-8c01-04d5a7ce3471
Reibaldi, Michele
fce109e8-0880-4616-94b0-6e9986772217
Fallico, Matteo
be88cf24-b71d-4d5b-9321-6ed27f670f28
Lotery, Andrew
5ecc2d2d-d0b4-468f-ad2c-df7156f8e514
Longo, Antonio
f63bece4-d592-4270-90f7-671f8254f524
Avitabile, Teresio
17f19c21-10a4-4d0d-869b-dfbe92e08030
Bonfiglio, Vincenza
a33708f3-7206-40cf-9b55-3f68d0bc4766
Russo, Andrea
91268f7c-8791-4fbf-8be6-36428cb66a4c
Murabito, Paolo
69031744-3edf-43b2-85ba-198b1410600e
Palmucci, Stefano
ae59b4f8-7eb0-4a4d-983d-2973503e7e2a
Pulvirenti, Alfredo
614a209d-f746-4ef6-8c01-04d5a7ce3471
Reibaldi, Michele
fce109e8-0880-4616-94b0-6e9986772217

Fallico, Matteo, Lotery, Andrew, Longo, Antonio, Avitabile, Teresio, Bonfiglio, Vincenza, Russo, Andrea, Murabito, Paolo, Palmucci, Stefano, Pulvirenti, Alfredo and Reibaldi, Michele (2019) Risk of acute stroke in patients with retinal artery occlusion: a systematic review and meta-analysis. Eye. (doi:10.1038/s41433-019-0576-y).

Record type: Article

Abstract

Objective

To estimate the incidence of acute cerebral ischaemia detected by magnetic resonance imaging (MRI) in acute central retinal artery occlusion (CRAO), branch retinal artery occlusion (BRAO) and transient monocular vision loss (TMVL).

Methods

Studies reporting the incidence of acute cerebral ischaemia, detected by MRI, within 7 days from diagnosis of acute CRAO, BRAO and TMVL up to January 2019 were systematically searched for on Pubmed, Medline and Cochrane Library. Meta-analysis was performed using random effects model. The primary outcome was the pooled estimate of incidence of acute cerebral ischaemia in CRAO, BRAO and TMVL cohorts including both neurologically symptomatic and asymptomatic patients, expressed as a proportion along with 95% confidence intervals (CIs). The pooled estimate of incidence of asymptomatic acute cerebral ischaemia represented a secondary outcome measure.

Results

For the primary outcome, the pooled proportion of acute cerebral ischaemia was 0.30 (CI 0.24–0.36) in the CRAO cohort, and 0.25 (CI 0.16–0.37) in the BRAO cohort, without statistical heterogeneity. The rate of acute cerebral ischaemia was 11.8% in the TMVL cohort. For the secondary outcome, the pooled proportion of asymptomatic acute cerebral ischaemia was 0.22 (CI 0.16–0.28) in the CRAO cohort, 0.29 (CI 0.20–0.41) in the BRAO cohort and 0.08 (CI 0.05–0.15) in the TMVL cohort, with no statistical heterogeneity.

Conclusions

30% of patients with acute CRAO and 25% of patients with acute BRAO presented an acute cerebral ischaemia on MRI. Such high rates support a care pathway of prompt referral of such patients for neurological evaluation and brain imaging.

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More information

Accepted/In Press date: 29 July 2019
e-pub ahead of print date: 16 September 2019

Identifiers

Local EPrints ID: 436844
URI: http://eprints.soton.ac.uk/id/eprint/436844
ISSN: 0950-222X
PURE UUID: 17174316-19fb-4d1c-af42-15b69413e716
ORCID for Andrew Lotery: ORCID iD orcid.org/0000-0001-5541-4305

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Date deposited: 10 Jan 2020 17:35
Last modified: 17 Mar 2024 02:57

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Contributors

Author: Matteo Fallico
Author: Andrew Lotery ORCID iD
Author: Antonio Longo
Author: Teresio Avitabile
Author: Vincenza Bonfiglio
Author: Andrea Russo
Author: Paolo Murabito
Author: Stefano Palmucci
Author: Alfredo Pulvirenti
Author: Michele Reibaldi

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