Clinical Features of Ocular Ischemic Syndrome and Risk Factors for Neovascular Glaucoma

Abstract

PurposeWe 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).MethodsThe 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.ResultsThe 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.ConclusionsOverall, 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.

Two Patients with a Rapid Increase in the Ocular Pressure after Carotid Artery Stenting for Cervical Internal Carotid Artery Stenosis with Ocular Ischemic Syndrome

“…On the other hand, the risk of neovascular glaucoma attacks is high in patients with findings suggestive of anterior chamber neovascularization, such as rubeosis iridis and angle adhesion, those with marked stenosis (NASCET: ≥90%) of the cervical internal carotid artery ipsilateral to an ocular lesion, and those with an interval of ≥7 days after the appearance of ocular symptoms related to ocular ischemic syndrome. 8) In our patients, the interval from the appearance of decreased vision until neurosurgical intervention was 5 to 6 months. Furthermore, rubeosis iridis and angle occlusion were observed; therefore, it was necessary to consider a rapid revascularization-related increase in the ocular pressure in the chronic phase of advanced ocular ischemic syndrome.…”

“…Concerning the pathogenesis of neovascular glaucoma, chronic anterior ocular ischemia may induce functional or structural occlusion of the angle related to neovascularization around the iris, which is termed rubeosis iridis, and neovascular membrane, increasing the ocular pressure through aqueous humor outflow disorder. 2,3,8) Ocular ischemic syndrome is a condition in which ≥90% stenosis to complete occlusion of the carotid artery causes ischemic symptoms of the ipsilateral eye. [2][3][4][5][6][7] This syndrome is characterized by ocular pain and suddenly or gradually exacerbating low vision.…”

Prevalence, Causes and Management of Neovascular Glaucoma: A 5-Year Review

“…The pathogenesis of anterior segment neovascularisation is believed to be a result of a stimulus from the posterior segment ischaemia. Posterior segment ischeamia usually arises from complications of ocular disorders, such as retinal venous and arterial occlusions, proliferative diabetic retinopathy, carotid artery obstructive disease and uveitis [4]…”

Neovascular glaucoma: Handling in the future

“…[ 3 ] As to OIS, NVG can occur in about 68% eyes and the risk increases with the length of time between symptom onset and diagnosis, as well as with the severity of ipsilateral carotid artery stenosis. [ 4 ] Having reviewed 301 cases of NVG in our department during the last 10 years, we found that there are >40 different kinds of diseases related to NVG, even local radiation therapy of nasopharyngeal carcinoma, which might compromise retinal circulation and induce retinal circulatory disturbance.…”