Ophthalmic findings before carotid endarterectomy in the ipsilateral and contralateral eye

Abstract

PurposeTo assess ophthalmic findings of ipsilateral (IL) and contralateral (CL) eyes of 30 first patients undergoing endarterectomy for carotid artery disease in Helsinki Carotid Endarterectomy Study 2‐ Substudy (HeCES‐BEST) (inclusion criteria ≥70% occlusion, exclusion criteria unable to undergo neuropsychological tests or MRI)MethodsBest corrected visual acuity (BCVA) with ETDRS chart at 4 meters, anterior and posterior segment biomicroscopy, and 30°/50°/200° fundus photography. Differences in proportions of quantitative variables assessed with Fisher's test.ResultsOf 30 patients (one female) with median age 68 years (range 53–91), eleven had experienced ocular ischemic attack, and one sudden visual loss and pain (40%). Three patients had had surgery of the CI side. All but two IL eyes had full BCVA, one with neovascular glaucoma (NVG) 0.16 and one with unrelated scar 0.63; all CL eyes had full BCVA. No corneal changes related to ischemia were found. Conjunctival and/or episcleral vessels were dilated in nine IL and two CL eyes (p = 0.042), including varicose‐like vessels. Iris transillumination in pupillary border was found in 17 IL and 12 CL eyes (p = NS). Rubeosis iridis occurred in two IL eyes (p = NS). Arteriolosclerotic changes (nickings) were found in all. Retinopathy: microaneyrysms, microinfarctations and hemorrhages were found in nine IL and one CL eye (p = 0.012), midperipheral hemorrhages in four IL eyes and Hollenhorst's plaque in one CL eye. Venous pulsation was undetectable and uninducible in nine IL and five CL eyes (p = NS), and arterial pulsation induceable in 5 IL and two CL eyes (p = NS); no spontaneous arterial pulsation detected. NVG occurred in one IL eyeConclusionsVision disturbance and signs of ischemia are not uncommon underlining the role of ophthalmologists in suspicion of carotid artery disease.