Retinal ischemia after cardiovascular interventions: Neuroimaging correlates and timing phenotypes in a consecutive series.

PURPOSE: To characterize symptomatic retinal ischemic events following cardiovascular procedures and evaluate their clinical features and association with cerebral ischemia.

METHODS

We conducted a retrospective review of OCT-confirmed acute retinal ischemia at a tertiary center (2015–2024), including patients who had undergone a cardiovascular procedure within 30 days preceding symptom onset.

RESULTS

Thirteen patients (mean age 67±8.5 years, 84.6% male) developed retinal ischemic events following cardiac catheterization (n=4), valve replacement (n=3), carotid interventions (n=3), and other procedures (n=3). All had cardiovascular risk factors; 85% were on antithrombotic therapy. Branch retinal artery occlusion was most common (69.2%), followed by paracentral acute middle maculopathy (23.1%) and central retinal artery occlusion (7.7%). Symptom onset ranged from immediately post-procedure to 28 days, with varying clinical characteristics across different timeframes. Neuroimaging revealed cerebral ischemia in 7 of 10 patients (70%).

CONCLUSIONS

Retinal ischemic events following cardiovascular procedures presented across a spectrum of timing, with varying clinical features that may suggest different pathophysiological mechanisms such as procedural embolization, perioperative hypoperfusion, or delayed complications from evolving embolic sources.The high rate of concurrent cerebral ischemia supports prompt brain imaging. These events, regardless of timing, should prompt comprehensive neurological and cardiological evaluation, as they may indicate systemic or evolving cardioembolic disease even in patients on antithrombotic therapy.