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Retinal arterial occlusion with multiple retinal emboli and carotid artery occlusion disease. Haemodynamic changes and pathways of embolism
  1. San-Ni Chen1,2,3,
  2. Jiunn-Feng Hwang1,
  3. Jeff Huang4,
  4. Shey-Lin Wu5
  1. 1Department of Ophthalmology, Changhua Christian Medical Foundation Changhua Christian Hospital, Changhua, Taiwan
  2. 2School of Medicine, Chung Shan Medical University, Changhua, Taiwan
  3. 3Department of Optometry, College of Nursing and Health Sciences, Da-Yeh University, Changhua, Taiwan
  4. 4Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
  5. 5Department of Neurology, Changhua Christian Medical Foundation Changhua Christian Hospital, Changhua City, Taiwan
  1. Correspondence to Dr Jiunn-Feng Hwang; hwangjf{at}


Objective To introduce a special subgroup, retinal artery occlusion (RAO) with multiple emboli, which is highly associated with ipsilateral carotid artery occlusion disease (CAOD).

Methods and analysis This is a cohort study. Cases of RAO with multiple retinal emboli were consecutively enrolled. All patients underwent at least one of the carotid/cerebral evaluations: carotid arteriography, orbital/carotid colour Doppler ultrasonography and CT angiography to demonstrate haemodynamic changes and to discuss possible mechanisms and pathways of the emboli.

Results Among 208 RAO eyes, 12 eyes (5.7%) in 11 patients had multiple emboli were recruited in this study. Eleven eyes (91.6%) had ipsilateral carotid plaques and atherosclerosis with high-grade stenosis; among them, five were total carotid occlusion. Haemodynamic changes were found in nine patients with RAO (81.8%) with carotid stenosis 60% or greater. Most compensatory intracranial circulations were re-established via the circle of Willi with antegrade ophthalmic flows, but the direction of ophthalmic flow reversed in three eyes indicating the recruitment of external collaterals. Two cases underwent carotid stent successfully.

Conclusion RAOs with multiple emboli are rare but highly associated with severe CAOD with haemodynamic flow changes, warning critical condition in carotid/cerebral circulations. Either direct embolism from the carotid or cardiac lesions or indirect embolism via the collateral pathways is the mechanism of pathogenesis. Immediate action should start to manage these patients to prevent further deterioration.

  • retina
  • imaging

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  • Contributors J-FH, JH and S-LW planned the study. S-NC conducted a survey. J-FH submitted the study.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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