Results of treatment of patients with carotid artery stenosis in pathology of vision

Abstract

The aim — to analyze the results of complex treatment of patients with carotid artery stenoses and abnormalities of the organ of vision. Materials and methods. The analysis was conducted of the results of the examination and treatment of 27 patients with changes in the visual fields and lesions of the carotid arteries in V. T. Zaitsev Institute of General and Emergency Surgery and Medical Center «Ophthalmika» during 2017—2018 years. The patients were divided into 2 groups: I group — 16 patients in whom the defeat of the carotid arteries required only conservative therapy and II group — 11 patients with hemodynamically significant stenosis or an unstable plaque that underwent carotid endarterectomy. Results and discussion. We evaluated the immediate results of the operation in a comprehensive manner based on the degree of change in clinical status, the presence of postoperative complications and data of instrumental studies. In I group on the background of disaggregant therapy and treatment with statins, the progression of the disease in the form of a narrowing of the visual fields on static perimetry was fixed in two cases, while stenosis of the internal carotid artery increased by 5 — 10 %. In II group, all operated patients had no complications in the postoperative period, enlargement of the fields of vision and expansion of the visual fields and improvement in visual acuity was noted in 10 patients. Complications in the form of a stroke, reduced vision and bleeding were not observed in any case. In two cases, on day 3, reperfusion syndrome manifested itself. Conclusions. Patients with a concentric narrowing of the visual fields and central scotomas should be screened for lesions of the carotid arteries. In case of hemodynamically significant stenosis or the presence of an unstable plaque, the patients must undergo carotid endarterectomy at the first stage, which reduces the risk of ischemic stroke and improves visual acuity and visual field.