Visual Outcome of Carotid Endarterectomy in Patients with Carotid Artery Stenosis

Abstract

Background: Carotid endarterectomy (CEA) is deemed to restore the blood flow of the carotid and ophthalmic arteries in patients with carotid artery stenosis. However, specific changes in visual function before and after CEA are not well understood; hence, this observational study aimed to investigate the functional and structural changes in vision after CEA in those patients. Methods: Patients with severe carotid artery stenosis (>70% with standard carotid duplex scanning or arteriography) scheduled to undergo CEA were consecutively recruited for the study between September 2015 and July 2016. All patients underwent a standardized ophthalmic examination, including intraocular pressure (IOP) measurement, slit-lamp examination, and fundus examination. Visual acuity, best corrected visual acuity (BCVA), and kinetic and static visual fields (VFs) were tested to evaluate subjective visual function. Flash and pattern visual evoked potentials (VEPs) and an electroretinogram (ERG) were measured for objective visual function. Retinal nerve fiber layer (RNFL) thickness was scanned using optical coherence tomography for structural evaluation. Results: The study involved 15 patients (11 male and 4 female, corresponding to 30 eyes; mean age 62.8 ± 5.0 years). After CEA, both uncorrected visual acuity and BCVA improved, and IOP significantly decreased from 17.41 ± 2.59 to 15.95 ± 2.50 mm Hg (P ¼ 0.0022). Kinetic VF range increased significantly (P ¼ 0.0126) as did mean sensitivity from 18.8 ± 5.5 to 20.6 ± 4.3 dB (P ¼ 0.0208), whereas mean defect decreased from 8.2 ± 5.3 to 6.5 ± 4.2 dB (P ¼ 0.025). RNFL thickness was not significantly altered. Latency of the P2 wave on flash VEP reduced significantly after CEA (P ¼ 0.0151), whereas the oscillatory potential amplitude of waveform 3 in the ERG significantly increased after CEA. Conclusions: Our results demonstrate that an improvement in carotid artery and ophthalmic artery blood flow after CEA does indeed enhance subjective and objective assessments of visual function in patients with carotid artery stenosis, including visual acuity, kinetic and static VF, P2 latency, and ocular pressure amplitude; however, it did not affect RNFL thickness.

Impact of Carotid Endarterectomy on Choroidal Thickness and Volume in Enhanced Depth Optical Coherence Tomography Imaging

“…ese data are in concordance with our previous investigation documenting that CEA for asymptomatic carotid artery stenosis is reproducibly associated with improvement of retinal function [23,31]. In contrast, Rabina et al, based on a group of 8 patients with unilateral severe ICAS undergoing carotid endarterectomy, did not find any significant differences in SFCT between 6 and 14 months after surgery.…”

“…Insufficient blood supply to the eye due to internal carotid artery stenosis (ICAS) may manifest as acute or chronic ischaemic symptoms [17][18][19][20]. Carotid endarterectomy (CEA) is considered an effective therapeutic method for improving cerebral and ocular circulation [21][22][23]. Moreover, improvements in blood flow within the ophthalmic, central retinal, and posterior ciliary arteries as well as in the retinal and choroidal circulation have been documented [21,22,[24][25][26].…”

The relationship between carotid disease and retinopathy in diabetes: a systematic review

“…It is plausible that significant stenosis causing disruption of carotid blood flow could impact the blood supply to the retina. Improved retinal blood flow assessed by optical coherence tomography angiography has been reported in participants with carotid stenosis > 70% after carotid endarterectomy [48], and there is evidence that vision improves after carotid endarterectomy [49]. However, as some studies found that IMT was independently associated with DR, more than one mechanism is likely with a combination of common soil and direct relationships.…”

Imaging retinal microvascular manifestations of carotid artery disease in older adults: from diagnosis of ocular complications to understanding microvascular contributions to cognitive impairment

“…The effect of carotid endarterectomy on ocular manifestations of CAS has been widely studied in the recent years. Yan et al observed an improvement in both subjective and objective visual function (such as visual acuity, static and kinetic visual fields, visually evoked potentials and electroretinographic parameters) in patients after surgical treatment [143]. However, no changes were detected regarding the RNFL thickness [143].…”

“…Yan et al observed an improvement in both subjective and objective visual function (such as visual acuity, static and kinetic visual fields, visually evoked potentials and electroretinographic parameters) in patients after surgical treatment [143]. However, no changes were detected regarding the RNFL thickness [143]. In contrast, Guclu et al reported a statistically significant decrease in peripapillary RNFL thickness in the superior quadrant following surgery [144].…”