Abstract
PurposeAnterior segment neovascularization (ASNV) could be a masquerade for ocular ischemic syndrome (OIS) in diabetic patients which misleads diagnosis and treatment. The purpose of our study is to find the relationship between blood flow velocity in carotid siphon and the development of ASNV in diabetic.MethodsWe reviewed 34 eyes of 17 diabetic patients who had Transcranial Color Doppler (TCD) examination with unilateral ASNV. The circulatory parameters of both eyes of each patient were compared and analyzed. In addition, 9 patients with more than 50% stenosis of extracranial internal carotid artery (ICA) and low velocity flow through TCD had been treated by carotid revascularization surgery.ResultsThe maximal velocity in systole (Vmax) of carotid siphon (SCA) was lower in the eyes with ASNV than in the eyes without ASNV (P<0.05). ASNV of all the 9 patients regressed totally and BCVA improved significantly (P<0.05). Stenosis of ICA and arm-retina time (ART) decreased significantly (P<0.01) and SCA and ophthalmic artery (OA) increased significantly (P<0.01).ConclusionsOur study showed ASNV could be a masquerade for OIS in patients with diabetic retinopathy. The decreased blood flow velocity in carotid siphon is related to the development of ASNV. Circulatory parameters screening of SCA by TCD is important to help us to evaluate the blood flow in SCA, the possibility of development of ASNV, and the prognosis of the patient. Interference such as carotid endarterectomy (CEA) or carotid artery stenting (CAS) can be performed if necessary to improve the blood flow in SCA and make ASNV regression.
Highlights
Our study showed anterior segment neovascularization (ASNV) could be a masquerade for ocular ischemic syndrome (OIS) in patients with diabetic retinopathy
The decreased blood flow velocity in carotid siphon is related to the development of ASNV
Circulatory parameters screening of Carotid siphon (SCA) by Transcranial Color Doppler (TCD) is important to help us to evaluate the blood flow in SCA, the possibility of development of ASNV, and the prognosis of the patient
Summary
Persons with diabetes are at risk of developing diabetic retinopathy (DR) and having it progress to proliferative DR (PDR), macular edema (ME) and anterior segment neovascularization (ASNV) [1]. The retinal and choroidal ischemia/hypoxia are considered the exciting factor for the development of ASNV. The presence of ASNV in diabetic always implies underlying retinal detachment with anterior proliferative vitreoretinopathy (PVR), severe ischemia retinopathy without enough coagulation, inflammation or ocular ischemic syndrome (OIS) [2, 3]. Ocular ischemic syndrome is a rare condition, which is caused by ocular hypoperfusion due to stenosis or occlusion of the common or internal carotid arteries. It is a frustrating condition for the ophthalmologist. We usually focus on retinal detachment with PVR, severe ischemia retinopathy without enough coagulation, ignore OIS. To prevent and reduce the extent of visual loss caused by ASNV, the first priority should be looking for predictable risk factors of ASNV and trying to interfere its development by appropriate management of the causative diseases
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