The Fate of Patients with Retinal Artery Occlusion and Hollenhorst Plaque

Objective: Ocular symptoms and findings often herald neurological events associated with cerebrovascular disease. However, the presence of a Hollenhorst plaque (HP) or retinal artery occlusion (RAO) and the risk of stroke is unclear. The purpose of this study was to examine the outcomes of all patients who presented with HP or RAO.
Methods: Between 2000 and 2005, the management and outcome of 130 consecutive patients (54% male, mean age 68 ± 16 years) with a diagnosis HP or RAO (ICD-9 codes 362.30-362.33) were reviewed. Patients with amaurosis fugax, retinal venous occlusion and other ocular pathologies were excluded. Medical records, and imaging studies of the carotid arteries were reviewed.
Results: Patients underwent ophthalmologic evaluation because of vision loss (52%), eye pain, or atypical visual symptoms. Atherosclerotic risk factors included hypertension (75%), diabetes (35%), hypercholesterolemia (75%), and tobacco use (38%). Carotid bifurcation stenoses ipsilateral to the ocular findings were <30% in 63% of the patients, between 30 and 60% in 13% and >60% in only 8%. Six patients (all >60% lesions) went on to have carotid endarterectomy or carotid stenting. In follow-up (range, 1-49 months), no stroke or transient ischemic attack was identified. There were 5 deaths during follow-up; none related to stroke. Serial Duplex exams failed to identify progression of carotid stenoses (mean follow-up, 9 months).
Conclusion: The presence of HP or RAO is associated with a low prevalence of extracranial cerebrovascular disease that requires intervention. Furthermore, these ocular findings are not associated with a high risk for hemispheric neurological events.