Major Adverse Cardiovascular and Cerebrovascular Events After Retinal Artery Occlusion: Clinical Predictors and Long-Term Outcomes

PURPOSE: To assess the incidence, timing, and predictors of major adverse cardiovascular and cerebrovascular events (MACCE) after retinal artery occlusion (RAO), as well as visual outcomes and the association of hyperbaric oxygen therapy (HBOT) with visual recovery. METHODS: In this retrospective cohort study, 190 consecutive patients with central, branch, or cilioretinal RAO and ≥6 months of follow-up were analyzed. Independent predictors of MACCE were assessed using multivariable logistic regression and Cox proportional hazards models. The primary outcome was MACCE, defined as ischemic stroke or myocardial infarction during follow-up. Secondary outcomes included best-corrected visual acuity (BCVA), clinically meaningful visual improvement, and MACCE-free survival. RESULTS: During a median follow-up of 26.5 months, MACCE occurred in 26 (13.7%) patients, with 7 (26.9%) of events occurring within the first month after RAO. Hyperlipidemia was independently associated with MACCE in both logistic regression (adjusted odds ratio [OR], 3.40; 95%CI, 1.37-8.43; p=0.008) and Cox regression (hazard ratio [HR], 3.04; 95%CI, 1.38-6.72;p=0.006). Central retinal artery occlusion (CRAO) was associated with higher MACCE risk compared with branch retinal artery occlusion and cilioretinal artery occlusion (BRAO/CLRAO), reaching significance only in logistic regression.Visual outcomes were primarily determined by baseline BCVA and age. HBOT-treated eyes showed significant within-group visual improvement, although final BCVA did not differ significantly between treated and untreated groups. CONCLUSIONS: RAO is associated with substantial MACCE risk, particularly early after diagnosis. Hyperlipidemia emerged as a strong and potentially modifiable predictor of adverse systemic outcomes, supporting urgent systemic evaluation and aggressive secondary prevention following RAO.