Chronic Ocular Ischemic Syndrome Research Articles

Возможности и перспективы лечения хронической ишемической ретинопатии, ассоциированной с гемодинамически значимым стенозом внутренней сонной артерии

Purpose . In prospective research to assess clinical efficacy of different surgical treatments for patients with chronic ocular ischemic syndrome (COIS) associated with hemodynamically significant internal carotid artery stenosis (ICAS). Material and methods . The research included 20 patients with 3rd degree severity COIS. Patients were divided into 3 groups due to type of their treatment. 1st group – 7 patients; only carotid endarterectomy (CE) of ICAS was performed; 2nd group – 6 patients; panretinal photocoagulation (PRP) of retina was performed; 3rd group – 7 patients; combined treatment: PRP of retinal capillary non-perfusion areas was performed by the 1st stage, then after 2 weeks by the 2nd stage CE was performed. All patients underwent standard and specialized ophthalmologic examination methods. Assessment of blood flow in brachiocephalic vessels, vessels of eye was performed by ultrasound scan, spiral computed tomography, fundus fluorescein angiography. Results . Monitoring of groups of patients for 1 year depending on type of treatment of COIS, allowed us to determine tactics of patients management and features of the postoperative period. CE at hemodynamically significant ICAS caused positive dynamic in intraocular blood flow, which contributed to improvement and preservation of best corrected visual acuity in 71% of patients; preventive PRP of retina, before performing reconstructive surgery of ICAS, optimized and reduced the time of visual recovery. PRP of retina as independent method of treatment of COIS, complicated by neovascular glaucoma, caused full or partial regression of neovascularization in iris, which increased possibilities of its effective treatment. Conclusion . Combined staged treatment of COIS associated with hemodynamically significant stenosis, which including PRP of retina and CE of ICAS, allows to stop the progression of ischemia in retina and to avoid complications, leading to loss of vision, and can be recommended for use in clinical practice for the treatment of COIS. PRP of retina can be use to stabilize process at impossible to perfomed CE. Surgical reconstruction of the ICAS, despite restoration of blood flow in ophthalmic artery, can aggravate processes of ischemic damage to the neurosensory layer of the retina with decreased vision.

Клинический опыт лазерного лечения пациентов с хронической ишемической ретинопатией тяжелой степени, ассоциированной с гемодинамически незначимым стенозом внутренней сонной артерии

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Analysis of Differentiated Approach Effectiveness in Patients with Varying Degrees of Severity of Chronic Ocular Ischemic Syndrome Caused by Internal Carotid Artery Stenosis

Purpose: to study the effect of differentiated treatment approach in patients with varying degrees of severity chronic ocular ischemic syndrome (OIS) on clinical course of disease and hemodynamics of eyes in prospective research.Patients and methods. The research included 20 patients with chronic OIS. Patients were divided into 4 groups due to severity of chronic OIS and type of treatment. 1st group — 7 patients with moderate severity chronic OIS and hemodynamically significant of internal carotid artery stenosis (ICAS); only carotid endarterectomy (CE) of ICAS was performed. 2nd group — 6 patients with severe degree chronic OIS and hemodynamically significant stenosis of ICAS; 2 weeks before CE, panretinal photocoagulation (PRP) of retinal capillary non-perfusion areas was performed. 3rd group — 4 patients with severe degree chronic OIS, complicated by rubeosis iris and increased IOP on hypotensive regimen, on the background of hemodynamically insignificant ICAS; PRP of retina was performed. 4th group — 3 patients with moderate severity chronic OIS with hemodynamically insignificant ICAS; course of neuroprotective therapy was performed. All patients underwent standard and specialized ophthalmologic examination methods. Assessment of blood flow in brachiocephalic vessels, eye vessels was performed by ultrasound scan, spiral computed tomography, OCT-angiography with the AngioVue.Results. Monitoring of patients’ groups for 1 year after chronic OIS treatment allowed us to determine tactics of patient management depending on degree of ICAS and severity of chronic OIS. Reconstructive surgery at hemodynamically significant ICAS caused positive dynamic in intraocular blood flow, which contributed to improvement and preservation of BCVA in 71 % of patients. Preventive PRP of retina, before performing reconstructive surgery of ICAS, optimized and reduced the time of visual recovery. PRP of retina as independent method of treatment of chronic OIS, complicated by neovascular glaucoma, caused full or partial regression of neovascularization in iris, which increased possibilities of its effective treatment. Neuroprotective pharmacotherapy in early stages of chronic OIS, in absence of indications for reconstructive surgery and PRP of retina, improved the prognosis for patients’ vision.Conclusion. Differentiated treatment approach in patients with chronic OIS, due to changes of hemodynamics of internal carotid artery, has improved indexes of hemodynamic and visual acuity.

Эффективность каротидной эндартерэктомии в хирургическом лечении пациентов с хронической ишемической ретинопатией, ассоциированной с гемодинамически значимым стенозом внутренней сонной артерии

Эффективность каротидной эндартерэктомии в хирургическом лечении пациентов с хронической ишемической ретинопатией, ассоциированной с гемодинамически значимым стенозом внутренней сонной артерии

Клинический случай эффективного лазерного лечения хронической ишемической ретинопатии, ассоциированной с осложненной миопией высокой степени

Клинический случай эффективного лазерного лечения хронической ишемической ретинопатии, ассоциированной с осложненной миопией высокой степени

Central retinal artery occlusion without underlying chronic ocular ischemic syndrome may lead to neovascular glaucoma

The prevalence and etiology of neovascular glaucoma (NVG) as a complication of central retinal artery occlusion (CRAO) is a debated issue. According to some authors, NVG associated with CRAO always involves underlying chronic ocular ischemic syndrome (COIS) as a primum movens for CRAO. However, we describe 5cases of NVG following CRAO with no underlying COIS, confirmed by carotid Doppler studies and ultrasound color Doppler imaging (USCDI) of the ophthalmic artery (OA). We conducted a single-center retrospective analysis of the medical records of 5consecutive patients who developed NVG following non-arteritic CRAO between July2010 and July2014. Five patients were included. All 5patients were examined at the emergency room. The 5patients had normal intraocular pressure and no intraocular neovascularization upon initial examination. They had no hemodynamically significant internal carotid artery stenosis, and the ophthalmic artery USCDI was normal. These 5patients developed NVG subsequently to the CRAO. In our patients, carotid Doppler studies and USCDI of the OA ruled out COIS. Thus, COIS did not cause the NVG. CRAO may therefore lead to neovascular glaucoma without underlying COIS.

Abstract TP126: Ocular Circulation in Carotid Artery Stenosis Treated by CEA or CAS

Background: The authors evaluated the effect of carotid artery revascularization surgery for ocular circulation and chronic ocular ischemic syndrome (OIS). Methods: The authors examined ninety-3 patients with carotid artery stenosis (more than 50% stenosis) at its origin treated by carotid endarterectomy (N=58) or carotid artery stenting (N=34). Twenty-six patients (28%) complained of chronic OIS evaluated by the ophthalmic examination. Ocular circulation was examined before and after revascularization surgery using ophthalmic artery (OphAr) and central retinal artery (CRA) color Doppler flow imaging. Results: 1) Ocular circulation: Preoperatively, the average OphAr peak systolic flow velocity (Vs) was 0.05 m/sec, and the average CRA Vs was 0.07 m/sec. At 1 week after surgery, the average OphAr Vs significantly increased to 0.32 ( p < 0.05), and the average CRA Vs significantly increased to 0.11 m/sec ( p < 0.05). These significant improvements were sustained throughout the three months of the follow up.2) OIS: During the follow-up period (mean: 3.6 years), 16 patients (62%) showed visual acuity improvement, and no patients complained of amaurosis fugax or worsening of the chronic OIS. Conclusion: Carotid revascularization surgery was effective in improving the ocular circulation, and it was also useful for the chronic OIS due to the carotid artery stenosis.

Etiopathogenesis of ocular ischemic syndrome

Ocular ischemic syndrome (OIS) is a collection of symptoms of carotid and ophthalmic artery disease of common genesis accompanied by ischemia of eyeball membranes. Specifically, the intraocular blood flow becomes impaired due to inflow reduction or arrest, while the venous outflow remains patent. Causes of OIS include arterial hypertension, atherosclerosis, diabetes, aortoarteritis and other vascular diseases. Clinical features depend on the extent, nature, and site of vascular involvement as well as the concurrent pathology. The process is unilateral and both the anterior and posterior eye segments become affected. Symptoms may vary in severity - from acute to indistinct, and thus, can be neglected or misdiagnosed. Acute course is characterized by sudden onset and sharp deterioration of vision. Clinical manifestations are the following: amaurosis fugax, acute ischemic optic neuropathy, central retinal artery and branch retinal artery occlusions, Amalric syndrome, and ischemic oculopathy. Chronic OIS is notable for slowly progressive visual loss and diverse manifestations, such as chronic ischemic optic neuropathy, chronic ischemic retinopathy, chronic ischemic choroidopathy, and open-angle glaucoma with anterior segment ischemia. To date, there is no general consensus on the nature of this disorder, which complicates its diagnosis and treatment and necessitates a multidisciplinary approach.

Abstract TMP20: Effect of Carotid Artery Revascularization for Ocular Circulation and Chronic Ocular Ischemic in Carotid Artery Stenosis

Background: We evaluated the effect of carotid revascularization surgery for ocular circulation and chronic ocular ischemic syndrome (OIS). Methods: We examined ninety-nine patients with carotid artery stenosis (more than 50% stenosis) at its origin treated by carotid endarterectomy (N=65) or carotid artery stenting (N=34). Twenty-six patients (26%) complained of chronic OIS. Ocular circulation was examined before and after revascularization surgery using ophthalmic artery (OphAr) and central retinal artery (CRA) color Doppler flow imaging. Results: 1) Ocular circulation: Preoperatively, the average OphAr peak systolic flow velocity (Vs) was 0.05 m/sec, and the average CRA Vs was 0.07 m/sec. At 1 week after surgery, the average OphAr Vs significantly increased to 0.32 (p < 0.05), and the average CRA Vs significantly increased to 0.11 m/sec (p < 0.05). These significant improvements were sustained throughout the three months of the follow up.2) OIS: During the follow-up period (mean: 3.6 years), 16 patients (62%) showed visual acuity improvement, and no patients complained of amaurosis fugax or worsening of the chronic OIS. Conclusion: Carotid revascularization surgery was effective in improving the ocular circulation, and it was also useful for the chronic OIS due to the carotid artery stenosis.

Analysis of choline alfoscerate effectiveness in chronic ocular ischemic syndrome

To investigate the effectiveness of choline alphoscerate in patients with chronic ocular ischemic syndrome (OIS) and coexisting cerebrovascular disease. We performed a comprehensive examination of 51 patients aged 46--72 years (57.8±6.82 years on average) and diagnosed with OIS. Patients were divided into two groups. In group 1 (main group, 26 patients) the standard therapy was supplemented with choline alphoscerate. Group 2 (controls, 25 patients) received the standard therapy only. Clinical and functional examinations revealed a more rapid and stable improvement of visual acuity in the choline alphoscerate group. Development and application of an adequate combination therapy for patients with ocular ischemic syndrome has yielded an increase in visual acuity, visual fields, and the mean light sensitivity of the retina as well as an improvement of ocular hemodynamics.

Abstract W P118: Ocular Circulation and Chronic Ocular Ischemic Syndrome in Carotid Artery Stenosis Treated by CEA and CAS

Background: We evaluated the effect of carotid revascularization surgery for ocular circulation and chronic ocular ischemic syndrome (OIS). Methods: We examined ninety-2 patients with carotid artery stenosis (more than 50% stenosis) at its origin treated by carotid endarterectomy (N=58) or carotid artery stenting (N=34). Twenty-five patients (28%) complained of chronic OIS. Ocular circulation was examined before and after revascularization surgery using ophthalmic artery (OphAr) and central retinal artery (CRA) color Doppler flow imaging. Results: 1) Ocular circulation: Preoperatively, the average OphAr peak systolic flow velocity (Vs) was 0.05 m/sec, and the average CRA Vs was 0.07 m/sec. At 1 week after surgery, the average OphAr Vs significantly increased to 0.32 ( p < 0.05), and the average CRA Vs significantly increased to 0.11 m/sec ( p < 0.05). These significant improvements were sustained throughout the three months of the follow up.2) OIS: During the follow-up period (mean: 3.6 years), 15 patients (60%) showed visual acuity improvement, and no patients complained of amaurosis fugax or worsening of the chronic OIS. Conclusion: Carotid revascularization surgery was effective in improving the ocular circulation, and it was also useful for the chronic OIS due to the carotid artery stenosis.

Clinical Applications of High Resolution In-Vivo Retinal Imaging

Clinical Applications of High Resolution In-Vivo Retinal Imaging

Ocular Circulation and Chronic Ocular Ischemic Syndrome before and after Carotid Artery Revascularization Surgery.

Background. We evaluated the effect of carotid revascularization surgery on ocular circulation and chronic ocular ischemic syndrome (OIS). Methods. We examined ninety patients with carotid artery stenosis (more than 50% stenosis) at its origin treated with carotid endarterectomy (N = 56) or carotid artery stenting (N = 34). Twenty-five patients (28%) complained of chronic OIS. Ocular circulation was examined before and after revascularization surgery using ophthalmic artery (OphAr) and central retinal artery (CRA) color Doppler flow imaging. Results. (1) Ocular circulation: preoperatively, the average OphAr peak systolic flow velocity (Vs) was 0.05 m/sec, and the average CRA Vs was 0.07 m/sec. At 1 week after surgery, the average OphAr Vs significantly increased to 0.32 (P < 0.05), and the average CRA Vs significantly increased to 0.11 m/sec (P < 0.05). These significant improvements were sustained throughout the three months of the followup. (2) OIS: during the follow-up period (mean: 3.6 years), 15 patients (60%) showed visual acuity improvement, and no patients complained of amaurosis fugax or worsening of the chronic OIS. Conclusion. Carotid revascularization surgery was effective in improving the ocular circulation, and it was also useful for the chronic OIS due to the carotid artery stenosis.

Effect of Carotid Artery Stenting on Ocular Circulation and Chronic Ocular Ischemic Syndrome

Background: The authors evaluated the effect of carotid artery stenting (CAS) on ocular circulation and chronic ocular ischemic syndrome. Methods: We examined 38 patients with carotid artery stenosis (>80%) at its origin treated with CAS. Ocular circulation and symptoms were examined before, within 24 h, and 1 week, 1 month, and 3 months after CAS based on ophthalmic artery color Doppler flow imaging and ophthalmological examinations. Results: Ocular circulation: Before CAS, 13 patients showed reversed ophthalmic artery flow, and 25 antegrade flow. Average peak systolic flow velocity was –0.038 m/s. Within 24 h after CAS, all patients showed antegrade ophthalmic artery flow; reversed flow before CAS was thus resolved. Average peak systolic flow velocity rose significantly to 0.36 m/s (p < 0.05). One week, 1 month and 3 months after CAS, there were no significant changes compared to the findings at 1 week after CAS. Ocular symptoms: Before CAS, 8 patients showed chronic ocular ischemic syndrome. During the follow-up period (mean: 2.8 years), the visual acuity improved in 7 cases. Average retinal artery pressure and arm-to-retina circulation time improved significantly to the normal level (p < 0.05). The other 30 patients complained of recurrent and worsened visual symptoms during the follow-up period. Conclusion: CAS was effective in improving ocular circulation, and also improved the chronic ocular ischemic syndrome caused by the severe carotid artery stenosis.

内頚動脈閉塞性病変に起因する虚血性網膜症に対するバイパス術の効果―眼動脈血流の解析から―

We examined the role of the STA-MCA bypass for chronic ocular ischemic syndrome due to the internal carotid artery (ICA) occlusive diseases. We examined 44 patients having chronic ocular ischemic syndrome due to the ICA occlusive diseases treated with STA-MCA bypass. Their visual symptoms were decline of visual acuity in 31 cases, frequent amaurosis fugax in 6 cases and both in 7 cases. In each patient, the ophthalmic artery flow was examined with color Doppler flow imaging (CDF) providing the flow direction, waveform and peak systolic flow velocity (PFV) before, at 1 month, and 3 months after surgery. Ophthalmologic examinations such as the visual acuity, retinal artery pressure and optic fundus were also examined. CDF findings: 1) Preoperatively, 39 patients showed reversed ophthalmic artery flow (average PFV: -0.32±0.16 m/sec). The other 5 patients showed antegrade ophthalmic artery flow (average PFV: 0.09±0.03 m/sec). 2) At 1 month after bypass, 17 patients showed the antegrade ophthalmic artery flow. Two of them showed the normal ophthalmic artery flow. Average PFV in the patients with preoperatively reversed ophthalmic artery flow significantly rose to -0.09±0.22 m/sec (p Visual symptoms: During the follow-up period (mean 4.5 years), no patients complained of recurrent visual symptoms. At the final stage, visual acuity improved in 18 patients (47%) and did not worsen in any of the remaining 26 patients. Ophthalmologic examinations also improved during the follow-up period. STA-MCA bypass played a useful and important role for the improvement or prevention of progress of the ocular ischemic syndrome due to the occlusive ICA diseases, especially for patients showing reversed ophthalmic artery flow.

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

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

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.

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

Effect of Carotid Endarterectomy on Chronic Ocular Ischemic Syndrome Due to Internal Carotid Artery Stenosis

Effect of Carotid Endarterectomy on Chronic Ocular Ischemic Syndrome Due to Internal Carotid Artery Stenosis

Atherosclerotic Carotid Disease and the Eye

The evaluation and management of retinal ischemia from atherosclerotic carotid disease is in a state of flux reflected by the change from emphasizing surgical management in the '70s toward skepticism about the benefit of surgery in the '80s. In addition, reliable noninvasive diagnostic testing of the carotid artery has reduced the risk. The decision to consider surgical versus medical management must be made on an individual basis based on the patient's health, age, and the risk of angiography and surgery at each institution. In children and young adults, amaurosis fugax is a benign condition. In the older population amaurosis fugax is often the sentinel event of diffuse atherosclerotic disease and possible early death from myocardial infarction. A team including the neurologist, internist, ophthalmologist, and surgeon optimizes care of the whole disease and not just the symptom. It is hoped that information in the next decade will supply additional guidance in the care of this multifaceted malady.