Increased prevalence of "Retinal Ischemic Perivascular Lesions" in retinal artery occlusion: A silent vascular biomarker in the fellow eye.

PURPOSE: To determine the prevalence of retinal ischemic perivascular lesions (RIPLs) in the unaffected fellow eyes of patients with retinal artery occlusion (RAO) and to evaluate their association with systemic vascular risk factors.

METHODS

A total of 80 eyes were included: 40 unaffected fellow eyes of patients diagnosed with RAO and 40 eyes of age-matched healthy control subjects. All participants underwent optical coherence tomography angiography imaging. RIPLs were identified and quantified in the fellow eyes of RAO patients and in control eyes. Quantitative vascular density analysis of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) was performed in regions where RIPLs were present. Associations between RIPLs and systemic vascular conditions - including hypertension, carotid artery stenosis, hypercoagulable states, smoking history, prior COVID-19 infection, and COVID-19 vaccination status - were analyzed using multivariate logistic regression models.

RESULTS

RIPLs were detected significantly more frequently in the fellow eyes of RAO patients than in control eyes (70% vs. 17.5%, P<0.001). The mean number of RIPLs per eye was significantly higher in the RAO group (2.21 vs. 0.29, P<0.001). In the inferior temporal quadrant, vascular density was significantly reduced in RIPL-positive regions of both the SCP (P=0.047) and DCP (P=0.045). The presence of RIPLs was independently associated with hypertension (OR=4.80; 95% CI: 1.04-9.15; P=0.035) and carotid artery stenosis (OR=2.96; 95% CI: 1.01-7.04; P=0.040). Overall, the odds of detecting RIPLs were 8.40 times higher in RAO fellow eyes compared with controls (P=0.010).

CONCLUSION

RIPLs are significantly more prevalent in the unaffected fellow eyes of patients with RAO and are strongly associated with systemic vascular risk factors, suggesting their potential role as a subclinical retinal biomarker of systemic vascular disease.