Ocular ischemic syndrome: recent trends in medical management

Hazin, Ribhi; Daoud, Yassine J.; Khan, Faisal

doi:10.1097/icu.0b013e3283313d38

Cited by 18 publications

(12 citation statements)

References 24 publications

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“…More infrequently, OIS may also be present in patients with giant cell arteritis, aortic arch syndrome, or Takayasu syndrome. 2,3,[11][12][13] Color Doppler ultrasound of the supra-aortic arteries remains essential to confirm the diagnosis of carotid artery disease. A transcranial ultrasound and color Doppler ultrasound of the ophthalmic artery, central retinal artery, and retrobulbar vessels add important information about the severity of the ischemia and the presence of an arterial shunt.…”

Section: Discussionmentioning

confidence: 99%

Rubeosis iridis as a sign of underlying carotid stenosis

Oller

Esteban

Pérez

et al. 2012

Journal of Vascular Surgery

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Severe carotid stenosis may be associated with uncommon clinical symptoms. We report a case of ocular ischemic syndrome and subsequent rubeosis iridis due to a high-grade carotid stenosis. The patient recovered visual acuity and his normal iris coloring after carotid endarterectomy. Rubeosis iridis may be the only clinical sign associated with severe carotid stenosis, making it mandatory to rule out the presence of carotid narrowing when it is detected. Establishing an early diagnosis is essential to improve quality of life, prognosis, and patients' outcome.

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Section: Discussionmentioning

confidence: 99%

Rubeosis iridis as a sign of underlying carotid stenosis

Oller

Esteban

Pérez

et al. 2012

Journal of Vascular Surgery

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“…Advanced stenosis in the carotid artery will therefore hemodynamically cause hypoperfusion to the eye, leading to ocular ischemic syndrome (OIS) [16]. Progression of OIS can lead to an irreversible decrease in visual acuity and subsequent loss of vision, which can be prevented through early detection and intervention [4, 17]. In patients with advanced internal carotid artery (ICA) stenosis accompanying OIS, improvements in visual function after revascularization surgery have been reported [18, 19].…”

Section: Discussionmentioning

confidence: 99%

Relationship between the Direction of Ophthalmic Artery Blood Flow and Ocular Microcirculation before and after Carotid Artery Stenting

Ishii

Hayashi

Yagi

et al. 2016

Journal of Ophthalmology

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When internal carotid artery stenosis is accompanied by ocular ischemic syndrome, intervention is recommended to prevent irreversible visual loss. In this study, we used laser speckle flowgraphy to measure the ocular microcirculation in the optic nerve head before and after carotid artery stenting (CAS) of 40 advanced internal carotid stenosis lesions from 37 patients. The aim was to investigate the relationship between ocular microcirculation and the direction of ophthalmic artery blood flow obtained by angiography. We found that there was a significant increase in blood flow after CAS (P = 0.003). Peak systolic velocity as an indicator of the rate of stenosis was also significantly higher in the group with retrograde/undetected flow of the ophthalmic artery than in the group with antegrade flow (P = 0.002). In all cases where retrograde flow of the ophthalmic artery was observed before stenting, the flow changed to antegrade after stenting. Through the use of laser speckle flowgraphy, this study found that CAS can improve ocular microcirculation. Furthermore, while patients displaying retrograde flow of the ophthalmic artery before stenting have a poor prognosis, CAS corrected the flow to antegrade, suggesting that visual loss can be prevented by improving the ocular microcirculation.

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“…4,5 Ophthalmoscopic findings, including conjunctival hyperemia, retinal hemorrhages, neovascular glaucoma, and macular edema, are consequences of the ocular hypoperfusion. 6 Although OIS only develops when the internal carotid stenosis is 90% or greater, almost 5% of patients with stenosis will develop OIS at some point in their lifetime. 7 The pathophysiology of OIS is related to the internal carotid artery stenosis and hypoperfusion of the ocular structures, which results in the emergence of collateral neovascularization.…”

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confidence: 99%