{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T22:10:00Z","timestamp":1790633400210,"version":"4.1.0"},"reference-count":22,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T00:00:00Z","timestamp":1761782400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003625","name":"Ministry of Health and Welfare","doi-asserted-by":"publisher","award":["RS-2024-00512384"],"award-info":[{"award-number":["RS-2024-00512384"]}],"id":[{"id":"10.13039\/501100003625","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100014188","name":"Ministry of Science and ICT, South Korea","doi-asserted-by":"publisher","award":["RS-2023-00248480"],"award-info":[{"award-number":["RS-2023-00248480"]}],"id":[{"id":"10.13039\/501100014188","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Central retinal artery occlusion (CRAO) is a vision-threatening emergency that can lead to chronic ischemic complications. This retrospective cohort study investigated clinical characteristics, neovascular complications, and stroke risk in patients with chronic CRAO defined as the post-acute phase state characterized by FA-confirmed persistent retinal ischemia \u22651 month after acute onset. We reviewed medical records of 570 eyes initially diagnosed with acute non-arteritic CRAO between September 2003 and December 2024, with 289 eyes meeting inclusion criteria. Chronic CRAO was defined as persistent prolonged arm-to-retina or arteriovenous transit times on fluorescein angiography performed &gt;1 month after symptom onset, and further classified as delayed perfusion or nonperfusion based on venous filling patterns. Among 289 patients, 215 eyes (74.4%) had acute CRAO with spontaneous reperfusion, while 74 eyes (25.6%) had chronic CRAO, including 55 eyes (74.3%) with delayed perfusion and 19 eyes (25.7%) with nonperfusion. Chronic CRAO patients were older with higher prevalence of systemic comorbidities. Previous stroke (43.2% vs. 26.0%, p\u2009=\u20090.009) and concurrent stroke (20.3% vs. 12.1%, p\u2009=\u20090.122) were more common in chronic CRAO patients compared to acute CRAO. Neovascularization of the iris occurred exclusively in chronic CRAO (32.4% vs. 0.0%, p\u2009&lt;\u20090.001), with the nonperfusion group showing significantly higher rates of neovascularization of the iris (90% vs. 13%, p\u2009&lt;\u20090.001) and neovascular glaucoma (68% vs. 9%, p\u2009&lt;\u20090.001) compared to delayed perfusion group. Kaplan-Meier analysis revealed earlier onset of neovascularization in nonperfusion cases (median 1.6 months) with a 20-fold increased hazard ratio. Approximately one quarter of acute non-arteritic CRAO patients progress to chronic CRAO, which is associated with increased stroke risk and ocular neovascularization, particularly when retinal arterial nonperfusion persists. These findings emphasize the importance of fluorescein angiography monitoring and systemic evaluation in CRAO management.<\/jats:p>","DOI":"10.1371\/journal.pone.0334907","type":"journal-article","created":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T17:22:43Z","timestamp":1761844963000},"page":"e0334907","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Chronic central retinal artery occlusion: Clinical manifestations, ocular neovascular complications, and risk of stroke"],"prefix":"10.1371","volume":"20","author":[{"given":"Jae Ryong","family":"Song","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3692-7169","authenticated-orcid":true,"given":"Se Joon","family":"Woo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,10,30]]},"reference":[{"issue":"10","key":"pone.0334907.ref001","doi-asserted-by":"crossref","first-page":"1933","DOI":"10.1016\/j.ophtha.2014.04.029","article-title":"Nationwide incidence of clinically diagnosed central retinal artery occlusion in Korea, 2008 to 2011","volume":"121","author":"SJ Park","year":"2014","journal-title":"Ophthalmology"},{"issue":"10","key":"pone.0334907.ref002","doi-asserted-by":"crossref","first-page":"1928","DOI":"10.1016\/j.ophtha.2009.03.006","article-title":"Retinal artery occlusion: associated systemic and ophthalmic abnormalities","volume":"116","author":"SS Hayreh","year":"2009","journal-title":"Ophthalmology"},{"issue":"5","key":"pone.0334907.ref003","doi-asserted-by":"crossref","first-page":"352","DOI":"10.3341\/kjo.2016.30.5.352","article-title":"Incidence and Clinical Features of Neovascularization of the Iris following Acute Central Retinal Artery Occlusion","volume":"30","author":"YH Jung","year":"2016","journal-title":"Korean J Ophthalmol"},{"issue":"3","key":"pone.0334907.ref004","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/S0039-6257(98)00035-6","article-title":"Ocular neovascularization: an epidemiologic review","volume":"43","author":"P Lee","year":"1998","journal-title":"Surv Ophthalmol"},{"issue":"5","key":"pone.0334907.ref005","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1016\/j.preteyeres.2007.06.001","article-title":"Neovascular glaucoma","volume":"26","author":"SS Hayreh","year":"2007","journal-title":"Prog Retin Eye Res"},{"issue":"6","key":"pone.0334907.ref006","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1177\/112067211002000603","article-title":"Ocular neovascularization following central retinal artery occlusion: prevalence and timing of onset","volume":"20","author":"AK Rudkin","year":"2010","journal-title":"Eur J Ophthalmol"},{"issue":"9","key":"pone.0334907.ref007","first-page":"1234","article-title":"Intravenous recombinant tissue-type plasminogen activator thrombolysis in treatment of central retinal artery occlusion","volume":"120","author":"JC Kattah","year":"2002","journal-title":"Arch Ophthalmol"},{"issue":"3","key":"pone.0334907.ref008","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1001\/archopht.1991.01080030041034","article-title":"A prospective study of acute central retinal artery obstruction. The incidence of secondary ocular neovascularization","volume":"109","author":"JS Duker","year":"1991","journal-title":"Arch Ophthalmol"},{"issue":"9","key":"pone.0334907.ref009","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1016\/S0161-6420(88)33042-3","article-title":"Iris neovascularization associated with obstruction of the central retinal artery","volume":"95","author":"JS Duker","year":"1988","journal-title":"Ophthalmology"},{"issue":"1","key":"pone.0334907.ref010","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/S0161-6420(89)32946-0","article-title":"The efficacy of panretinal photocoagulation for neovascularization of the iris after central retinal artery obstruction","volume":"96","author":"JS Duker","year":"1989","journal-title":"Ophthalmology"},{"issue":"6","key":"pone.0334907.ref011","article-title":"Retinal artery occlusion and associated recurrent vascular risk with underlying etiologies","volume":"12","author":"J-H Hong","year":"2017","journal-title":"PLoS One"},{"key":"pone.0334907.ref012","doi-asserted-by":"crossref","first-page":"2336","DOI":"10.1016\/j.ophtha.2015.07.018","article-title":"Risk and Risk Periods for Stroke and Acute Myocardial Infarction in Patients with Central Retinal Artery Occlusion","volume":"122","author":"SJ Park","year":"2015","journal-title":"Ophthalmology"},{"issue":"12","key":"pone.0334907.ref013","doi-asserted-by":"crossref","first-page":"7746","DOI":"10.1167\/iovs.13-12952","article-title":"Efficacy and safety of intra-arterial thrombolysis in central retinal artery occlusion","volume":"54","author":"SJ Ahn","year":"2013","journal-title":"Invest Ophthalmol Vis Sci"},{"issue":"3","key":"pone.0334907.ref014","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1097\/01.iae.0000238095.97104.9b","article-title":"Fundus changes in central retinal artery occlusion","volume":"27","author":"SS Hayreh","year":"2007","journal-title":"Retina"},{"issue":"9","key":"pone.0334907.ref015","doi-asserted-by":"crossref","first-page":"2083","DOI":"10.1161\/01.STR.0000136722.30008.b1","article-title":"Measuring carotid stenosis on contrast-enhanced magnetic resonance angiography: diagnostic performance and reproducibility of 3 different methods","volume":"35","author":"JMKS U-King-Im","year":"2004","journal-title":"Stroke"},{"issue":"22","key":"pone.0334907.ref016","doi-asserted-by":"crossref","first-page":"1480","DOI":"10.1056\/NEJM199412013312203","article-title":"Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders","volume":"331","author":"LP Aiello","year":"1994","journal-title":"N Engl J Med"},{"issue":"8","key":"pone.0334907.ref017","doi-asserted-by":"crossref","first-page":"880","DOI":"10.1097\/JCMA.0000000000000766","article-title":"Risk factors for ocular neovascularization after central retinal artery occlusion","volume":"85","author":"W-J Lo","year":"2022","journal-title":"J Chin Med Assoc"},{"issue":"4","key":"pone.0334907.ref018","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1016\/j.preteyeres.2004.12.001","article-title":"Prevalent misconceptions about acute retinal vascular occlusive disorders","volume":"24","author":"SS Hayreh","year":"2005","journal-title":"Prog Retin Eye Res"},{"key":"pone.0334907.ref019","first-page":"100848","article-title":"Iatrogenic ophthalmic artery occlusion and retinal artery occlusion","author":"JS Lee","year":"2020","journal-title":"Prog Retin Eye Res"},{"issue":"4","key":"pone.0334907.ref020","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1016\/j.ajo.2015.01.001","article-title":"Retinal and choroidal changes and visual outcome in central retinal artery occlusion: an optical coherence tomography study","volume":"159","author":"SJ Ahn","year":"2015","journal-title":"Am J Ophthalmol"},{"issue":"11","key":"pone.0334907.ref021","article-title":"No-Reflow Phenomenon in Central Retinal Artery Occlusion: Incidence, Risk Factors, and Clinical Implications","volume":"10","author":"SJ Ahn","year":"2015","journal-title":"PLoS One"},{"issue":"3","key":"pone.0334907.ref022","doi-asserted-by":"crossref","first-page":"215","DOI":"10.3341\/kjo.2009.23.3.215","article-title":"Intravitreal bevacizumab for the treatment of neovascular glaucoma associated with central retinal artery occlusion","volume":"23","author":"M Sagong","year":"2009","journal-title":"Korean J Ophthalmol"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0334907","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T17:22:49Z","timestamp":1761844969000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0334907"}},"subtitle":[],"editor":[{"given":"Oana","family":"Dumitrascu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,10,30]]},"references-count":22,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10,30]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0334907","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,30]]}}}