Retinal Ischemia after Cardiovascular Interventions: Neuroimaging Correlates and Timing Phenotypes in a Consecutive Series

Purpose : To characterize symptomatic retinal ischemic events following cardiovascular procedures and evaluate their clinical features and association with cerebral ischemia. Methods : We retrospectively reviewed acute retinal ischemia cases confirmed by optical coherence tomography (OCT) at a tertiary center (2015–2024). Patients who underwent cardiovascular procedures within 30 days prior to symptom onset were included. Results : Thirteen patients (mean age 67±8.5 years, 84.6% male) developed retinal ischemic events. All patients had cardiovascular risk factors and 85% of patients were on antithrombotic therapy prior to their procedure. Procedures included cardiac catheterization (n=4), valve replacement (n=3), carotid interventions (n=3), heart transplant (n=1), aortic surgery (n=1), and peripheral vascular intervention (n=1). Nine patients (69.2%) developed branch retinal artery occlusion (BRAO), 1 (7.7%) central retinal artery occlusion (CRAO) and 3 patients (25%) developed paracentral acute middle maculopathy (PAMM). Three timing presentations were observed: immediate onset (day 0, n=4), early onset (days 1-7, n=5) characterized by absence of visible emboli, and delayed onset (days 8-28, n=4) with visible emboli in all cases. Neuroimaging revealed cerebral ischemia in 7 of 10 patients (70%). Two patients died from systemic embolic complications. Conclusions : Retinal ischemic events can occur from immediately to 28 days following cardiovascular procedures. The timing of onset may suggest different mechanisms, such as procedural release of emboli, perioperative hypoperfusion, or delayed evolving embolic sources such as new onset atrial fibrillation, thrombus, or vegetation. Neuroimaging shows a striking association with cerebral ischemic pathology (70%), supporting consideration of brain imaging in these cases.