Utility of Hollenhorst Plaques for Determining Embolic Sources in Patients Diagnosed with Central Retinal Artery Occlusion
Objective:
The objective of this study was to investigate the association between the characteristics of visible emboli in central retinal artery occlusion (CRAO) and their potential embolic sources, as well as to evaluate the clinical outcomes and therapeutic implications based on these findings.
Background:
CRAO is the ocular equivalent of an ischemic stroke, most commonly caused by emboli from carotid plaques or cardiac sources, with an incidence of 1-2 per 100,000 people. Patients typically present with sudden, severe vision loss, often without other symptoms. Emboli are visible in 40% of cases during fundoscopy. Cholesterol emboli (Hollenhorst plaques) are linked to carotid or aortic disease, while fibrin emboli are usually cardiac in origin.
Design/Methods:
A retrospective analysis was conducted on CRAO patients from 01/01/2010 to 30/09/2019. Inclusion criteria included patients over 18 with complete etiological workups and at least three months of follow-up. Data collected included age, sex, cardiovascular risk factors, and visual acuity. Patients were divided into two groups: those with visible emboli and those without.
Results:
Of 173 records, 59 met the inclusion criteria. The mean age was 74.6 years, with peak incidence in the seventh decade. Visible emboli appeared in 33.8% of cases, 95% of which were cholesterol emboli. Patients with visible emboli had worse initial vision but better recovery (16.6% vs. 5.5%). They also had higher total cholesterol and LDL levels. Carotid stenosis >80% was found in 15% of the visible emboli group vs. 4% in the non-visible group. Cryptogenic embolism was the most common diagnosis, followed by carotid and high-risk cardiac embolism.
Conclusions:
CRAO is a vision-threatening condition requiring thorough etiological investigation. Cholesterol emboli often suggest carotid artery disease, but many patients lack a clear embolic source, emphasizing the need for better diagnostic methods. Identifying visible emboli helps predict the source and guides treatment, including carotid surgery or anticoagulation.
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