Transient Retinopathy in Acute Aortic Dissection

Purpose: To explore the occurrence of transient retinopathy and its prognostic importance in patients with acute aortic dissection (AAD). Design: Prospective, observational study. Participants: Sixty-four patients with Stanford type B AAD were treated with conservative medical therapy. Methods: Retinopathy findings, such as cotton-wool spots and hemorrhage, were examined. Fundus photography was performed on hospital days 9 to 14 and after 2 or 3 months. The association between the appearance of retinopathy and the subsequent cardio-cerebrovascular events was investigated. Main Outcome Measures: The primary outcomes included the incidence of retinopathy and subsequent adverse cardio-cerebrovascular events. Results: Retinopathy was detected in 55% (35 of 64) of patients (cotton-wool spots alone, n = 31; dot hemorrhage alone, n = 1; and both, n = 3). These findings disappeared in all 12 patients who underwent follow-up fundus examinations. In the multivariate analysis, a history of hypertension and higher peak C-reactive protein level were independently associated with retinopathy. At a median follow-up of 911 days, adverse cardiocerebrovascular events were reported in 11 patients, of whom those with retinopathy experienced adverse events significantly more frequently than those without retinopathy (P = 0.045). Conclusions: Retinopathy occurred frequently in patients with AAD. This retinopathy was associated with a history of hypertension and higher peak C-reactive protein levels and was an important predictive factor for adverse cardio-cerebrovascular outcomes. (C) 2014 by the American Academy of Ophthalmology.