Early functional recovery in retinal artery occlusion: a cohort study of factor Xa inhibitor use
Wan-Yu Liu, Yih-Shiou Hwang, Hung-Chi Chen, Wei-Chi Wu, An-Ning Chao, Laura Liu, Kuan-Jen Chen, Yi-Hsing ChenBackground:
Retinal artery occlusion (RAO) is an ophthalmic emergency causing sudden, painless, and often severe vision loss. Despite various treatments, including anticoagulation, having been attempted, no consistently effective or predictable therapy exists. Novel oral anticoagulants (NOACs), such as rivaroxaban, offer a favorable efficacy and safety profile and may represent a promising therapeutic option for RAO.
Objectives:
To investigate the efficacy and safety profile of direct factor Xa inhibitor in retinal artery occlusion (RAO) patients.
Designs:
A retrospective cohort study.
Methods:
Eight naïve RAO (five CRAO and three BRAO) patients treated with rivaroxaban ⩾2 months were included. Best corrected visual acuity (BCVA), change in central retinal thickness (including innermost retinal layer (IMRL); middle retinal layer (MRL); outer retinal layer (ORL) on Optical Coherence Tomography (OCT)), foveal volume, and emboli size (presented as percentage of disc area (DA)) were collected and analyzed.
Results:
Patients received rivaroxaban for a median of 5.1 months (Interquartile Range (IQR) 2.9–6.8), with a median follow-up of 4.9 months (IQR 2.3–10.5). At 3 months, 5 patients (62.5%) achieved a ⩾10 ETDRS letter gain, and none had visual deterioration. Compared with baseline, full retinal thickness and foveal volume at the 1-, 3-, and 6-mm macular regions were significantly reduced at 1 month and remained stable at 3 months. IMRL, MRL, and ORL thicknesses showed similar reductions at 1 month (all
Conclusion:
Retinal emboli may be partially resolved with rivaroxaban, with preservation of retinal thickness and foveal volume at 3 months in RAO patients. Early treatment may help prevent retinal atrophic changes.