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A Retrospective Review

Sanjay Sharma, MD; Arif Naqvi, MD; Susan M. Sharma, MD; Alan F. Cruess, MD; Gary C. Brown, MD; Retinal Emboli of Cardiac Origin Group

Arch Ophthalmol. 1996;114(10):1189-1192.

Abstract
Objective
To assess the importance of cardio-embolic (emboli of cardiac origin) risk stratification in the cardiac evaluation of patients with acute retinal arterial obstruction.

Design
A multicenter retrospective study of patients with acute retinal arterial obstruction who underwent trans-thoracic echocardiography.

Settings
Four North American hospital centers.

Patients
One hundred patients with acute retinal artery obstruction in whom transthoracic echocardiography was performed.

Main Outcome Measure
Anticoagulation or cardiac surgery based on abnormalities detected on transthoracic echocardiography. Transesophageal echocardiographic results were not evaluated, as they were rarely performed in our centers. Thus, the outcome measure was determined solely by the results of transthoracic echocardiography.

Results
Patients were divided into high- and low-risk groups based on their history of cardioembolic risk factors or the presence of a cardiac murmur. Of 67 patients with no risk factors, 41 (61%) had normal echocardiographic study results and 26 (39%) had abnormalities detected, of whom only 1 (1.5%) received anticoagulation or cardiac surgery. The presence of 1 or more cardioembolic risk factors increased the likelihood for anticoagulation or cardiac surgery 25 times (odds ratio=25; 95% confidence interval=3.04-217.02). Although this result is clinically and statistically significant, it is possible that abnormalities missed by transthoracic methods may have been detected by transesophageal technology.

Conclusions
In patients with acute retinal arterial obstruction at low cardioembolic risk, transthoracic echocardiography resulted in anticoagulation or cardiac surgery in 1 (1.5%) of 67 patients. Routine transthoracic echocardiography without follow-up transesophageal echocardiography for patients identified as having abnormalities such as left ventricular hypertrophy or mitral annular calcification and who are at low cardioembolic risk rarely resulted in anticoagulation or cardiac surgery.

Author Affiliations
From Queen's University, Kingston, Ontario. A complete list of the members of the Retinal Emboli of Cardic Origin Group is given in the acknowledgments on page 1191.

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