Venous stasis retinopathy in symptomatic carotid artery occlusion: Prevalence, cause, and outcome. Klijn CJM, Kappelle LJ, van Schooneveld MJ, Hoppenreijs VPT, Algra A, Tulleken CAF, van Gijn J. Stroke 2002;33:695–701

Abstract

Ischemic symptoms of the eye are common in patients with occlusive disease of the carotid artery, typically demonstrating as transient monocular blindness, so-called amaurosis fugax. Less common, and less symptomatic, is the chronic form of ocular ischemia. The early and often asymptomatic stage of chronic ocular ischemia is referred to as venous stasis retinopathy (VSR). In this study, 110 patients with recently symptomatic carotid artery occlusion were prospectively investigated for the frequency of VSR, the association between the presence of VSR and impaired cerebral blood flow, and the proportion of patients who developed clinically manifest chronic ocular ischemic syndrome with ischemia of the anterior segment or visual loss. At study entry, VSR was found in 32 patients (29%), particularly in those with symptoms classically associated with a hemodynamic cause, such as limb shaking. Patients with VSR had lower pulsatility indexes in the ophthalmic artery in case of reversed flow, lower cerebral CO2 reactivity, and lower cerebropetal blood flow than patients without VSR. On follow-up (mean, 29 months), clinically manifest chronic ocular ischemia developed in four patients (annual rate, 1.5%); it tended to occur more often in patients in whom VSR was present at study entry. The authors conclude that in patients with symptomatic carotid occlusive disease, VSR is common and related to a low flow state of the brain. They recommend routine referral of patients with symptomatic carotid occlusive disease to an ophthalmologist, regardless of whether they have had visual symptoms. Although development of the full-blown symptomatic ocular ischemic syndrome is rare, close follow-up of carotid occlusive disease patients with VSR is recommended to prevent vision loss.—Nancy J. Newman