Extracranial Cerebrovascular Revascularization for Chronic Ocular Ischemia

Clouse, W. Darrin; Hagino, Ryan T.; Chiou, Andy C.; DeCaprio, Jeffrey D.; Kashyap, Vikram S.

doi:10.1007/s10016-001-0137-1

Cited by 14 publications

(13 citation statements)

References 18 publications

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“…Promising results suggest that CEA is effective in reversing or preventing the progression of chronic ocular ischemia such as improving visual acuity and resolution of clinical ophthalmoscopic findings. 11,34 In addition, an increase in ipsilateral retrobulbar blood flow was found after CEA. 13,35 However, negative results were also reported in two studies.…”

Section: Discussionmentioning

confidence: 94%

“…Ophthalmologists have found results suggesting visual acuity improvement from the procedure. [11][12][13] At the same time, studies have reported negative effects of CEA on visual acuity. 14 No data have been published concerning the effect of CEA on hearing ability.…”

mentioning

confidence: 96%

“…There are discrepant reports on the effects of cognitive function after CEA, ranging from improvement, 5,6 decline, 7,8 and mixed results to no change. 9,10 Cognitive function in the elderly population could be influenced by the state of visual and hearing ability, 11 so the change in these functions also required study. Ophthalmologists have found results suggesting visual acuity improvement from the procedure.…”

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confidence: 99%

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Improved visual, acoustic, and neurocognitive functions after carotid endarterectomy in patients with minor stroke from severe carotid stenosis

Feng

Zou

et al. 2015

Journal of Vascular Surgery

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Section: Discussionmentioning

confidence: 94%

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confidence: 96%

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confidence: 99%

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Improved visual, acoustic, and neurocognitive functions after carotid endarterectomy in patients with minor stroke from severe carotid stenosis

Feng

Zou

et al. 2015

Journal of Vascular Surgery

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“…The early and often asymptomatic stage of chronic ocular ischemia is referred to as venous stasis retinopathy (VSR) which can occur in up to a third of patients with symptomatic carotid disease. 10) In addition to this, patients with carotid occlusive disease can present with a variety of other ocular symptoms including teichopsia, anterior segment ischaemia, A Case Report and Review of the Literature particularly in patients with existing comorbidities like hypertension and diabetes that are associated with ocular symptoms. If ocular symptoms post CEA are discovered, then an urgent ophthalmology review is recommended to exclude neovascular glaucoma as a potential cause in addition to other investigations such as a cerebral MRI.…”

Section: Case Reportmentioning

confidence: 99%

Neovascular Glaucoma Post Carotid Endarterectomy: A Case Report and Review of the Literature

Choong

Walker

2015

Annals of Vascular Diseases

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The patient subsequently underwent an urgent right carotid endarterectomy (CEA). Intra-operatively, he was noted to have an extremely tight stenosis of the right ICA. On the second postoperative day, he complained of worsening visual acuity with associated vomiting and headaches. An urgent ophthalmology review revealed a non-reactive right pupil, an elevated intraocular pressure of 47 mmHg and changes consistent with neovascular glaucoma.Concern over cerebral hyperperfusion syndrome post carotid endarterectomy culminated in cerebral magnetic resonance imaging (MRI), which revealed no acute intracranial pathology, and specifically no evidence of cerebral oedema. The patient underwent intravitreal anti-vascular endothelial growth factor (anti-VEGF) administration with serial measurements of intraorbital pressures and retinal photocoagulation. Blood pressure control was also maintained at a systemic target of 150 mmHg with medical therapy. He recovered well with no complications on followup a month later. DiscussionCarotid endarterectomy has numerous complications, one of which is cerebral hyperperfusion syndrome. It occurs as a result of transient increase in cerebral perfusion after revascularisation of the cerebral blood supply as well as alteration of the cerebral vascular autoregulatory mechanisms. Cerebral hyperperfusion syndrome is defined as a cerebral blood flow increase of more than 100% baseline. The classic triad of headache, convulsions and neurological deficit soon manifests and is followed by cerebral oedema, hemorrhage and eventual death. In our patient who experienced headaches and vomiting, this was our utmost concern and the reason for the urgent cerebral MRI.The manifestation of neovascular glaucoma post CEA, however, is extremely rare. Only 11 case reports exist as outlined in our extensive search of the literature ( Table 1). [1][2][3][4][5][6][7][8][9] In our table of collated cases of neovascular glaucoma manifesting post CEA available in the literature (Table 1), we note that all patients presented with vague ocular symptoms, which included eye pain, glare, blurred vision and headache. In our case, the patient developed amaurosis fugax after debridement of his foot wound but had no Carotid endarterectomy is a standard vascular surgical procedure performed worldwide and encompasses multiple risks including cerebral hyperperfusion syndrome, stroke, carotid dissection and aneurysmal formation, all of which are well documented in the literature. However, neovascular glaucoma manifesting post carotid endarterectomy, is extremely rare and can have disastrous consequences if left undiagnosed. In this article, we present one such case of neovascular glaucoma manifesting post carotid endarterectomy and review the available literature on this uncommon entity.Keywords: carotid endarterectomy, carotid surgery, neovascular glaucoma Case ReportA 58-year-old male presented with sepsis secondary to diabetic foot infection, on a background of longstanding non-insulin dependent diabetes, complicated by neuro...

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“…Despite being much less common an entity than TMVL, surgical management of carotid occlusive disease in the setting of chronic ocular ischemia has led to gratifying improvement in visual function. 8,9 Hollenhorst's description of bright plaques in the retina implicated cholesterol crystal embolization from ulcerated proximal atherosclerotic lesions. 2 Further data linking HP to critical carotid stenosis was described by Chawluk and colleagues.…”

Section: Discussionmentioning

confidence: 98%