Ocular signs of carotid stenosis in ipsi‐ and contralateral eyes before and after carotid endarterectomy: a prospective study

Abstract

Purpose We describe hypoperfusion‐related and embolic ocular signs of carotid stenosis (CS) before and six months after carotid endarterectomy (CEA) in a CS population. Methods We enrolled prospectively 70 CEA patients (81% male, mean age 69) and 41 non‐medicated control subjects (76%, 68), from March 2015 to December 2018, assessing intraocular pressure (IOP), best‐corrected visual acuity (BCVA) in logMAR units and performing a bio‐microscopy examination. Results Main index symptoms included amaurosis fugax (Afx) (29, 41%) and hemispheric TIA (17, 24%), and 17 (24%) were asymptomatic. Of the 70, 17 patients (24%, 95% CI 16‐36) showed ocular signs of CS. Of four embolic (Hollenhorst plaques) findings, one small macular plaque disappeared postoperatively. Four had hypoperfusion, that is ocular ischaemic syndrome (OIS), requiring panretinal photocoagulation: one for multiple mid‐peripheral haemorrhages, two for iris neovascularization and one for neovascular glaucoma (NVG); only the NVG proved irreversible. Nine (de novo in three) showed mild OIS, that is only few mid‐peripheral haemorrhages, ranging pre‐ /postoperatively in ipsilateral eyes from one to eleven (median two)/ one to two (median one), and in contralateral eyes from three to nine (median five)/ one to six (median three). Pre‐ and postoperative median BCVA was 0 or better, and mean IOP was normal, except in the NVG patient. Temporary visual impairment from 0 to 0.3 occurred in one eye soon after CEA due to ocular hyperperfusion causing macular oedema. Conclusions Ocular signs of CS are common in CEA patients, ranging from few mid‐peripheral haemorrhages to irreversible NVG. Clinicians should be aware of these signs in detecting CS.

Flicker‐induced retinal vascular dilation in ipsi‐ and contralateral eyes of patients with carotid stenosis before and after carotid endarterectomy: a prospective study

“…In this same study group, we have confirmed bilaterally thinner SFCT before and after CEA than in controls (Ala-Kauhaluoma et al 2020). Furthermore, we have found ocular signs of CS, indicating ocular hypoperfusion, as being common in CEA patients (Ala-Kauhaluoma et al 2021). Neither SFCT nor ocular signs of CS were associated with flicker-induced vasodilation.…”

“…Furthermore, we have found ocular signs of CS, indicating ocular hypoperfusion, as being common in CEA patients (Ala‐Kauhaluoma et al . 2021 ). Neither SFCT nor ocular signs of CS were associated with flicker‐induced vasodilation.…”

“…We examined 71 eligible patients and 42 healthy controls between March 2015 and December 2018 in Helsinki University Hospital, Finland, including patients who had CS of 70% or more in their first computed tomography angiography (CTA) evaluation. Part of the data concerning this same cohort has been published earlier (Ala-Kauhaluoma et al 2020;Ala-Kauhaluoma et al 2021). We excluded patients with a recent (<6 months) cerebral infarction and excluded the DVA data of participants who had used caffeine or nicotine within 3 hours prior to the examination.…”

“… 2020 ; Ala‐Kauhaluoma et al . 2021 ). We excluded patients with a recent (<6 months) cerebral infarction and excluded the DVA data of participants who had used caffeine or nicotine within 3 hours prior to the examination.…”

“…Ocular signs of CS we divided into embolic (Hollenhorst plaques and BRAO) and hypoperfusion‐related (midperipheral haemorrhages) findings, the former was found in 4 and the latter in 13 patients (Ala‐Kauhaluoma et al . 2021 ). Enhanced‐depth spectral‐domain optical coherence tomography (EDI‐OCT) (Heidelberg Spectralis; version 6.3.2.0; Heidelberg Engineering, Heidelberg, Germany) allowed us to measure subfoveal choroidal thickness (SFCT) (Ala‐Kauhaluoma et al .…”