Effect of carotid endarterectomy on chronic ocular ischemic syndrome due to internal carotid artery stenosis. Kawaguchi S, Okuno S, Sakaki T, Nishikawa N. Neurosurgery 2001;48:328–333.

Abstract

Ocular ischemic syndrome, albeit rare, can cause devastating visual dysfunction. The most common cause of chronic ocular hypoperfusion is severe, usually bilateral, carotid artery disease. In this study, 11 patients with various degrees of ocular ischemic syndrome who had hemodynamically-significant ipsilateral carotid artery stenosis (>70% stenosis) were evaluated clinically and with ophthalmic artery color Doppler flow imaging before and after ipsilateral carotid endarterectomy. All patients had minimal or no iris rubeosis. Ophthalmic artery color Doppler flow imaging indicating ophthalmic artery flow direction and peak systolic flow velocity was performed before and at one week, one month, and three months after surgery. Before undergoing carotid endarterectomy, five patients showed reversed ophthalmic artery flow. In the other six patients who experienced antegrade ophthalmic artery flow, the average peak systolic flow velocity was 0.09 ± 0.05 m/s (mean ± standard deviation). Preoperative reversed flow resolved in each patient one week after undergoing surgery. All patients showed antegrade ophthalmic artery flow post-operatively. The average peak systolic flow velocity in the patients who had preoperative antegrade flow rose significantly, to 0.21 ± 0.14 m/s (P < 0.05). These values were still less than the value of the lower limit of the control patients. During the follow-up period (mean, 32.4 months), no patients complained of recurrent visual symptoms. At the end of the study period, visual acuity had improved in five patients and had not worsened in the other six patients. In these 11 patients with nonadvanced disease, carotid endarterectomy was effective in improving or preventing the progress of chronic ocular ischemia related to internal carotid artery stenosis.—Nancy J. Newman