Early reperfusion in patients with acute retinal artery occlusion: A multicenter prospective study

Background: The visual outcome after central retinal artery occlusion (CRAO) is poor, but its relationship with early reperfusion (ER) is poorly known. We evaluated the incidence of ER in acute CRAO or branch retinal artery occlusion (BRAO), and its association with clinical outcome. Methods: In this prospective observational multicenter study, we included patients with acute CRAO or macula-involving BRAO presenting within 24 hours from symptom onset. ER was evaluated within 24 hours after the initial clinical evaluation using indocyanine green angiography (ICGA). The primary outcome was the best-corrected visual acuity (BCVA) at 1 month. Results: In all, 70 patients were enrolled, of whom 63 (90%) had CRAO. Median age was 71 years (interquartile range: 67–77), 63% were male, median time from symptom onset to presentation was 5.3 hours (interquartile range: 3.1–15.1), and 17% received intravenous fibrinolysis. ER was identified in 34 patients (49%), of whom 21 (30%) achieved complete reperfusion (100% filling of the 55° ICGA field). Patients with ER were less likely to have hypertension and diabetes mellitus ( p < 0.001 and p = 0.046, respectively). At the 1-month follow-up, BCVA was significantly better in ER patients (median BCVA 1.3 logMAR vs 1.7 logMAR, p = 0.001), with greater benefit with complete reperfusion ( p for trend < 0.001). ER was also associated with improved visual field and quality of life at the 1-month follow-up (both p < 0.05). Conclusion: ER occurred in almost 50% of the patients and was associated with improved visual outcomes and quality of life. Therapies that increase ER in CRAO will likely improve clinical outcomes. Clinical Trial Registration: This study was registered on ClinicalTrials.gov (identifier NCT03049514); https://classic.clinicaltrials.gov/ct2/show/NCT03049514