Abstract: Objective To compare the clinical characteristics of central retinal artery occlusion (CRAO) in patients with or without internal carotid artery stenosis (ICAS). Design Retrospective case series． Participants 92 patients with CRAO treated in Beijing Tongren Hospital from 2014 to 2021. Methods Thirty five patients (35 eyes) who had CRAO with ICAS formed CRAO-ICAS group and the other 57 patients (57 eyes) who only had CRAO formed CRAO-NICAS group. Demographic factors, clinical symptoms, vascular risk factors, internal medicine comorbidities, laboratory parameters and imaging examinations, treatment, 1-week and 1-year visual acuity improvement after treatment, and 1-year follow-up vascular events (e.g., ischemic stroke, acute myocardial infarction, death) were analyzed by comparing the two groups. Main Outcome Measures Clinical features, visual acuity improvement, 1-year follow-up vascular events. Results There was no statistically difference between CRAO-ICAS group and CRAO-NICAS group in affected eye, visual field defect, increased intraocular pressure, history of smoking, history of family cardiovascular and cerebrovascular disease, history of coronary artery disease, diabetes and atrial fibrillation (all P>0.05). Male (OR=5.765, P=0.003), hyperlipidemia (OR=3.638, P=0.028), hypertension (OR=3.769, P=0.020) were the independent risk factors for CRAO with ICAS. Compared with the CRAO-NICAS group, the CRAO-ICAS group was characterized by the higher rates of transient amaurosis before the onset, and acute cerebral infarction, and the difference were statistically significant (?字2=5.845, P=0.016; ?字2=9.563, P=0.004). The visual acuity was significantly improved in 12 cases (44.4%) of the 27 patients with CRAO-ICAS at 1 week after thrombolysis via super-selective ophthalmic artery catheterization, partially improved in 5 cases above 0.1, 1 case above 0.5 at 1 year of follow-up, furthermore improved in 2 new cases. The visual acuity was significantly improved in 19 cases(47.5%) of the 40 patients with CRAO-NICAS at 1 week after thrombolysis, partially improved in 7 cases above 0.5 at 1 year of follow-up. The visual acuity was significantly improved by early thrombolytic therapy (<24 h) in patients with CRAO-ICAS (?字2=9.258, P=0.002) and CRAO-NICAS (?字2=10.639, P=0.001). One year follow-up after treatment, there were 9 cases (25.7%) of vascular events (8 cases of cerebral infarction and 1 case of myocardial infarction) in CRAO-ICAS group, and 5 cases (8.8%) of cerebral infarction in CRAO-NICAS group, and the difference were statistically significant (?字2=4.825, P=0.038). Conclusions The visual recovery is relatively better by the thrombolysis via super-selective ophthalmic cartery catheterization within 24 hours of symptom onset both CRAO with ICAS and CRAO without ICAS. The patients of CRAO-ICAS have the higher rates of acute cerebral infarction at symptom onset and cerebrovascular and cardiovascular events at 1 year of follow-up. (Ophthalmol CHN, 2023, 32: 332-337)

Key words:  retinal artery occlusion, internal carotid artery stenosis, arterial thrombolysis, vascular events