Abstract

Purpose. This study was designed to assess retinal and optic nerve bioelectrical function in patients with unilateral asymptomatic but hemodynamically significant internal carotid artery stenosis (ICAS). Methods. Forty-two subjects with a diagnosis of unilateral ICAS and 34 controls were analyzed. Full-field electroretinogram (ERG), pattern electroretinogram (PERG), and pattern visual-evoked potentials, as well as optical coherence tomography and ophthalmological examination, were performed. Data analysis included eyes ipsilateral to ICAS (EIS) and eyes contralateral to ICAS (ECS). Results. Intraocular pressure was significantly decreased in EIS and ECS compared to that in the controls. In the macula, both the cube average thickness and cube volume values were significantly reduced both in EIS and ECS compared to those in the controls. Similarly, PERG P50 and N95 wave amplitudes were significantly smaller in EIS and ECS compared to those in the controls. The ERG rod b-wave and rod-cone a-wave amplitudes were decreased, and implicit times were significantly prolonged, whereas the OP wave index was reduced in EIS compared to that in the controls. No differences in IOP, OCT, or ERG and PERG parameters were identified between EIS and ECS. Conclusions. Our study demonstrated that retinal bioelectrical function is negatively affected by ICAS despite the absence of objective clinical signs and symptoms of ocular ischemia.

Highlights

  • The management of patients with asymptomatic carotid artery stenosis is one of the most controversial problems in clinical practice

  • The outcomes of the Asymptomatic Carotid Atherosclerosis Study (ACAS) have indicated that carotid endarterectomy (CEA) reduces the risk of stroke compared with noninvasive management [1]; the potential risks of angiography and vascular surgical intervention may not justify their introduction into routine clinical strategies

  • The subjects were randomly selected from a group of patients in the Vascular Surgery Department of Pomeranian Medical University in Szczecin, Poland who qualified for carotid endarterectomy (CEA)

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Summary

Introduction

The management of patients with asymptomatic carotid artery stenosis is one of the most controversial problems in clinical practice. The outcomes of the Asymptomatic Carotid Atherosclerosis Study (ACAS) have indicated that carotid endarterectomy (CEA) reduces the risk of stroke compared with noninvasive management [1]; the potential risks of angiography and vascular surgical intervention may not justify their introduction into routine clinical strategies. The retina is a light-sensitive tissue of the central nervous system and is composed of several types of cells. ERG is a sensitive tool used to detect ischemic injury, and it is well established how retinal ischemia may affect different retinal cells and their functions. The b-wave of flash ERG is a sensitive index of retinal ischemia and represents a functional measure for retinal ischemic damage as a result of the reduction of blood flow or blood pressure [3]. Pattern ERG (PERG) has the ability to quantify retinal ganglion cell function in the course of ischemia [5]

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