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Management of ocular arterial ischemic diseases: a review

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Abstract

Purpose

To summarize the existing treatment options regarding central retinal artery occlusion (CRAO), branch retinal artery occlusion (BRAO), arteritic anterior ischemic optic neuropathy (AAION), non-arteritic anterior ischemic optic neuropathy (NAION), and ocular ischemic syndrome (OIS), proposing an approach to manage and treat these patients.

Methods

A systematic literature search of articles published since 1st January 2010 until 31st December 2020 was conducted using MEDLINE (PubMed), Scopus, and Web of Science. Exclusion criteria included case reports, non-English references, articles not conducted in humans, and articles not including diagnostic or therapeutic options. Further references were gathered through citation tracking, by hand search of the reference lists of included studies, as well as topic-related European society guidelines.

Results

Acute ocular ischemia, with consequent visual loss, has a variety of causes and clinical presentations, with prognosis depending on an accurate diagnosis and timely therapeutic implementation. Unfortunately, most of the addressed entities do not have a standardized management, especially regarding their treatment, which often lacks good quality evidence on whether it should or not be used to treat patients.

Conclusion

Ophthalmologic signs and symptoms may be a warning sign of cardiovascular or cerebrovascular events, namely stroke. Most causes of acute ocular ischemia do not have a standardized management, especially regarding their treatment. Timely intervention is essential to improve the visual, and possibly vital, prognosis. Awareness must be raised among non-ophthalmologist clinicians that might encounter these patients. Further research should focus on assessing the benefit of the management strategies already being employed .

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Data availability

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Code availability

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Author notes

  1. Rodrigo Vilares-Morgado and Hugo Miguel Meireles Nunes contributed equally to this work and share first authorship.

Authors and Affiliations

  1. Faculty of Medicine of the University of Porto, Porto, Portugal

    Rodrigo Vilares-Morgado, Hugo Miguel Meireles Nunes & Ricardo Soares dos Reis

  2. Cardiovascular R&D Center, Faculty of Medicine of the University of Porto, Porto, Portugal

    Rodrigo Vilares-Morgado & João Barbosa-Breda

  3. Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal

    Rodrigo Vilares-Morgado & João Barbosa-Breda

  4. Department of Neurology, Centro Hospitalar e Universitário São João, Porto, Portugal

    Ricardo Soares dos Reis

  5. i3S - Instituto de Investigação e Inovação em Saúde, Porto, Portugal

    Ricardo Soares dos Reis

  6. Departamento de Neurociências Clínicas e Saúde Mental, Faculty of Medicine of the University of Porto, Porto, Portugal

    Ricardo Soares dos Reis

  7. KULeuven, Research Group Ophthalmology, Department of Neurosciences, Leuven, Belgium

    João Barbosa-Breda

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  1. Rodrigo Vilares-Morgado
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Contributions

The authors confirm contribution to the paper as follows: study conception and design: Rodrigo Vilares-Morgado, Hugo Miguel Meireles Nunes, and João Barbosa-Breda; data collection: Hugo Miguel Meireles Nunes; analysis and interpretation of results: Rodrigo Vilares-Morgado, Hugo Miguel Meireles Nunes, João Barbosa-Breda, and Ricardo Soares dos Reis; draft manuscript preparation: Rodrigo Vilares-Morgado, Hugo Miguel Meireles Nunes, João Barbosa-Breda, and Ricardo Soares dos Reis. All authors reviewed the results and approved the final version of the manuscript.

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Correspondence to Rodrigo Vilares-Morgado.

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Vilares-Morgado, R., Nunes, H.M.M., dos Reis, R.S. et al. Management of ocular arterial ischemic diseases: a review. Graefes Arch Clin Exp Ophthalmol 261, 1–22 (2023). https://doi.org/10.1007/s00417-022-05747-x

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