Do Hollenhorst Plaques or Retinal Artery Occlusions Predict Stroke?

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Do Hollenhorst Plaques or Retinal Artery Occlusions Predict Stroke?

Researchers challenge the assumption that these ocular findings herald hemispheric neurologic events.

Retinal artery occlusions (RAOs) and Hollenhorst plaques (i.e., embolization of cholesterol crystals to retinal vessels) are often assumed to be harbingers of hemispheric neurologic events. This retrospective case series from the Cleveland Clinic suggests otherwise.

Researchers identified 130 patients (mean age, 68) with coded diagnoses of Hollenhorst plaques (95), branch RAOs (34), or central RAOs (1). Eighty patients had been evaluated for eye symptoms, and 50 were asymptomatic (suggesting that Hollenhorst plaques or RAOs were incidental findings). Of 88 patients who underwent carotid duplex imaging, 8 exhibited high-grade stenosis (6 underwent endarterectomy or stenting). Although the prevalence of hypertension, diabetes, hyperlipidemia, and coronary disease was high in this cohort, none of the patients experienced documented strokes or transient ischemic attacks (TIAs) during a median follow-up of 22 months.

Comment: According to the authors, this study is the largest to date on the natural history of retinal artery occlusion and Hollenhorst plaque. That no patient had a stroke or TIA during intermediate-term follow-up is intriguing and suggests that branch RAOs or Hollenhorst plaques need not trigger an urgent search for carotid disease or other sources of embolism. However, this retrospective study has important limitations, including possible incomplete follow-up for some patients. Thus, a carefully conducted prospective study would be desirable.

— Allan S. Brett, MD

Published in Journal Watch General Medicine January 8, 2008

Citation(s):

Dunlap AB et al. The fate of patients with retinal artery occlusion and Hollenhorst plaque. J Vasc Surg 2007 Dec; 46:1125.

Medline abstract (Free)

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carotid revasc
Tome R Nascimento, 18 Dec 2009 1:57 PM EST
I do not understand the coclusion, that is, that Hollenhorst plaque has little prognostic meaning, when a number of pts... [more]

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