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Hou Y, Tang S, Meng Z, Zhao Y, Li J, Li H, Wang Y. Incidence of ocular ischemic syndrome in patients with asymptomatic severe internal carotid artery stenosis. Int Ophthalmol 2025; 45:161. [PMID: 40319146 PMCID: PMC12049290 DOI: 10.1007/s10792-025-03537-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Accepted: 04/05/2025] [Indexed: 05/07/2025]
Abstract
OBJECTIVES To evaluate the incidence of ocular ischemic syndrome (OIS) in patients with asymptomatic Severe Internal Carotid Artery Stenosis or occluded (ipICA-SO). DESIGN AND METHODS 260 patients with ipICA stenosis ≥ 70%, 120 patients with ipsilateral OIS, and 140 with normal ocular condition. The logistic regression analysis was conducted to establish risk prediction models of OIS/Neovascular-OIS/Chronic-OIS for patients with ipICA-SO. The area under the receiver operating characteristic curve (AUC) was used to test the application value of the prediction models. RESULTS In ipICA-SO patients, OIS patients showed significantly higher incidence of ipICA occlusion (p < 0.001), plaque unstable (p < 0.001 ipsilateral/contralateral) or plaque located at both the primary and siphon section (p = 0.004 in ipsilateral), contralateral ICA or anterior/middle cerebral artery severe stenosis (p = 0.001, 0.016, 0.040, respectively), and ipsilateral OphAr low /reflux blood flow (p < 0.001). The hypertension was significantly higher in the control group (p = 0.002). The AUC of the prediction model of OIS was 0.834. Diabetes mellitus (DM) and OphAr reflux blood flow are risk factors for Neovascular-OIS. The AUC of Neovascular-OIS was 0.724. Chronic progress is likely in OIS patients with ipICA occlusion and DM. The AUC of Chronic-OIS was 0.673. CONCLUSIONS The ipICA-SO patients without sufficient collateral flow are more likely to develop OIS. IpICA-SO patients with hypertension had a lower risk of developing OIS. Neovascular was commonly found in OIS patients with DM and reversed OphAr blood flow. Chronic OIS was associated with ipICA total occlude and DM.
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Affiliation(s)
- Yanli Hou
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Simeng Tang
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Zhaoyang Meng
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Yingying Zhao
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Jing Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Hongyang Li
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
| | - Yanling Wang
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
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Lin WY, Wang JJ, Chen CY, Liu CY, Lin MH, Yang YH, Lai CH. The Relationship Between Carotid Artery Stenosis and the Development of Open-Angle Glaucoma: A Long-term Cohort Study in Taiwan. Ophthalmic Epidemiol 2025; 32:213-221. [PMID: 39146467 DOI: 10.1080/09286586.2024.2371467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 05/28/2024] [Accepted: 06/18/2024] [Indexed: 08/17/2024]
Abstract
PURPOSES To determine the relationship between carotid artery stenosis (CAS) and the development of open-angle glaucoma (OAG) in the Taiwanese population. METHODS This retrospective cohort study was conducted using Chang Gung Research Database. Cox-proportional hazards model was applied to calculate the hazard ratio for OAG between CAS and the control cohort. RESULTS Among 19,590 CAS patients, 17,238 had mild CAS (<50%), 1,895 had moderate CAS (50-69%), and 457 had severe CAS (≥70%). The CAS cohort had a higher proportion of several comorbidities. After adjusting for comorbidities, no significant difference in OAG development was found between CAS and control cohorts. Matching for key comorbidities, no significant differences in OAG incidence were found between matched cohorts (P = .869). Subdividing the matched CAS cohort by stenosis severity: mild (<50%), moderate (50-69%), and severe (≥70%), a statistically significantly lower OAG risk was observed in patients with mild CAS stenosis (HR: 1.12, 95% CI = 1.03-1.21, P = .006). Kaplan-Meier analysis revealed reduced OAG incidence in CAS patients who underwent surgical intervention, compared to the control cohort (P <.001). Subgroup analysis revealed that patients in the mild CAS stenosis group, those who underwent surgical intervention exhibited a reduced OAG risk (HR: 0.29, 95% CI = 0.15-0.58, P = .001). CONCLUSIONS No statistically significant differences in OAG risk were observed between patients with CAS and the control cohort. The severity of CAS appears to influence OAG risk, with surgical intervention potentially offering protective effects, particularly in patients with mild CAS stenosis (<50%), suggesting that enhanced ocular perfusion post-surgery may act as a protective factor against OAG development.
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Affiliation(s)
- Wen-Yun Lin
- Department of Ophthalmology, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Jin-Jhe Wang
- Department of Ophthalmology, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Ophthalmology, College of Medicine, Chang Gung University, Linkuo, Taiwan
| | - Chauyin-Yin Chen
- Department of Ophthalmology, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Ophthalmology, College of Medicine, Chang Gung University, Linkuo, Taiwan
| | - Chia-Yen Liu
- Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Meng-Hung Lin
- Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yao-Hsu Yang
- Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chien-Hsiung Lai
- Department of Ophthalmology, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Ophthalmology, College of Medicine, Chang Gung University, Linkuo, Taiwan
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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3
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Cuba-Sulluchuco FK, Pascual-Santiago MA, Garcia-Bermudez M, Pampillon-Albert M, Cabo-Sanchez A, Domingo Gordo B. Orbital ischemic syndrome following iatrogenic ophthalmic artery dissection. J Fr Ophtalmol 2025; 48:104415. [PMID: 39788863 DOI: 10.1016/j.jfo.2024.104415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 07/05/2024] [Accepted: 08/19/2024] [Indexed: 01/12/2025]
Affiliation(s)
- F K Cuba-Sulluchuco
- Servicio de Oftalmología, Instituto de Investigación, Hospital Clínico San Carlos, Calle Profesor-Martin-Lagos s/n, Madrid, Spain; Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Red Temática de Investigación Cooperativa en Salud (RETICS), Oftared, Instituto de Salud Carlos III, Madrid, Spain
| | - M A Pascual-Santiago
- Servicio de Oftalmología, Instituto de Investigación, Hospital Clínico San Carlos, Calle Profesor-Martin-Lagos s/n, Madrid, Spain; Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Red Temática de Investigación Cooperativa en Salud (RETICS), Oftared, Instituto de Salud Carlos III, Madrid, Spain
| | - M Garcia-Bermudez
- Servicio de Oftalmología, Instituto de Investigación, Hospital Clínico San Carlos, Calle Profesor-Martin-Lagos s/n, Madrid, Spain; Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Red Temática de Investigación Cooperativa en Salud (RETICS), Oftared, Instituto de Salud Carlos III, Madrid, Spain
| | - M Pampillon-Albert
- Servicio de Oftalmología, Instituto de Investigación, Hospital Clínico San Carlos, Calle Profesor-Martin-Lagos s/n, Madrid, Spain; Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Red Temática de Investigación Cooperativa en Salud (RETICS), Oftared, Instituto de Salud Carlos III, Madrid, Spain
| | - A Cabo-Sanchez
- Servicio de Oftalmología, Instituto de Investigación, Hospital Clínico San Carlos, Calle Profesor-Martin-Lagos s/n, Madrid, Spain; Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Red Temática de Investigación Cooperativa en Salud (RETICS), Oftared, Instituto de Salud Carlos III, Madrid, Spain
| | - B Domingo Gordo
- Servicio de Oftalmología, Instituto de Investigación, Hospital Clínico San Carlos, Calle Profesor-Martin-Lagos s/n, Madrid, Spain; Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Red Temática de Investigación Cooperativa en Salud (RETICS), Oftared, Instituto de Salud Carlos III, Madrid, Spain
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4
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Rohowetz LJ, Staropoli P, da Cruz NF, Mendoza C, Starke RM, Morcos JJ, Berrocal AM. Ocular ischemic syndrome secondary to cerebral aneurysms. Am J Ophthalmol Case Rep 2024; 36:102214. [PMID: 39553911 PMCID: PMC11566319 DOI: 10.1016/j.ajoc.2024.102214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 10/07/2024] [Accepted: 10/28/2024] [Indexed: 11/19/2024] Open
Abstract
Purpose To describe the clinical findings in an 11-year-old male with a history of hemifacial microsomia presenting with ocular ischemic syndrome secondary to large cerebral aneurysms. Observations An 11-year-old male with a history of hemifacial microsomia presented to the Bascom Palmer Eye Institute Emergency Department complaining of nausea, diarrhea, headache, and decreased vision in the left eye. Visual acuity was light perception in the left eye and intraocular pressure was within normal limits. Gonioscopy revealed the presence of diffuse neovascularization of the angle. Posterior segment examination revealed mild vitreous hemorrhage, optic disc pallor, preretinal hemorrhage, generalized arteriolar narrowing, retinal microaneurysms, and abnormal arteriovenous communications with branching retinal vessels. Fluorescein angiography demonstrated patchy and delayed choroidal filling, a prolonged venous filling time, arteriolar attenuation, and vascular staining consistent with ocular ischemic syndrome. Magnetic resonance angiography was obtained which revealed large left internal carotid and anterior cerebral artery aneurysms. The patient underwent successful cerebral revascularization via bypass, ligation, clipping, and coiling procedures. At postoperative year 1, there was no evidence of ocular neovascularization and visual acuity remained light perception. Conclusion and Importance Ocular ischemic syndrome is uncommon in children but may occur with any cause of ocular hypoperfusion. Hemifacial microsomia is a rare congenital disorder of craniofacial development caused by a vascular event in utero affecting the first and second branchial arches. This case demonstrates a rare cause of ocular ischemic syndrome and illustrates the potential for the development of clinically significant vascular abnormalities in patients with disorders of craniofacial development.
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Affiliation(s)
- Landon J. Rohowetz
- Department of Ophthalmology, Bascom Palmer Eye Institute, 900 NW 17th St., Miami, FL, USA
| | - Patrick Staropoli
- Department of Ophthalmology, Bascom Palmer Eye Institute, 900 NW 17th St., Miami, FL, USA
| | - Natasha F.S. da Cruz
- Department of Ophthalmology, Bascom Palmer Eye Institute, 900 NW 17th St., Miami, FL, USA
| | - Carlos Mendoza
- Department of Ophthalmology, Bascom Palmer Eye Institute, 900 NW 17th St., Miami, FL, USA
| | - Robert M. Starke
- Department of Neurological Surgery, University of Miami, Jackson Health System, 1095 Northwest 14th Ter., Miami, FL, 33136, USA
| | - Jacques J. Morcos
- Department of Neurological Surgery, University of Miami, Jackson Health System, 1095 Northwest 14th Ter., Miami, FL, 33136, USA
| | - Audina M. Berrocal
- Department of Ophthalmology, Bascom Palmer Eye Institute, 900 NW 17th St., Miami, FL, USA
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5
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Yu HJ, Choi S, Guiseppi R, Banaee T. Retinal Artery Occlusion: A Review of Current Management Practices. J Ophthalmic Vis Res 2024; 19:488-507. [PMID: 39917461 PMCID: PMC11795002 DOI: 10.18502/jovr.v19i4.16559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Accepted: 09/02/2024] [Indexed: 02/09/2025] Open
Abstract
Retinal artery occlusion (RAO) is a well-characterized ischemic ophthalmic event that may result in sudden and devastating vision loss. The etiology of RAO may vary including both arteritic and non-arteritic causes and the location of the lesion can extend from the ophthalmic artery to the branches of the central retinal artery. Given this variable causes of RAO, the clinical presentation and extent of vision loss may also differ from case to case, necessitating a prompt and thorough evaluation, including a full stroke work up. While there is currently no widely accepted standard for the treatment of RAO, there are several proposed methods that have been or are currently being investigated through retrospective studies and prospective trials. The current article aims to provide a review of the pathophysiology, clinical presentation, and management of RAO in addition to presenting a systematic review of recently published studies on treatment options for RAO.
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Affiliation(s)
- Hannah J. Yu
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Sophia Choi
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Rodney Guiseppi
- Department of Ophthalmology and Visual Sciences, University of Texas. Medical Branch, Galveston, Texas, USA
| | - Touka Banaee
- Department of Ophthalmology and Visual Sciences, University of Texas. Medical Branch, Galveston, Texas, USA
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Srejovic JV, Muric MD, Jakovljevic VL, Srejovic IM, Sreckovic SB, Petrovic NT, Todorovic DZ, Bolevich SB, Sarenac Vulovic TS. Molecular and Cellular Mechanisms Involved in the Pathophysiology of Retinal Vascular Disease-Interplay Between Inflammation and Oxidative Stress. Int J Mol Sci 2024; 25:11850. [PMID: 39519401 PMCID: PMC11546760 DOI: 10.3390/ijms252111850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Revised: 10/28/2024] [Accepted: 10/30/2024] [Indexed: 11/16/2024] Open
Abstract
Retinal vascular diseases encompass several retinal disorders, including diabetic retinopathy, retinopathy of prematurity, age-related macular degeneration, and retinal vascular occlusion; these disorders are classified as similar groups of disorders due to impaired retinal vascularization. The aim of this review is to address the main signaling pathways involved in the pathogenesis of retinal vascular diseases and to identify crucial molecules and the importance of their interactions. Vascular endothelial growth factor (VEGF) is recognized as a crucial and central molecule in abnormal neovascularization and a key phenomenon in retinal vascular occlusion; thus, anti-VEGF therapy is now the most successful form of treatment for these disorders. Interaction between angiopoietin 2 and the Tie2 receptor results in aberrant Tie2 signaling, resulting in loss of pericytes, neovascularization, and inflammation. Notch signaling and hypoxia-inducible factors in ischemic conditions induce pathological neovascularization and disruption of the blood-retina barrier. An increase in the pro-inflammatory cytokines-TNF-α, IL-1β, and IL-6-and activation of microglia create a persistent inflammatory milieu that promotes breakage of the blood-retinal barrier and neovascularization. Toll-like receptor signaling and nuclear factor-kappa B are important factors in the dysregulation of the immune response in retinal vascular diseases. Increased production of reactive oxygen species and oxidative damage follow inflammation and together create a vicious cycle because each factor amplifies the other. Understanding the complex interplay among various signaling pathways, signaling cascades, and molecules enables the development of new and more successful therapeutic options.
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Affiliation(s)
- Jovana V. Srejovic
- University Clinical Center “Kragujevac”, 34000 Kragujevac, Serbia; (J.V.S.); (S.B.S.); (N.T.P.); (D.Z.T.)
- Department of Ophthalmology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Maja D. Muric
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (M.D.M.); (V.L.J.)
| | - Vladimir Lj. Jakovljevic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (M.D.M.); (V.L.J.)
- Center of Excellence for the Study of Redox Balance in Cardiovascular and Metabolic Disorders, University of Kragujevac, 34000 Kragujevac, Serbia
- Department of Human Pathology, First Moscow State Medical University I.M. Sechenov, Moscow 119435, Russia;
| | - Ivan M. Srejovic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (M.D.M.); (V.L.J.)
- Center of Excellence for the Study of Redox Balance in Cardiovascular and Metabolic Disorders, University of Kragujevac, 34000 Kragujevac, Serbia
- Department of Pharmacology, First Moscow State Medical University I.M. Sechenov, Moscow 119435, Russia
| | - Suncica B. Sreckovic
- University Clinical Center “Kragujevac”, 34000 Kragujevac, Serbia; (J.V.S.); (S.B.S.); (N.T.P.); (D.Z.T.)
- Department of Ophthalmology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Nenad T. Petrovic
- University Clinical Center “Kragujevac”, 34000 Kragujevac, Serbia; (J.V.S.); (S.B.S.); (N.T.P.); (D.Z.T.)
- Department of Ophthalmology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Dusan Z. Todorovic
- University Clinical Center “Kragujevac”, 34000 Kragujevac, Serbia; (J.V.S.); (S.B.S.); (N.T.P.); (D.Z.T.)
- Department of Ophthalmology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Sergey B. Bolevich
- Department of Human Pathology, First Moscow State Medical University I.M. Sechenov, Moscow 119435, Russia;
| | - Tatjana S. Sarenac Vulovic
- University Clinical Center “Kragujevac”, 34000 Kragujevac, Serbia; (J.V.S.); (S.B.S.); (N.T.P.); (D.Z.T.)
- Department of Ophthalmology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
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Sadri BS, Low DW, Jackson OA, Jackson BM, Belkin N. Subclavian to carotid artery bypass for a case of ocular ischemic syndrome. Vascular 2024; 32:792-796. [PMID: 36917226 DOI: 10.1177/17085381231164015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
BACKGROUND Ocular Ischemic Syndrome (OIS) is a rare, vision threatening condition associated with severe carotid artery disease. There are few cases of OIS reported in the literature. METHODS We present the case of a 54-year-old male with history of multiple previous carotid interventions including a right carotid stent, who presented with right-sided OIS. RESULTS CTA and angiogram showed a severe calcific plaque causing restenosis of the right carotid stent, with a patent right internal carotid artery (ICA) in the very distal neck. The right common carotid artery (CCA) was patent but diseased with ulcerated plaque extending proximally to below the level of the clavicle. The left CCA was chronically occluded from its origin all the way to the bifurcation. Given our patient's surgical history, the imperative to revascularize the ipsilateral carotid, and a diffusely diseased ipsilateral CCA, he was successfully treated with an ipsilateral subclavian to internal carotid bypass. CONCLUSION There is paucity of data regarding the best approach for carotid revascularization in OIS. This case report discusses our unique perioperative decision making as well as relevant literature.
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Affiliation(s)
- Babak S Sadri
- Department of Surgery, Lehigh Valley Hospital, Allentown, PA, USA
| | - David W Low
- Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Oksana A Jackson
- Department of Surgery, Division of Plastic, Reconstructive and Oral Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Nathan Belkin
- Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Gkiala A, Zaheer N, Anwar S, Perera S, Sharara A, Lip PL. Is a Carotid Doppler Scan Useful for Managing Patients with Suspected Ocular Ischemic Syndrome? Clin Ophthalmol 2024; 18:2041-2048. [PMID: 39044766 PMCID: PMC11265215 DOI: 10.2147/opth.s467513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 07/02/2024] [Indexed: 07/25/2024] Open
Abstract
Purpose This review aims to understand the value of a carotid Doppler scan (CDS) when managing patients with clinical/suspected ocular ischaemic syndrome (OIS); correlations between internal carotid artery (ICA) stenosis reports; subsequent patterns of referral to vascular experts; and subsequent decisions concerning surgical versus medical management. Methods A retrospective review of 402 CDS requests by a single eye center over 4 years (2016-2019) for patients with a clinical suspicion of OIS was conducted. Data analysis included 344 patients who had reported CDS of both ICAs. We also studied referral patterns by ophthalmologists to other specialties. Results CDS requests were related to the retina (53.2%), neuro/TIA problems (31.1%), glaucoma (10.5%) and other issues (5.2%). The majority of patients (209/344, 60.8%) had normal CDA results. Of the 688 ICAs reported, 469 (68.2%) were normal, 219 (31.8%) had atheroma present, and only 83 (12.1%) had significant stenosis. Of 83 ICAs with stenosis, 23 (27.7%) had ≥70% stenosis, 24 (28.9%) had 50-69% stenosis, and 25 (30.1%) had <50% stenosis. A total of 60/344 (17.4%) patients were referred to vascular/stroke teams: 15/60 (25%) referred had bilateral disease, and only 2/60 (3.3%) were offered carotid endarterectomy. All referred patients commenced statins and low-dose aspirin. Conclusion Our cohort showed a low incidence of ICA stenosis according to CDS reports in patients with suspected OIS. There were very low rates of vascular and endarterectomy referral. Commencement of conservative treatment (mini aspirin+statin) by ophthalmologists could be beneficial even in the early stage of presenting clinical evidence of OIS.
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Affiliation(s)
- Anastasia Gkiala
- Birmingham & Midland Eye Centre, Sandwell & West Birmingham NHS Trust, City Hospital, Birmingham, B18 7QH, UK
| | - Naima Zaheer
- Birmingham & Midland Eye Centre, Sandwell & West Birmingham NHS Trust, City Hospital, Birmingham, B18 7QH, UK
| | - Saba Anwar
- Birmingham & Midland Eye Centre, Sandwell & West Birmingham NHS Trust, City Hospital, Birmingham, B18 7QH, UK
| | - Shalika Perera
- Birmingham & Midland Eye Centre, Sandwell & West Birmingham NHS Trust, City Hospital, Birmingham, B18 7QH, UK
| | - Ahmad Sharara
- Birmingham & Midland Eye Centre, Sandwell & West Birmingham NHS Trust, City Hospital, Birmingham, B18 7QH, UK
| | - Peck Lin Lip
- Birmingham & Midland Eye Centre, Sandwell & West Birmingham NHS Trust, City Hospital, Birmingham, B18 7QH, UK
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9
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Caplash S, Paez-Escamilla M, Westcott M, Dansingani KK, Indermill C, Kisma N, Frau E, Sahel JA, Bodaghi B, Jhanji V, Errera MH. Mimickers of anterior uveitis, scleritis and misdiagnoses- tips and tricks for the cornea specialist. J Ophthalmic Inflamm Infect 2024; 14:14. [PMID: 38594487 PMCID: PMC11004105 DOI: 10.1186/s12348-024-00396-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 03/29/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Anterior uveitis, inflammation of the anterior chamber and related structures, is a cohort of diseases that can present to almost any general or sub-specialty Ophthalmology practice. Its features classically involve anterior chamber cell and flare. Below the surface of these two signs exist a panoply of diagnoses. BODY: The purpose of this review is to provide a general framework for diagnoses of anterior uveitis that are often missed as well as non-uveitic pathologies that often mimic anterior uveitis. Diagnostic deviation in either direction can have vision-threatening and rarely life-threatening consequences for patients. Using a comprehensive literature review we have collected a broad spectrum of etiologies of anterior uveitis that are easily missed and non-uveitic pathologies that can masquerade as anterior uveitis. CONCLUSIONS We present a focused review on specific misdiagnosed anterior uveitis pathologies and some of the conditions that can masquerade as anterior uveitis and scleritis.
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Affiliation(s)
- Sonny Caplash
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Manuel Paez-Escamilla
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Mark Westcott
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK
| | - Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Chad Indermill
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Nacima Kisma
- Universite Libre de Bruxelles, Hopital Universitaire de Bruxelles, 808 route de Lennik 1170, Bruxelles, Belgium
| | - Eric Frau
- Department of Ophthalmology, Centre hospitalier National des Quinze-Vingts, Paris, France
| | - Jose-Alain Sahel
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Bahram Bodaghi
- Department of Ophthalmology, Pitié-Salpêtrière University Hospital, Sorbonne Universités, F-75013, Paris, France
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Marie-Helene Errera
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA.
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Demeuleneere A, Lambert J, Demeestere J, Lemmens R, Fourneau I, Houthoofd S, Schauwvlieghe PP, Jacob J, Cassiman C. A rare presentation of a common carotid artery occlusion. GMS OPHTHALMOLOGY CASES 2023; 13:Doc20. [PMID: 38111470 PMCID: PMC10726582 DOI: 10.3205/oc000228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
Background A common carotid artery occlusion (CCAO) is very rare and the clinical features of CCAO have rarely been described. Since the blood supply of the eye and orbit is derived from the internal carotid artery, a CCAO may present with various ophthalmological symptoms, ranging from incidental findings to complete visual loss but also other neuro-ophthalmological abnormalities. Case report A 61-year-old woman presented with acute monocular vision loss and an elevation deficit of the right eye. Fluorescein angiography showed delayed filling of both the retinal and choroidal vasculature, without occlusion/embolisms of the retinal arteries. Vascular imaging showed a right CCAO. Conclusion CCAO has a variable presentation. In patients with acute unilateral visual loss a CCAO should be considered, especially when ocular motility deficits are present. Fluorescein angiography examination can aid in the localization and diagnosis of the vascular insult. Urgent referral for a systemic work-up is essential.
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Affiliation(s)
| | - Julie Lambert
- Radiology Department, University Hospitals Leuven, Belgium
| | | | - Robin Lemmens
- Neurology Department, University Hospitals Leuven, Belgium
| | - Inge Fourneau
- Vascular Surgery Department, University Hospitals Leuven, Belgium
| | | | | | - Julie Jacob
- Ophthalmology Department, University Hospitals Leuven, Belgium
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Ng JY, Zarook E, Nicholson L, Khanji MY, Chahal CAA. Eyes and the heart: what a clinician should know. Heart 2023; 109:1670-1676. [PMID: 37507215 PMCID: PMC10646879 DOI: 10.1136/heartjnl-2022-322081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/27/2023] [Indexed: 07/30/2023] Open
Abstract
The eye is prone to various forms of afflictions, either as a manifestation of primary ocular disease or part of systemic disease, including the cardiovascular system. A thorough cardiovascular examination should include a brief ocular assessment. Hypertension and diabetes, for example, would present with retinopathy and dyslipidaemia would present with corneal arcus. Multisystem autoimmune diseases, such as Graves' disease, rheumatoid arthritis and sarcoidosis, would present with proptosis, episcleritis and scleritis, respectively. Myasthenia gravis, while primarily a neuromuscular disease, presents with fatigable ptosis and is associated with Takotsubo cardiomyopathy and giant cell myocarditis. Connective tissue diseases such as Marfan syndrome, which commonly presents with aortic root dilatation, would be associated with ectopia lentis and myopia. Wilson's disease, which is associated with arrhythmias and cardiomyopathies, would present usually with the characteristic Kayser-Fleischer rings. Rarer diseases, such as Fabry disease, would be accompanied by ocular signs such as cornea verticillata and such cardiac manifestations include cardiac hypertrophy as well as arrhythmias. This review examines the interplay between the eye and the cardiovascular system and emphasises the use of conventional and emerging tools to improve diagnosis, management and prognostication of patients.
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Affiliation(s)
- Jing Yong Ng
- Medical Education Department, Queen Mary University of London, Barts and the London School of Medicine and Dentistry, London, UK
| | - Essa Zarook
- Medical Education Department, Queen Mary University of London, Barts and the London School of Medicine and Dentistry, London, UK
| | - Luke Nicholson
- NIHR Moorfields Biomedical Research Centre, London, UK
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Mohammed Yunus Khanji
- Department of Cardiology, University Hospital, Barts Health NHS Trust, London, UK
- Department of Cardiology, Barts Heart Centre, London, UK
- NIHR Barts Biomedical Research Centre, London, UK
| | - Choudhary Anwar Ahmed Chahal
- Department of Cardiology, Barts Heart Centre, London, UK
- Center for Inherited Cardiovascular Diseases, WellSpan Health, York, Pennsylvania, USA
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
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12
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Chen Y, Feng X, Huang Y, Zhao L, Chen X, Qin S, Sun J, Jing J, Zhang X, Wang Y. Blood flow perfusion in visual pathway detected by arterial spin labeling magnetic resonance imaging for differential diagnosis of ocular ischemic syndrome. Front Neurosci 2023; 17:1121490. [PMID: 36860621 PMCID: PMC9969084 DOI: 10.3389/fnins.2023.1121490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 01/19/2023] [Indexed: 02/16/2023] Open
Abstract
Background Ocular ischemic syndrome (OIS), attributable to chronic hypoperfusion caused by marked carotid stenosis, is one of the important factors that cause ocular neurodegenerative diseases such as optic atrophy. The current study aimed to detect blood flow perfusion in a visual pathway by arterial spin labeling (ASL) and magnetic resonance imaging (MRI) for the differential diagnosis of OIS. Methods This diagnostic, cross-sectional study at a single institution was performed to detect blood flow perfusion in a visual pathway based on 3D pseudocontinuous ASL (3D-pCASL) using 3.0T MRI. A total of 91 participants (91 eyes) consisting of 30 eyes with OIS and 61 eyes with noncarotid artery stenosis-related retinal vascular diseases (39 eyes with diabetic retinopathy and 22 eyes with high myopic retinopathy) were consecutively included. Blood flow perfusion values in visual pathways derived from regions of interest in ASL images, including the retinal-choroidal complex, the intraorbital segments of the optic nerve, the tractus optics, and the visual center, were obtained and compared with arm-retinal circulation time and retinal circulation time derived from fundus fluorescein angiography (FFA). Receiver operating characteristic (ROC) curve analyses and the intraclass correlation coefficient (ICC) were performed to evaluate the accuracy and consistency. Results Patients with OIS had the lowest blood flow perfusion values in the visual pathway (all p < 0.05). The relative intraorbital segments of optic nerve blood flow values at post-labeling delays (PLDs) of 1.5 s (area under the curve, AUC = 0.832) and the relative retinal-choroidal complex blood flow values at PLDs of 2.5 s (AUC = 0.805) were effective for the differential diagnosis of OIS. The ICC of the blood flow values derived from the retinal-choroidal complex and the intraorbital segments of the optic nerve between the two observers showed satisfactory concordance (all ICC > 0.932, p < 0.001). The adverse reaction rates of ASL and FFA were 2.20 and 3.30%, respectively. Conclusion 3D-pCASL showed that the participants with OIS had lower blood flow perfusion values in the visual pathway, which presented satisfactory accuracy, reproducibility, and safety. It is a noninvasive and comprehensive differential diagnostic tool to assess blood flow perfusion in a visual pathway for the differential diagnosis of OIS.
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Affiliation(s)
- Yanan Chen
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xue Feng
- Department of Ophthalmology, Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, Beijing, China
| | - Yingxiang Huang
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Lu Zhao
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xi Chen
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shuqi Qin
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jiao Sun
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaolei Zhang
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China,*Correspondence: Xiaolei Zhang ✉
| | - Yanling Wang
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China,Yanling Wang ✉
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13
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[Retinal arterial occlusions (RAV) : S2e guidelines of the German Society of Ophthalmology (DOG), the German Retina Society (RG) and the German Professional Association of Ophthalmologists (BVA). Version: 7 October 2022]. DIE OPHTHALMOLOGIE 2023; 120:15-29. [PMID: 36525048 DOI: 10.1007/s00347-022-01780-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 12/23/2022]
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14
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Tuzlaev VV, Kolenko OV, Egorov VV, Kravchenko IZ, Smolyakova GP, Yarovaya AV, Breev DV. [Optical coherence tomography angiography in diagnosis of changes in macular capillary blood flow in chronic ischemic retinopathy]. Vestn Oftalmol 2023; 139:17-27. [PMID: 37067928 DOI: 10.17116/oftalma202313902117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
PURPOSE Assessment of the indices of macular capillary blood flow and subfoveal choroidal thickness (SCT) using optical coherence tomography angiography in patients with retinal manifestations of ocular ischemic syndrome (RMOIS) associated with atherosclerotic internal carotid artery stenosis. MATERIAL AND METHODS The study included 34 patients (68 eyes): 21 men, 13 women with RMOIS in one eye. All patients were divided into 2 groups depending on the severity of atherosclerotic internal carotid artery stenosis and ophthalmoscopic picture of the fundus. To obtain objective information we analyzed the degree of decrease in the main indices characterizing macular microcirculation and SCT depending on the severity of RMOIS. RESULTS AND DISCUSSION Analysis of the results showed relationship between the severity of RMOIS and the deficit in macular microcirculation. The macula of the patients with mild RMOIS was characterized by a decrease in the density of superficial vascular plexus (SVP) and the density of deep capillary plexus (DCP) by 13.5% and 10.5% compared to the controls, respectively; in moderate RMOIS - by 19.7% and 14.6%; in severe RMOIS - by 35.9% and 28%, respectively. With an increase in the severity of RMOIS, the area of the foveal avascular zone increased too: in mild degree RMOIS - by 19%, in moderate - by 38.6%, in severe - by 51%. In proportion to the severity of RMOIS, SCT was reduced: in mild degree RMOIS - by only 8%, in moderate - by 22%, and in severe - by 29.8% of the control. CONCLUSION The conducted research indicates that pathological changes in RMOIS extend to the entire capillary network of the macula and SCT. With increase in the degree of RMOIS, ischemic changes in all capillary layers of the central parts of the retina proportionally increase in comparison with the control group by 1.15 times in mild degree, by 1.24 times in moderate degree, and by 1.5 times in severe RMOIS.
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Affiliation(s)
- V V Tuzlaev
- Khabarovsk branch of S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Khabarovsk, Russia
| | - O V Kolenko
- Khabarovsk branch of S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Khabarovsk, Russia
- Postgraduate Institute for Public Health Workers, Khabarovsk, Russia
| | - V V Egorov
- Khabarovsk branch of S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Khabarovsk, Russia
- Postgraduate Institute for Public Health Workers, Khabarovsk, Russia
| | - I Z Kravchenko
- Khabarovsk branch of S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Khabarovsk, Russia
| | - G P Smolyakova
- Khabarovsk branch of S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Khabarovsk, Russia
- Postgraduate Institute for Public Health Workers, Khabarovsk, Russia
| | - A V Yarovaya
- Federal Center for Cardiovascular Surgery, Khabarovsk, Russia
| | - D V Breev
- Federal Center for Cardiovascular Surgery, Khabarovsk, Russia
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Ramsey DJ, Kwan JT, Sharma A. Keeping an eye on the diabetic foot: The connection between diabetic eye disease and wound healing in the lower extremity. World J Diabetes 2022; 13:1035-1048. [PMID: 36578874 PMCID: PMC9791566 DOI: 10.4239/wjd.v13.i12.1035] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/27/2022] [Accepted: 11/18/2022] [Indexed: 12/15/2022] Open
Abstract
Diabetic eye disease is strongly associated with the development of diabetic foot ulcers (DFUs). DFUs are a common and significant complication of diabetes mellitus (DM) that arise from a combination of micro- and macrovascular compromise. Hyperglycemia and associated metabolic dysfunction in DM lead to impaired wound healing, immune dysregulation, peripheral vascular disease, and diabetic neuropathy that predisposes the lower extremities to repetitive injury and progressive tissue damage that may ultimately necessitate amputation. Diabetic retinopathy (DR) is caused by cumulative damage to the retinal mic-rovasculature from hyperglycemia and other diabetes-associated factors. The severity of DR is closely associated with the development of DFUs and the need for lower extremity revascularization procedures and/or amputation. Like the lower extremity, the eye may also suffer end-organ damage from macrovascular compromise in the form of cranial neuropathies that impair its motility, cause optic neuropathy, or result in partial or complete blindness. Additionally, poor perfusion of the eye can cause ischemic retinopathy leading to the development of proliferative diabetic retinopathy or neovascular glaucoma, both serious, vision-threatening conditions. Finally, diabetic corneal ulcers and DFUs share many aspects of impaired wound healing resulting from neurovascular, sensory, and immunologic compromise. Notably, alterations in serum biomarkers, such as hemoglobin A1c, ceruloplasmin, creatinine, low-density lipoprotein, and high-density lipoprotein, are associated with both DR and DFUs. Monitoring these parameters can aid in prognosticating long-term outcomes and shed light on shared pathogenic mechanisms that lead to end-organ damage. The frequent co-occurrence of diabetic eye and foot problems mandate that patients affected by either condition undergo reciprocal comprehensive eye and foot evaluations in addition to optimizing diabetes management.
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Affiliation(s)
- David J Ramsey
- Department of Ophthalmology, Lahey Hospital and Medical Center, Burlington, MA 01805, United States
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA 02111, United States
| | - James T Kwan
- Department of Ophthalmology, Lahey Hospital and Medical Center, Burlington, MA 01805, United States
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA 02111, United States
| | - Arjun Sharma
- Department of Ophthalmology, Lahey Hospital and Medical Center, Burlington, MA 01805, United States
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA 02111, United States
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16
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Metry Y, Joseph S. Optic Disc Neovascularization as the Only Sign of Ocular Ischemic Syndrome: A Case Report. Cureus 2022; 14:e29972. [DOI: 10.7759/cureus.29972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 11/07/2022] Open
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17
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Lo WJ, Lin YC, Chang HY, Chen MJ. Risk factors for ocular neovascularization after central retinal artery occlusion. J Chin Med Assoc 2022; 85:880-885. [PMID: 35727105 DOI: 10.1097/jcma.0000000000000766] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To report the incidence and risk factors associated with ocular neovascularization (NV) in patients with central retinal artery occlusion (CRAO). METHODS This retrospective study included patients diagnosed with acute CRAO in a single tertiary center. Medical charts were reviewed for ocular NV occurrences. We analyzed systemic and ocular conditions on first visit and demographic data. RESULTS Eighty-seven eyes were eligible for this study. Among these, 13 eyes had ocular NV after CRAO, with an incidence of 15%. The prevalences of hypertension, diabetes mellitus, history of stroke, chronic kidney disease (CKD), and age at first visit were higher among patients with ocular NV than among patients without ocular NV after CRAO. Moreover, most patients with CKD in the ocular NV group had undergone dialysis. A multivariate regression analysis revealed that CKD (hazard ratio [HR]: 9.27, 95% CI, 1.87-46.05, p = 0.006) and glaucoma history (HR: 7.52, 95% CI, 1.14-49.46, p = 0.036) were significant risk factors for developing ocular NV among patients with CRAO. CONCLUSION CKD and glaucoma history were significant risk factors for developing ocular NV after CRAO, particularly among patients that underwent dialysis.
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Affiliation(s)
- Wen-Jung Lo
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Ophthalmology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yu-Ching Lin
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hsin-Yi Chang
- Department of Ophthalmology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC
| | - Mei-Ju Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Ophthalmology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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18
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Ocular Ischemic Syndrome and Its Related Experimental Models. Int J Mol Sci 2022; 23:ijms23095249. [PMID: 35563640 PMCID: PMC9100201 DOI: 10.3390/ijms23095249] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/28/2022] [Accepted: 05/06/2022] [Indexed: 12/17/2022] Open
Abstract
Ocular ischemic syndrome (OIS) is one of the severe ocular disorders occurring from stenosis or occlusion of the carotid arteries. As the ophthalmic artery is derived from the branch of the carotid artery, stenosis or occlusion of the carotid arteries could induce chronic ocular hypoperfusion, finally leading to the development of OIS. To date, the pathophysiology of OIS is still not clearly unraveled. To better explore the pathophysiology of OIS, several experimental models have been developed in rats and mice. Surgical occlusion or stenosis of common carotid arteries or internal carotid arteries was conducted bilaterally or unilaterally for model development. In this regard, final ischemic outcomes in the eye varied depending on the surgical procedure, even though similar findings on ocular hypoperfusion could be observed. In the current review, we provide an overview of the pathophysiology of OIS from various experimental models, as well as several clinical cases. Moreover, we cover the status of current therapies for OIS along with promising preclinical treatments with recent advances. Our review will enable more comprehensive therapeutic approaches to prevent the development and/or progression of OIS.
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19
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López-Herrero F, Montenegro-Quintana MA, Franco-Ruedas C, Lechón-Caballero B, Rodríguez-Fernández CM, Sánchez-Vicente JL. Lens subluxation in two cases of ocular ischemic syndrome: A late complication? J Fr Ophtalmol 2022; 45:664-666. [PMID: 35513925 DOI: 10.1016/j.jfo.2021.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/22/2021] [Indexed: 11/25/2022]
Affiliation(s)
- F López-Herrero
- Department of Ophthalmology. Virgen del Rocío University Hospital, Avenue Manuel-Siurot, 41013 Seville, Spain
| | - M A Montenegro-Quintana
- Department of Ophthalmology. Virgen del Rocío University Hospital, Avenue Manuel-Siurot, 41013 Seville, Spain
| | - C Franco-Ruedas
- Department of Ophthalmology. Virgen del Rocío University Hospital, Avenue Manuel-Siurot, 41013 Seville, Spain.
| | - B Lechón-Caballero
- Department of Ophthalmology. Virgen del Rocío University Hospital, Avenue Manuel-Siurot, 41013 Seville, Spain
| | - C M Rodríguez-Fernández
- Department of Ophthalmology. Virgen del Rocío University Hospital, Avenue Manuel-Siurot, 41013 Seville, Spain
| | - J L Sánchez-Vicente
- Department of Ophthalmology. Virgen del Rocío University Hospital, Avenue Manuel-Siurot, 41013 Seville, Spain
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20
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Goel R, Arora R, Shah S, Chhabra M, Kumar J, Khurana N, Gupta S, Khanam S, Kumar S, Singh S, Meher R, Thakar M, Garg A. Clinico-Radiological-Pathological Correlation of Visual Loss in COVID-Associated Rhino-Orbito-Cerebral Mucormycosis. Ophthalmic Plast Reconstr Surg 2022; 38:242-249. [PMID: 34919070 PMCID: PMC9093237 DOI: 10.1097/iop.0000000000002112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To correlate the clinical, radiological, and histopathological features in Covid-associated Rhino-orbito-cerebral mucormycosis cases presenting with acute visual loss. DESIGN Cross-sectional study. METHODS Covid-associated Rhino-orbito-cerebral mucormycosis cases with unilateral visual loss, planned for exenteration, underwent orbital and ophthalmological ocular examination. The available radiological sequences, doppler ultrasonography and histopathology findings were correlated with clinical manifestations. RESULTS The median age was 51 years and the male: female ratio was 3:1. All except one presented with unilateral ophthalmoplegia. The ocular media were hazy in 2 eyes. In 8 eyes, retinal changes were suggestive of occlusion of CRA (6), combined occlusion of CRA and central retinal vein (1), and myopic degeneration with hypertensive retinopathy (1). The contralateral eye showed retinal ischemic changes in one patient. Radiological imaging showed orbital apex involvement in the 10 affected eyes and one contralateral eye. Ipsilateral cavernous sinus thrombosis, diffusion restriction on MRI of optic nerve, internal carotid artery narrowing/thrombosis, and cortical watershed infarcts were seen in 8, 4, 4, and 2 cases, respectively. The blood flow in CRA and ophthalmic artery was absent or reduced in all the 10 affected eyes and in 1 contralateral eye. On histopathology, orbital fat necrosis, fungal hyphae, acute inflammation, granuloma formation, ischemic thrombosis of ophthalmic artery was observed in 10 specimens. CRA was patent in 9 and thrombosed in 1 eye. Optic nerve was ischemic in 8 and viable in 2 eyes. CONCLUSION Acute visual loss in ROCM cases is associated with orbital apex involvement and thrombotic ischemia of ophthalmic artery. Cessation of flow in CRA possibly occurs secondary to ophthalmic artery thrombosis.
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Affiliation(s)
- Ruchi Goel
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Ritu Arora
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Shalin Shah
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Mohit Chhabra
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Jyoti Kumar
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Nita Khurana
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Swati Gupta
- Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India
| | - Samreen Khanam
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Sumit Kumar
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Sonam Singh
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Ravi Meher
- Department of Otorhinolaryngology, Maulana Azad Medical College, New Delhi, India
| | - Meenakshi Thakar
- Department of Ophthalmology (Guru Nanak Eye Centre), Maulana Azad Medical College, New Delhi, India
| | - Anju Garg
- Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India
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İncekalan TK, Taktakoğlu D, Şimdivar GHN, Öztürk İ. Optical cohorence tomography angiography findings in carotid artery stenosis. Int Ophthalmol 2022; 42:2501-2509. [PMID: 35355166 DOI: 10.1007/s10792-022-02297-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 03/10/2022] [Indexed: 01/09/2023]
Abstract
AIM To investigate vascular density (VD) changes in the superficial (SCP) and deep capillary plexus (DCP), radial peripapillar capillary plexus (RPCP), Foveal avascular zone (FAZ) and thickness changes of peripapillary retinal nerve fiber layer (ppRNFL) and choroid (CT) using optical coherence tomography angiography (OCTA) ipsilateral eyes of patient with internal carotid artery stenosis (ICAS) and to compare the obtained values with kontralateral eyes of patients with İCAS and healthy individuals. METHODS This prospective cross-sectional case-control study was conducted in 43 patients with a diagnosis of unilateral ICAS and 47 age- and sex-matched healthy subjects. The patients were divided into three groups. Group 1 consisted of ipsilateral eyes of patients with ICAS, group 2 consisted of contralateral eyes of patients with CAS and group 3 comprised healthy individuals without ICAS, All participants underwent a comprehensive ophthalmologic examination including OCTA. RESULTS FAZ, Superficial parafoveal and superficial superior VD were significantly lower in group 1 compared to group 2 (p = < 0.001, p = 0.018 and 0.021, respectively). Group 1 also had lower superficial superior (p = 0.038), superficial inferior (p = 0.034), deep superior (p = 0.034), and deep inferior (p = 0.012) VD compared to group 3. There was no significant difference between the groups in terms of ppRNFLT, whereas CT and RPC mean, superior, and inside-disc VD values were significantly lower in group 1 compared to both group 2 and 3 (p < 0.05). CONCLUSION OCTA measurements may be useful in preventing irreversible ocular complications by detecting early structural changes in patients with ICAS before the development of symptomatic ocular ischemic syndrome.
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Affiliation(s)
- Tuğba Kurumoğlu İncekalan
- Department of Ophthalmology, Adana City Training and Research Hospital, University of Health Sciences, Adana, Turkey.
| | - Derya Taktakoğlu
- Department of Neurology, Adana City Training and Research Hospital, University of Health Sciences, Adana, Turkey
| | - Göksu Hande Naz Şimdivar
- Department of Ophthalmology, Adana City Training and Research Hospital, University of Health Sciences, Adana, Turkey
| | - İlker Öztürk
- Department of Neurology, Adana City Training and Research Hospital, University of Health Sciences, Adana, Turkey
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22
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Durusoy GK, Gumus G, Onay M, Altay CM, Binboga AB. EARLY COROIDAL STRUCTURE AND COROIDAL VASCULARITY INDEX CHANGE AFTER CAROTIS STENTING. Photodiagnosis Photodyn Ther 2022; 38:102748. [DOI: 10.1016/j.pdpdt.2022.102748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/18/2022] [Accepted: 02/01/2022] [Indexed: 10/19/2022]
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Retinal Degeneration in a Murine Model of Retinal Ischemia by Unilateral Common Carotid Artery Occlusion. BIOMED RESEARCH INTERNATIONAL 2022; 2021:7727648. [PMID: 35005021 PMCID: PMC8741345 DOI: 10.1155/2021/7727648] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 01/21/2023]
Abstract
Retinal degeneration is a progressive retinal damage in ocular vascular diseases. There are several reasons for this, such as occlusion of arteries or veins, diabetic retinopathy, or hereditary retinal diseases. To study pathological mechanisms of retinal degeneration, it is required to develop experimentally reproducible and clinically relevant models. In our previous studies, we developed a murine model of retinal hypoperfusion by unilateral common carotid artery occlusion (UCCAO) which mimics the pathophysiology of ocular ischemic syndrome (OIS) in humans, and described broad pathological mechanisms in the retina after UCCAO. However, there still remain missing pieces of the ocular pathologic process by UCCAO. In this study, we examined those unfound mechanisms. UCCAO was performed on adult mice. Ocular dysfunctions, histological deficits, and inflammation were examined after UCCAO, compared with sham-operated mice. Evaluation values were analyzed by electrophysiological, histological, and molecular biological methods. Eyelid drooping was permanently seen after UCCAO. Induction time point of acute reversible cataract under anesthesia was shortened. Retinal/visual dysfunctions were detected 2-4 weeks after UCCAO. Specifically, scotopic b-wave was more affected than a-wave, with the dysfunction of photopic b-wave. Impaired oscillatory potentials and visual evoked potential were constantly observed. Pathological Müller gliosis/inflammation was featured with NeuN-positive cell loss in the ganglion cell layer. Axial length, intraocular pressure, pupillary light reflex, and retinal pigment epithelium/choroidal thickness were not changed by UCCAO. A murine model of retinal ischemia by UCCAO can be useful for studying a series of degenerative process in the ischemic retina.
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Kalloniatis M, Wang H, Katalinic P, Ly A, Apel W, Nivison-Smith L, Kalloniatis KF. Ocular ischaemia: signs, symptoms, and clinical considerations for primary eye care practitioners. Clin Exp Optom 2022; 105:117-134. [PMID: 34982952 DOI: 10.1080/08164622.2021.1999771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Ischaemic stroke is a major disease burden as well as a leading cause of death. Early signs of ischaemic stroke can manifest in the eye, placing primary eyecare practitioners in an important position to identify patients at risk of ischaemic stroke and initiate suitable referral pathways. The vascular supply to the brain is reviewed with reference to vision including the various retinal signs and ocular symptoms associated with transient ischaemic attacks and ischaemic stroke. Using a range of clinical cases, the diverse clinical presentations of retinal embolic events, as well as other forms of vascular occlusion, are highlighted and the underlying pathophysiology is discussed. A succinct scheme for the assessment and management of ischaemic events for primary eye care practitioners is provided.
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Affiliation(s)
- Michael Kalloniatis
- Centre for Eye Health, the University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Henrietta Wang
- Centre for Eye Health, the University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Paula Katalinic
- Centre for Eye Health, the University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Angelica Ly
- Centre for Eye Health, the University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Warren Apel
- Centre for Eye Health, the University of New South Wales, Sydney, Australia.,The Eye Health Centre, Aspley, Australia
| | - Lisa Nivison-Smith
- Centre for Eye Health, the University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
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25
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Pemafibrate Prevents Retinal Dysfunction in a Mouse Model of Unilateral Common Carotid Artery Occlusion. Int J Mol Sci 2021; 22:ijms22179408. [PMID: 34502311 PMCID: PMC8431531 DOI: 10.3390/ijms22179408] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/21/2021] [Accepted: 08/27/2021] [Indexed: 12/14/2022] Open
Abstract
Cardiovascular diseases lead to retinal ischemia, one of the leading causes of blindness. Retinal ischemia triggers pathological retinal glial responses and functional deficits. Therefore, maintaining retinal neuronal activities and modulating pathological gliosis may prevent loss of vision. Previously, pemafibrate, a selective peroxisome proliferator-activated receptor alpha modulator, was nominated as a promising drug in retinal ischemia. However, a protective role of pemafibrate remains untouched in cardiovascular diseases-mediated retinal ischemia. Therefore, we aimed to unravel systemic and retinal alterations by treating pemafibrate in a new murine model of retinal ischemia caused by cardiovascular diseases. Adult C57BL/6 mice were orally administered pemafibrate (0.5 mg/kg) for 4 days, followed by unilateral common carotid artery occlusion (UCCAO). After UCCAO, pemafibrate was continuously supplied to mice until the end of experiments. Retinal function (a-and b-waves and the oscillatory potentials) was measured using electroretinography on day 5 and 12 after UCCAO. Moreover, the retina, liver, and serum were subjected to qPCR, immunohistochemistry, or ELISA analysis. We found that pemafibrate enhanced liver function, elevated serum levels of fibroblast growth factor 21 (FGF21), one of the neuroprotective molecules in the eye, and protected against UCCAO-induced retinal dysfunction, observed with modulation of retinal gliosis and preservation of oscillatory potentials. Our current data suggest a promising pemafibrate therapy for the suppression of retinal dysfunction in cardiovascular diseases.
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Uchida W, Kamide T, Uno T, Yoshikawa A, Misaki K, Nakada M. Ocular ischemic syndrome due to severe internal carotid artery stenosis improved by intracranial stent placement: A case report. Surg Neurol Int 2021; 12:294. [PMID: 34221625 PMCID: PMC8247690 DOI: 10.25259/sni_361_2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/28/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Treatment of cervical internal carotid artery (ICA) stenosis has contributed to the improvement of ocular ischemic syndrome. However, there have been few cases of visual impairment caused by ocular ischemic syndrome due to intracranial ICA stenosis, which improved through intracranial stent placement. Case Description: A 76-year-old man presented with right-sided paralysis. Radiographic examination revealed severe stenosis of the left intracranial ICA (distal cavernous-infraclinoid portion) and a watershed infarction of the left cerebral hemisphere. Conservative therapy including antiplatelet drugs was initiated, but severe visual acuity disturbance in his left eye occurred 1 month after onset. The antegrade ocular artery flow recovered after urgent intracranial stent placement, and his vision improved immediately after the procedure. Conclusion: Visual impairment presenting as ocular ischemic syndrome can occur due to severe stenosis of the intracranial ICA, and treatment of these lesions could improve the symptoms.
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Affiliation(s)
- Wataru Uchida
- Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Tomoya Kamide
- Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Takehiro Uno
- Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Akifumi Yoshikawa
- Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Kouichi Misaki
- Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan
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27
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Zhang Y, Sun J, Ye Q, Jiang W, Hong H, Jiang X, Xia Y, Zhang S, Wu W. In vivo evaluation of outer retinal function and structure after retrobulbar optic nerve crush by lateral orbitotomy in goats. Exp Eye Res 2021; 209:108652. [PMID: 34097904 DOI: 10.1016/j.exer.2021.108652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 05/14/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
Large animal model of optic nerve crush (ONC) plays an important role in translating novel therapeutic strategies developed in rodent model to clinical application. Due to the poor accessibility of the optic nerve (ON) in humans and large animals, lateral orbitotomy is needed to expose the retrobulbar ON. This study was to explore the effects of ONC and ON exposure with lateral orbitotomy (sham surgery) on the outer retinal function and structure in goats by using standard flash electroretinogram (FERG) and spectral-domain optical coherence tomography (SD-OCT). We found that ONC led to a transient reduction in FERG amplitudes at 1 week post injury (wpi), which recovered gradually over 2 months afterwards. Sham surgery alone also caused a similar pattern of amplitude reduction in FERG, although not as significantly as ONC did. Transient outer retinal thickening following ONC occurred at 4 wpi (when progressive thinning of the ganglion cell complex began), peaked at 8 wpi, then recovered gradually at 12 wpi. In contrast, outer retinal thickness remained unchanged statistically 3 months after sham surgery. Fundus fluorescein angiography showed that neither ONC nor ON exposure with lateral orbitotomy significantly caused any significant delay or absence of central retinal vascular filling. In summary, ONC with lateral orbitotomy affects outer retinal function and structure transiently.
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Affiliation(s)
- Yikui Zhang
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, 325027, China.
| | - Jiaying Sun
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, 325027, China
| | - Qian Ye
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, 325027, China
| | - Wenhao Jiang
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, 325027, China
| | - Huifeng Hong
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, 325027, China
| | - Xiaohui Jiang
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, 325027, China
| | - Yu Xia
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, 325027, China
| | - Si Zhang
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, 325027, China
| | - Wencan Wu
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, 325027, China.
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Gunna NT, Paritala A, Takkar B, Sheth J. Ocular ischaemic syndrome following coil embolisation for direct carotid cavernous fistula. BMJ Case Rep 2021; 14:14/5/e242121. [PMID: 34045204 DOI: 10.1136/bcr-2021-242121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 36-year-old man presented with proptosis and external ophthalmoplegia of the left globe following road traffic injury. Cerebral angiogram revealed moderate flow direct carotid cavernous fistula on left side for which coil embolisation was done repeatedly. Subsequently, the patient developed decreased vision in left eye and developed features of left-sided ocular ischaemic syndrome. The patient was treated conservatively with spontaneous reversal of ocular ischaemic syndrome and complete regain of visual function.
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Affiliation(s)
- Nithin Teja Gunna
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Anusha Paritala
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Brijesh Takkar
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India .,Indian Health Outcomes, Public Health and Economics Research (IHOPE) Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Jenil Sheth
- Child Sight Institute, Jasti V Ramanamma Children's Eye Care Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India
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29
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Bilateral Ocular Ischemic Syndrome in the Setting of Chronic Angle Closure Glaucoma. J Glaucoma 2020; 30:e262-e264. [PMID: 33394841 DOI: 10.1097/ijg.0000000000001767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 11/06/2020] [Indexed: 11/25/2022]
Abstract
We report novel case of a 57-year-old woman who developed bilateral ocular ischemic syndrome in the setting of chronic angle closure glaucoma without associated angle neovascularization. Detailed is a course in which markedly prolonged, elevated intraocular pressure led to significantly reduced arterial perfusion at the level of the central retinal artery, leading to the clinical picture of ocular ischemic syndrome.
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Dagdelen K, Muz OE. Investigation of macular and optic nerve head structural changes using spectral domain optical coherence tomography in internal carotid artery stenosis. Int Ophthalmol 2020; 41:875-882. [PMID: 33170420 DOI: 10.1007/s10792-020-01642-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 10/29/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To demonstrate differences in optic nerve head (ONH), retinal nerve fiber layer (RNFL), and macular thickness in patients with internal carotid artery (ICA) stenosis using spectral domain optical coherence tomography (SD-OCT). METHODS A case-controlled study was conducted in 31 patients with a diagnosis of unilateral ICA stenosis (the percentage of stenosis was between 65 and 85%), and 53 age- and sex-matched healthy subjects (control group) from March 2016 to April 2018. The ONH parameters, RNFL, and macular thicknesses in the nine macular quadrants according to the Early Treatment Diabetic Retinopathy Study (ETDRS) were measured using SD-OCT. RESULTS The average macular thickness and outer macular quadrants measurements were lower in the ICA stenosis group (P < 0.05). The thickness of the fovea and inner macular quadrants was similar in healthy and patient eyes. Similarly, the ONH and RNFL profiles based on SD-OCT parameters were similar between the groups. There was a negative weak correlation between mean macular and RNFL thicknesses and the duration and percentage of ICA stenosis. CONCLUSION The average macular thickness and measurements of outer macular quadrants in the ICA stenosis group were lower than in the control group. Macular changes may occur before symptomatic ocular ischemic syndrome (OIS). SD-OCT macular measurements may be beneficial in the early detection of OIS due to ICA stenosis.
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Affiliation(s)
- Kenan Dagdelen
- Department of Ophthalmology, Eskisehir Yunus Emre State Hospital, Uluonder Mahallesi, Tepebasi, 26190, Eskisehir, Turkey
| | - Omer Ersin Muz
- Department of Ophthalmology, Eskisehir Yunus Emre State Hospital, Uluonder Mahallesi, Tepebasi, 26190, Eskisehir, Turkey.
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Eitle JF, Kupferschmid S. [Ocular ischemic syndrome : An important differential diagnosis]. Ophthalmologe 2020; 118:948-952. [PMID: 32975660 DOI: 10.1007/s00347-020-01233-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/28/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Ocular ischemic syndrome is a rare disease, which must be considered as a differential diagnosis in cases of painful loss of vision. CASE REPORT A 63-year-old male patient presented as an emergency in our consultation with hyphemia and decompensated intraocular pressure of the right eye. The right eye had been painful for 3 weeks. Apart from nicotine abuse, no relevant pre-existing medical conditions were known. With suspected iritis, the initial treatment was performed with eye drops containing a corticosteroid. After initial improvement in symptoms, an acute deterioration occurred with decrease in visual acuity and increased pain starting 2 days previously. Biomicroscopic examination revealed rubeosis iridis with hyphemia. Due to the hyphemia the view of the fundus was greatly reduced but there were no indications for retinal bleeding. In gonioscopy a chamber angle closure was evident. Fluorescence angiography showed a significantly longer arm-retina time, a delayed arteriovenous passage, peripheral vascular leaks and reduced fluorescence of the choroid. An ocular ischemic syndrome was suspected, therefore, duplex sonography of the carotid arteries and computed tomography angiography were performed and showed complete stenosis of the right internal carotid artery and moderate stenosis of the left internal carotid artery. An intravitreal administration of anti-VEGF and panretinal laser photocoagulation were carried out. Furthermore, an evaluation of the cardiovascular risk factors was initiated as part of the interdisciplinary investigation.
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Affiliation(s)
- J F Eitle
- Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland.
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32
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Yamazaki R, Hashimoto R, Masahara H, Sakamoto M, Maeno T. Time Course in Ocular Blood Flow and Pulse Waveform in a Case of Ocular Ischemic Syndrome with Intraocular Pressure Fluctuation. Vision (Basel) 2020; 4:vision4020031. [PMID: 32532078 PMCID: PMC7356182 DOI: 10.3390/vision4020031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 01/12/2023] Open
Abstract
We report on a 70-year-old Japanese man with complaints of worsening left visual acuity who was diagnosed with ocular ischemic syndrome (OIS) associated with internal carotid artery (ICA) stenosis. A gonioscopy examination showed rubeosis iridis and elevated intraocular pressure (IOP) in the left eye (50 mmHg) at the baseline visit. The optic nerve head (ONH) and choroidal blood flow measured by laser speckle flowgraphy (LSFG) was impaired in the left eye compared with that in the right eye. Additionally, the blowout score (BOS), which indicates the variation of the mean blur rate (MBR) during systolic and diastolic periods, was decreased in the left eye. After treatment with an injection of bevacizumab and administration of Rho-associated kinase-inhibitor ripasudil eye drops, both ocular blood flow and BOS in each vascular bed gradually increased along with IOP reduction. The visual acuity also improved. The current case demonstrated increased blood flow and decreased fluctuation of blood flow in the ONH and choroid before and after the treatment in OIS with rubeosis iridis. The LSFG technique is useful to non-invasively assess the ocular circulation and pulse waveform in OIS.
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Affiliation(s)
| | - Ryuya Hashimoto
- Correspondence: ; Tel.: +81-43-462-8811; Fax: +81-43-462-8820
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Kang HM, Choi JH, Koh HJ, Lee SC. Significant changes of the choroid in patients with ocular ischemic syndrome and symptomatic carotid artery stenosis. PLoS One 2019; 14:e0224210. [PMID: 31639146 PMCID: PMC6804994 DOI: 10.1371/journal.pone.0224210] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 10/08/2019] [Indexed: 11/21/2022] Open
Abstract
Purpose To evaluated the changes in choroidal vasculature in patients with ocular ischemic syndrome (OIS) and in the ipsilateral eyes of patients with symptomatic carotid artery stenosis (CAS) Method A total of 50 patients (15 patients with OIS, 10 patients with symptomatic CAS, 25 patients of age-and sex-matched control group) were included, and the medical records were retrospectively reviewed. The mean subfoveal choroidal thickness (SFCT) of each eye was measured, and binary images of the choroid were evaluated to compare the mean choroidal area and the luminal area. Results The mean SFCT was 170.5±75.3 μm in the eyes with OIS, 154.8±62.9 μm in the ipsilateral eyes with symptomatic CAS, and 277.5±73.2 μm in the right eyes of the control group patients (P<0.001). The mean choroidal area was 494,478.6±181,846.2 μm2 in the eyes with OIS, 453,750.0±196,725.8 μm2 in the ipsilateral eyes with symptomatic CAS, and 720,520±281,319.5 μm2 in the control group eyes (P = 0.036). The mean luminal area was 333,185.7±112,665.9 μm2 in the eyes with OIS, 313,983.3±132,032.1 μm2 in the ipsilateral eyes with symptomatic CAS, and 480,325.0±185,112.6 μm2 in the control group eyes (P = 0.046). The mean SFCT, mean choroidal area, and mean luminal area were significantly smaller in the eyes with OIS (P = 0.017, P = 0.005, and P = 0.004, respectively), and those with symptomatic CAS (P = 0.020, P = 0.016, and P = 0.021, respectively) than in the unaffected contralateral eyes. There were no significant differences between the eyes in the control group (P = 0.984, P = 284, and P = 0.413, respectively). Conclusion The mean SFCT, mean choroidal area, and mean luminal area were significantly thinner in the eyes with OIS and the ipsilateral eyes with symptomatic CAS, compared with the control group eyes. The eyes with OIS and those with symptomatic CAS had significantly thinner SFCT, and smaller choroidal area and luminal area than the unaffected contralateral eyes. Choroid may reflect the vascular status of the carotid artery, indicated by choroidal thinning and decreasing choroidal area, especially luminal area.
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Affiliation(s)
- Hae Min Kang
- Department of Ophthalmology, Catholic Kwandong University College of Medicine, International St. Mary’s Hospital, Incheon, Republic of Korea
- * E-mail:
| | | | - Hyoung Jun Koh
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Chul Lee
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Republic of Korea
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Song JX, Lin XM, Hao ZQ, Wu SD, Xing YX. Ocular manifestations of internal carotid artery dissection. Int J Ophthalmol 2019; 12:834-839. [PMID: 31131245 DOI: 10.18240/ijo.2019.05.21] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 02/25/2019] [Indexed: 11/23/2022] Open
Abstract
Internal carotid artery dissection (ICAD) results from disruption of the intima of the arterial wall, and can lead to intrusion of blood into the arterial wall and form an intramural hematoma. The hematoma can compress the true lumen of the vessel, causing functional stenosis or occlusion. The classic triad signs of ICAD include pain in the ipsilateral neck, head and orbital regions; a (partial) Horner syndrome; and cerebral or retinal ischemia. However, not all ICAD patients present with this classic signs. In some cases, ocular manifestations are the initial (and sometimes the only) findings. We summarize the ocular manifestations associated with ICAD in 3 categories: visual symptoms, oculosympathetic palsy, and ocular motor nerve palsy.
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Affiliation(s)
- Jin-Xin Song
- Department of Ophthalmology, the First Hospital of Xi'an; Shaanxi Institute of Ophthalmology; First Affiliated Hospital of Northwestern University, Xi'an 710002, Shaanxi Province, China.,Medical College of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Xue-Mei Lin
- Department of Neurology, the First Hospital of Xi'an; First Affiliated Hospital of Northwestern University, Xi'an 710002, Shaanxi Province, China
| | - Zhao-Qin Hao
- Department of Ophthalmology, the First Hospital of Xi'an; Shaanxi Institute of Ophthalmology; First Affiliated Hospital of Northwestern University, Xi'an 710002, Shaanxi Province, China
| | - Song-Di Wu
- Department of Neurology, the First Hospital of Xi'an; First Affiliated Hospital of Northwestern University, Xi'an 710002, Shaanxi Province, China
| | - Yong-Xin Xing
- Department of Ophthalmology, the First Hospital of Xi'an; Shaanxi Institute of Ophthalmology; First Affiliated Hospital of Northwestern University, Xi'an 710002, Shaanxi Province, China
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Klefter ON, Kofoed PK, Munch IC, Larsen M. Macular perfusion velocities in the ocular ischaemic syndrome. Acta Ophthalmol 2019; 97:113-117. [PMID: 30369090 DOI: 10.1111/aos.13950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 09/19/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess retinal perfusion in eyes with unilateral ocular ischaemic syndrome (OIS) and to compare with control subjects. METHODS Retrospective case series. Linear blood flow velocities in macular vessels were estimated using motion-contrast fundus photography in eight patients with unilateral OIS (eight OIS eyes, seven fellow eyes) and 12 control subjects. The diagnosis of OIS was supported by carotid artery Doppler ultrasonography and pneumoplethysmographic measurement of ocular systolic perfusion pressure. RESULTS Macular arterial blood flow velocity (median, range) was 1.8 (1.4-2.7) mm/s in OIS eyes, 4.0 (2.9-5.3) mm/s in fellow eyes (p = 0.016) and 3.8 (2.3-5.1) mm/s in control eyes (p = 0.0004 and p = 0.67 versus OIS and fellow eyes, respectively). Macular venous blood flow velocity was 1.5 (1.0-2.1) mm/s in OIS eyes, 2.6 (2.0-2.9) mm/s in fellow eyes (p = 0.016) and 2.7 (1.8-3.5) mm/s in control eyes (p = 0.0007 and p = 0.64). Arterial velocities were below or equal to the lowest value observed in control subjects (≤2.3 mm/s) in seven of eight eyes with OIS. Visual acuity 0.7 or worse was found in two OIS eyes with arterial velocities below 1.7 mm/s and venous velocities below 1.3 mm/s and together with neovascular glaucoma or polycythemia vera (one eye each). CONCLUSION Motion-contrast imaging revealed markedly reduced macular perfusion velocities in OIS eyes compared with unaffected fellow eyes and healthy control eyes. The method appears to provide a clinically meaningful quantitative measure of macular hypoperfusion.
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Affiliation(s)
- Oliver Niels Klefter
- Department of Ophthalmology; Rigshospitalet; Glostrup Denmark
- Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | | | - Inger Christine Munch
- Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
- Department of Ophthalmology; Zealand University Hospital; Roskilde Denmark
| | - Michael Larsen
- Department of Ophthalmology; Rigshospitalet; Glostrup Denmark
- Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
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Qin Y, Ji M, Deng T, Luo D, Zi Y, Pan L, Wang Z, Jin M. Functional and morphologic study of retinal hypoperfusion injury induced by bilateral common carotid artery occlusion in rats. Sci Rep 2019; 9:80. [PMID: 30643163 PMCID: PMC6331588 DOI: 10.1038/s41598-018-36400-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 11/20/2018] [Indexed: 12/20/2022] Open
Abstract
Retinal hypoperfusion injury is the pathophysiologic basis of ocular ischemic syndrome (OIS) which often leads to severe visual loss. In this study, we aimed to establish a rat model of retinal chronic hypoperfusion by bilateral common carotid artery occlusion (BCCAO) and observe changes in the retinal function and morphology. We found that model rats showed retinal arteriosclerosis, slight dilated retinal vein, small hemangiomas, hemorrhages, vascular segmental filling, and nonperfused areas after 2 weeks of BCCAO. In the model rats, the retinal circulation time was significantly prolonged by fluorescein fundus angiography (FFA), the latency of a and b waves was delayed and the amplitude was decreased significantly at each time point by electroretinogram (ERG), and the perfusion of the eyes continued to reduced. Morphologic and ultrastructural changes covered that the retinal ganglion cells (RGCs) presented obvious apoptosis and the thickness in the retinal layers were significantly thinner. Collectively, these findings suggested that BCCAO induced retinal hypoperfusion injury in the model rats, thus providing an ideal animal model for the study of OIS.
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Affiliation(s)
- Yali Qin
- Beijing University of Chinese Medicine, Beijing, 100029, China.,Department of Ophthalmology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Meiqi Ji
- Beijing University of Chinese Medicine, Beijing, 100029, China.,Department of Ophthalmology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Tingting Deng
- Clinical Medical Research Institute, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Dan Luo
- Department of Ophthalmology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Yingxin Zi
- Beijing University of Chinese Medicine, Beijing, 100029, China.,Department of Ophthalmology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Lin Pan
- Clinical Medical Research Institute, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Zhijun Wang
- Department of Ophthalmology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Ming Jin
- Department of Ophthalmology, China-Japan Friendship Hospital, Beijing, 100029, China.
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Jo YJ, Choi SK, Park SH, Lee JJ, Lee JE, Park SW. Initial Clinical Manifestations of Ocular Ischemic Syndrome in Koreans. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.12.1231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Yeon Ji Jo
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea
| | - Seung Kwon Choi
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea
| | - Sun Ho Park
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea
| | - Jae Jung Lee
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea
| | - Ji Eun Lee
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea
| | - Sung Who Park
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea
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39
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Akinsoji E, Goldhardt R, Galor A. A Glimpse into Uveitis in the Aging Eye: Pathophysiology, Clinical Presentation and Treatment Considerations. Drugs Aging 2018; 35:399-408. [PMID: 29663152 PMCID: PMC5955816 DOI: 10.1007/s40266-018-0545-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Uveitis describes a group of inflammatory conditions of the eye that have various underlying causes and clinical presentations. Susceptibilities to uveitis in the elderly may be attributed to age-related risk factors such as immunosenescence, increased immunological inflammatory mediators, and autoimmunity. Overall, anterior uveitis is more common than posterior and panuveitis in the general population and also in the elderly. Some causes of uveitis in the elderly are herpes simplex virus, ocular ischemic syndrome, sarcoidosis, and central nervous system lymphoma, and these will be discussed in detail herein. Eye care professionals need to consider the wide differential for uveitis, obtain the appropriate history, conduct a detailed clinical examination, and tailor management to the clinical presentation and underlying cause of disease. The challenges of polypharmacy and nonadherence in the elderly impact patient outcomes and must be taken into consideration when considering treatment.
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Affiliation(s)
| | - Raquel Goldhardt
- University of Miami Miller School of Medicine, Miami, FL, USA
- Miami Veterans Administration Medical Center, Miami, FL, USA
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL, 33136, USA
| | - Anat Galor
- University of Miami Miller School of Medicine, Miami, FL, USA.
- Miami Veterans Administration Medical Center, Miami, FL, USA.
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL, 33136, USA.
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Cécité monoculaire transitoire : causes vasculaires et diagnostics différentiels. J Fr Ophtalmol 2018; 41:453-461. [DOI: 10.1016/j.jfo.2017.06.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 06/16/2017] [Indexed: 01/03/2023]
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41
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Bidot S, Biotti D. Transient monocular blindness: Vascular causes and differential diagnoses. J Fr Ophtalmol 2018; 41:e129-e136. [PMID: 29673627 DOI: 10.1016/j.jfo.2017.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 11/16/2017] [Accepted: 12/15/2017] [Indexed: 01/03/2023]
Abstract
Transient monocular blindness is an acute episode of ischemic origin in which one eye has profound visual loss, followed by full recovery within one hour. Transient monocular blindness most often occurs in the setting of retinal ischemia secondary to carotid embolism, but other mechanisms have been reported, including thrombosis (most often in the setting of giant cell arteritis), hemodynamic disorders (secondary to severe carotid stenosis), or vasospasm. Transient monocular blindness is considered a transient ischemic attack originating in the carotid arteries, and must be managed the same as transient ischemic attack involving the brain, in order to prevent a subsequent stroke.
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Affiliation(s)
- S Bidot
- Fondation ophtalmologique Adolphe-de-Rothschild, 25, rue Manin, 75019 Paris, France; Centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France.
| | - D Biotti
- Centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Service de neurologie B4, neurologie inflammatoire, neuro-ophtalmologie, bâtiment Pierre-Paul-Riquet, place du Dr-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
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Touzé R, Touitou V, Shotar E, Gabrieli J, Drir M, Mathon B, Sourour NA, Clarençon F. Long-term visual outcome in patients treated by flow diversion for carotid-ophthalmic aneurysms. J Neurointerv Surg 2018; 10:1067-1073. [PMID: 29572267 DOI: 10.1136/neurintsurg-2017-013684] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 02/12/2018] [Accepted: 02/20/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Flow-diverter stents (FDSs) are an upgrade in the treatment of intracranial aneurysms. However, complications concerning covered branches have been reported, especially the ophthalmic artery (OA). The purpose of our study was to evaluate the long-term ophthalmic complication rate of carotid-ophthalmic aneurysms (COA) without visual pathways compression, treated by a FDS covering the OA by performing an exhaustive ophthalmic examination. MATERIAL AND METHODS Retrospective analysis of a single-center database screening the patients treated from October 2009 to April 2015 for an intracranial aneurysm with a FDS. The patients treated for a non-compressive COA with coverage of the OA by the device were studied (n=30). Among these patients, 15 (50%) were excluded. The remaining 15 patients underwent a systematic and extensive ophthalmic examination at least 2 years after the stent placement by two ophthalmologists. RESULTS Fifteen patients with 16 COAs treated with a FDS were included. Mean follow-up was 4.1±2 years. Six patients (40%), presented ophthalmic complications, including three fugax amauroses (18.8%) and four significant visual field defects (25%). After comparing each eye's visual field's patients, we observed a significant difference between the eye on the FDS side compared with the contralateral eye, with a mean deviation of -1.58 dB versus -0.67 dB respectively (P=0.003). Visual acuity was preserved in all patients. CONCLUSION Patients treated by FDS for COA have a good long-term clinical ophthalmic outcome. However, extensive ophthalmic examination shows a high percentage of minor ophthalmic modifications. Interventional neuroradiologists should be aware of these possible complications when choosing to treat these aneurysms with FDS.
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Affiliation(s)
- Romain Touzé
- Departement of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France.,Departement of Ophthalmology, Pitié-Salpêtrière Hospital, Paris, France
| | - Valérie Touitou
- Departement of Ophthalmology, Pitié-Salpêtrière Hospital, Paris, France.,Paris VI University, Pierre et Marie Curie, Paris, France
| | - Eimad Shotar
- Departement of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France.,Paris VI University, Pierre et Marie Curie, Paris, France
| | - Joseph Gabrieli
- Departement of Interventional Neuroradiology, Padova University Hospital, Padova, Italy
| | - Mehdi Drir
- Departement of Anesthesiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Bertrand Mathon
- Paris VI University, Pierre et Marie Curie, Paris, France.,Departement of Neurosurgery, Pitié-Salpêtrière Hospital, Paris, France.,Paris VI University, Pierre et Marie Curie, Paris, France
| | | | - Frédéric Clarençon
- Departement of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France.,Paris VI University, Pierre et Marie Curie, Paris, France
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Clinical Analysis of 42 Cases of Ocular Ischemic Syndrome. J Ophthalmol 2018; 2018:2606147. [PMID: 29713523 PMCID: PMC5866889 DOI: 10.1155/2018/2606147] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 02/07/2018] [Indexed: 11/18/2022] Open
Abstract
Ocular ischemic syndrome (OIS) is a severe ocular disease caused by ocular hypoperfusion due to stenosis or occlusion of the common or internal carotid arteries. OIS is easily misdiagnosed or undiagnosed given its asymptomatic onset and complicated ocular manifestations. The present study reviewed 42 patients with OIS, including 30 males (71.43%), 29 older patients (69.05%, >61 yrs), and 35 patients (83.33%) with two or more systemic diseases. Only 6 patients had ocular symptoms as the initial signs upon visiting the Department of Ophthalmology of three hospitals (the First Affiliated Hospital, Sun Yat-sen University; Zhongshan Ophthalmic Center, Sun Yat-sen University; and the Second Affiliated Hospital, Guangzhou Medical University). The ocular symptoms varied from visual deterioration to periorbital pain. Thirty-seven patients (88.10%) complained of constitutional symptoms. Ocular manifestations were diverse and involved both anterior and posterior segments. We reported a case of corneal edema and corneal epithelium erosion in the ipsilateral eye due to internal carotid artery stenosis. As the clinical manifestations of OIS are complex, ophthalmologists must carefully examine patients to avoid a misdiagnosis or a failure to diagnose. The management of OIS requires cooperation with cardiologists and neurologists.
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Depth-Resolved Imaging of Papillary Vitreoretinal Neovascularization: OCT-Angiography Assessment in Ocular Ischemic Syndrome. Retina 2018; 37:e42-e44. [PMID: 28333756 DOI: 10.1097/iae.0000000000001422] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Çakır A, Düzgün E, Demir S, Çakır Y, Ünal MH. Spectral Domain Optical Coherence Tomography Findings in Carotid Artery Disease. Turk J Ophthalmol 2017; 47:326-330. [PMID: 29326849 PMCID: PMC5758767 DOI: 10.4274/tjo.84565] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 06/07/2017] [Indexed: 12/01/2022] Open
Abstract
Objectives: To evaluate the effect of carotid artery disease on retinal morphology by means of spectral domain optical coherence tomography (SD-OCT). Materials and Methods: We examined 23 eyes with internal carotid artery (ICA) stenosis and 24 age- and gender-matched healthy eyes as a control group in this prospective, case-control study. Compherensive ophthalmic examination and SD-OCT scan were performed to all the patients. The average RNFL and macular thicknesses (MT) in the nine macular ETDRS areas were the major OCT measurements for our study. Results: Although all of the average RNFL and MT measurements were lower in the ICA stenosis group, only the total MT and outer ETDRS area (temporal/superior/nasal/inferior outer macula) values were found to be significantly thinner compared to the control group (p=0.004, p=0.009, p<0.001, p=0.002, and p=0.001, respectively). Conclusion: In addition to our knowledge about the effects of ICA stenosis on the retino-choroidal circulation, we found that OCT measurements may be beneficial in the early detection of ocular damage due to ICA stenosis.
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Affiliation(s)
- Akın Çakır
- University of Health Sciences, Okmeydanı Training and Research Hospital, Department of Ophthalmology, İstanbul, Turkey
| | - Eyüp Düzgün
- University of Health Sciences, Okmeydanı Training and Research Hospital, Department of Ophthalmology, İstanbul, Turkey
| | - Serkan Demir
- University of Health Sciences, Haydarpaşa Sultan Abdülhamid Han Training and Research Hospital, Department of Neurology, İstanbul, Turkey
| | - Yavuz Çakır
- University of Health Sciences, Haydarpaşa Sultan Abdülhamid Han Training and Research Hospital, Department of Ophthalmology, İstanbul, Turkey
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Vaghefi E, Kauv K, Pan W, Squirrell D. Application of Arterial Spin Labelling in Detecting Retinal Ischemia. Case Rep Ophthalmol 2017; 8:545-557. [PMID: 29422857 PMCID: PMC5803724 DOI: 10.1159/000485316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 11/15/2017] [Indexed: 11/24/2022] Open
Abstract
Purpose Here, we have tried to quantify the chorioretinal blood perfusion in patients who are clinically identified to be suffering from retinal ischemia using arterial spin labelling (ASL) MRI. Method Four participants, diagnosed with retinal ischemia based on their structural OCT and angiography test, were then scanned using anatomical MRI as well as ASL. We optimized MR parameters to maximize resolution and target fixation, blinking, and breathing ques to minimize motion artifacts. Results Participants had a maximum of ∼50 mL/100 mL/min of blood perfusion, which is below the normal values of ∼200 mL/100 mL/min. It also appeared that thinning of the choroid contributes more to the measured decreased chorioretinal perfusion, compared to slowed arterial filling time. Conclusion Decreased chorioretinal perfusion is a multifactorial event and has been implicated in several posterior eye pathologies. Based on our current results, it seems that ischemia of the eye could be due to anatomy (tissue volume) and/or functionality (arterial flow).
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Affiliation(s)
- Ehsan Vaghefi
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand.,Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Kevin Kauv
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Wilson Pan
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - David Squirrell
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand.,Auckland District Health Board Ophthalmology Services, Auckland, New Zealand
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Multimodality Imaging Assessment of Ocular Ischemic Syndrome. J Ophthalmol 2017; 2017:4169135. [PMID: 29375911 PMCID: PMC5742453 DOI: 10.1155/2017/4169135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 10/14/2017] [Accepted: 10/19/2017] [Indexed: 11/17/2022] Open
Abstract
Objectives To assess the underlying mechanisms of OIS and confirm the haemodynamic and retinal structure changes of early OIS. Methods An observational cross-sectional study was conducted of 60 internal carotid artery (ICA) stenosis patients, and they were divided into OIS and control group. Colour doppler imaging, optical coherence tomography, and fundus fluorescein angiography were performed. Results The middle cerebral artery (MCA) stenosis differs significantly between the two groups. More OIS patients had new collateral patency of posterior communicating artery (PCoA) and retrograde flow via the ophthalmic artery (OA) (p < 0.001). The peak systolic velocity (PSV) in central retinal artery (CRA) and choroidal thickness (CT) was significantly reduced in OIS patients (p = 0.001 and p < 0.001). The arm-retina time (ART) and the retinal arteriovenous passage time (AVP) were prolonged in OIS patients (p < 0.001 and p = 0.001). CT, ART, and PSV of the CRA showed high sensitivity, while ART and ICA stenosis grade showed high specificity for the diagnosis of OIS according to ROC curve. Conclusions Patients who suffered from severe ipsilateral ICA stenosis, new collateral patency of PCoAs, and MCA stenosis may be more susceptible to OIS. The most sensitive sign is PSV of CRA and CT, and the most specific sign is ART.
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Ma F, Su J, Shang Q, Ma J, Zhang T, Wang X, Ma H, Yu J. Changes in Ocular Hemodynamics after Carotid Artery Angioplasty and Stenting (CAAS) in Patients with Different Severity of Ocular Ischemic Syndrome. Curr Eye Res 2017; 43:266-272. [PMID: 29135355 DOI: 10.1080/02713683.2017.1390771] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the effects of carotid artery angioplasty and stenting (CAAS) on patients who were diagnosed with ocular ischemic syndrome (OIS). METHODS Sixty-four eyes of 64 OIS patients with ipsilateral internal carotid artery stenosis ≥70% were included in the study. The study eyes were divided into two groups according to the presence of iris neovascularization: NVI-absent group and NVI-present group, with 32 eyes, respectively. All patients received ocular treatment modality according to the presence of non-perfusion area (pan-retinal photocoagulation) and intraocular pressure (medical treatment included timolol maleate eye drops combined with brinzolamide eye drop; trabeculectomy and cyclophotocoagulation). All patients went through CAAS surgery for treatment of internal carotid artery stenosis. Best-corrected visual acuity (BCVA); intraocular pressure (IOP), slit lamp examination, iris fluorescence angiography, fundus fluorescein angiography and color Doppler ultrasound of the internal carotid artery (ICA), ophthalmic artery (OA), central retinal artery (CRA), and short posterior ciliary arteries (PCA) were performed pre-operatively and 1 month, 3 months, 6 months, and 12 months post-operatively. RESULTS There was no significant BCVA change postoperatively in the NVI-absent group, while postoperative BCVA in the INV-present group decreased significantly. There was no significant BCVA difference at pre-operative and 1month post-operative follow-up between the two groups. However, post-operative BCVA of NVI-present group starting from 3-months follow-up was significantly worse than NVI-absent group. Arm-retinal artery circulation time and arteriovenous circulation time decreased significantly in NVI-absent group, while showed no statistical difference in NVI-present group during the 12-months follow-up. Postoperative peak systolic velocity (PSV) of the ophthalmic artery, the central retinal artery, and short posterior ciliary artery showed significant increases at 1 month, 3 months, 6 months and 12 months follow-up in both groups. CONCLUSION CAAS can greatly improve ocular blood in OIS patients with and without iris neovascularization. However, CAAS improved BCVA only in patients without iris neovascularization.
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Affiliation(s)
- Feiyan Ma
- a Department of Ophthalmology , The Second Hospital of Hebei Medical University , Shijiazhuang China
| | - Jing Su
- a Department of Ophthalmology , The Second Hospital of Hebei Medical University , Shijiazhuang China
| | - Qingli Shang
- a Department of Ophthalmology , The Second Hospital of Hebei Medical University , Shijiazhuang China
| | - Jingxue Ma
- a Department of Ophthalmology , The Second Hospital of Hebei Medical University , Shijiazhuang China
| | - Tongdi Zhang
- b B-mode Ultrasonography , The Second Hospital of Hebei Medical University , Shijiazhuang China
| | - Xin Wang
- a Department of Ophthalmology , The Second Hospital of Hebei Medical University , Shijiazhuang China
| | - Honglei Ma
- a Department of Ophthalmology , The Second Hospital of Hebei Medical University , Shijiazhuang China
| | - Jianghua Yu
- c Neural Department of Internal Medicine Intervention , The Second Hospital of Hebei Medical University , Shijiazhuang China
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Brown G, Yoo J, Brown M, Turpcu A, Rajput Y, Benson W, Brown G, Fineman M, Fischer D, Garg S, Gupta O, Ho A, Hsu J, Kaiser R, Maguire J, Park C, Regillo C, Sivalingam A, Spirn M, Tasman W, Vander J. The Burden of Retinal Venous Occlusion: An Assessment of Fellow Eyes in 1000 Cases. ACTA ACUST UNITED AC 2017; 1:404-412. [DOI: 10.1016/j.oret.2017.01.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 01/26/2017] [Accepted: 01/27/2017] [Indexed: 12/15/2022]
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Kim YH, Sung MS, Park SW. Clinical Features of Ocular Ischemic Syndrome and Risk Factors for Neovascular Glaucoma. KOREAN JOURNAL OF OPHTHALMOLOGY 2017; 31:343-350. [PMID: 28682017 PMCID: PMC5540990 DOI: 10.3341/kjo.2016.0067] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 09/04/2016] [Indexed: 12/20/2022] Open
Abstract
Purpose We aimed to examine the clinical features and prognosis of ocular ischemic syndrome and to investigate the risk factors for the development of neovascular glaucoma (NVG). Methods The medical records from 25 patients (25 eyes) who were diagnosed with ocular ischemic syndrome were retrospectively analyzed. We recorded the length of time between symptom onset and diagnosis, visual acuity, intraocular pressure, clinical findings of the anterior and posterior segments of the eye, fluorescein angiography, systemic diseases, smoking history, and the extent of any ipsilateral carotid artery stenosis. The risk factors for NVG in patients with ocular ischemic syndrome were investigated. Results The mean age was 67.9 ± 12.5 years, and 21 men and 4 women were included in this study. At initial examination, the mean logarithm of the minimum angle of resolution (logMAR) was 2.02 ± 1.26, and the mean intraocular pressure was 21.0 ± 10.3 mmHg. Among 25 eyes of the 25 patients, NVG occurred in 17 eyes after a mean period of 12.6 ± 14.0 months. The length of time between symptom onset and diagnosis (p = 0.025) and the extent of ipsilateral carotid artery stenosis (p = 0.032) were identified as significant risk factors for NVG. At the final follow-up, the mean logMAR visual acuity was 3.13 ± 1.24, showing a poor prognosis regardless of whether NVG occurred. Conclusions Overall, the prognosis for ocular ischemic syndrome is very poor. The risk of NVG increases with the length of time between symptom onset and diagnosis, as well as with the severity of ipsilateral carotid artery stenosis.
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Affiliation(s)
- Yung Hui Kim
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Mi Sun Sung
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Sang Woo Park
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
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