Hong Kong Med J 2024;30(Suppl 7):S46-7
Retinal imaging to identify patients with atrial fibrillation at increased risk of intracerebral haemorrhage: abridged secondary publication
Y Soo1, C Cheung2, D Yang2, J Abrigo3, B Lam1,4,5, H Zheng1,4,5, SF Tsang1, B Ip1, W Chu3, V Mok1,4,5, T Leung1
1 Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
2 Department of Ophthalmology and Visual Sciences, Hong Kong Eye Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
3 Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
4 Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
5 Nuffield Department of Clinical Neurosciences, Wellcome Centre for Integrative Neuroimaging, University of Oxford, United Kingdom
 
 
  1. In patients with atrial fibrillation receiving oral anticoagulants for stroke prevention, there is an increasing incidence of anticoagulant-associated intracerebral haemorrhage, which carries high risks of morbidity and mortality.
  2. The presence of cerebral microbleeds (CMBs) on magnetic resonance imaging (MRI) of the brain is associated with an increased risk of intracerebral haemorrhage.
  3. The retina shares an embryological origin and similar pathological characteristics with the brain; thus, changes in retinal vessels may indicate the presence of CMBs. A non-invasive method to evaluate bleeding-prone cerebral small vessel disease in patients with atrial fibrillation could help to identify those at increased risk of anticoagulant-associated intracerebral haemorrhage.
  4. We recruited patients with atrial fibrillation to undergo optical coherence tomography-angiography (OCT-A) for examination of the three-dimensional capillary network of the retina. We compared capillary network matrix parameters between patients with and without CMBs on MRI.
  5. Alterations in the retinal capillary network across various retina layers were associated with the presence and burden of CMBs on MRI. These findings suggest a role for OCT-A in identifying patients with atrial fibrillation at increased risk of bleeding-prone microangiopathy.