Ocular Ischemic Syndrome

Mendrinos, Efstratios; Machinis, Theofilos G.; Pournaras, Constantin J.

doi:10.1016/j.survophthal.2009.02.024

Cited by 151 publications

(214 citation statements)

References 201 publications

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“…DISCUSSION OIS is a potentially blinding and underdiagnosed disorder that arises in the context of chronic arterial hypoperfusion of the eye. 1 OIS most frequently results from hemodynamically significant internal carotid artery occlusion, as the ophthalmic artery is the first branch of the carotid artery and the main arterial source of the eye. 2 Failure to recognize and appropriately treat OIS can result in serious consequences, as the 5-year mortality rate for patients with OIS is 40%, mainly due to stroke or myocardial infarction.…”

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confidence: 99%

Pearls & Oy-sters: Ocular ischemic syndrome

Fernández‐Torrón¹,

Palma²,

Pagola³

2012

Neurology

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confidence: 99%

Pearls & Oy-sters: Ocular ischemic syndrome

Fernández‐Torrón¹,

Palma²,

Pagola³

2012

Neurology

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“…The ex ist ing nomen cla ture in cludes: amaurosis fugax -brief at tack of monoc u lar par tial or to tal blind ness that lasts sec onds to minutes; tran sient mon oc u lar vi sual loss (TMVL) -more persis tent vi sual loss, last ing min utes or lon ger; and tran sient bi lat eral vi sual loss (TBVL) -ep i sode af fect ing ei ther both eyes or both ce re bral hemi spheres, caus ing vi sual loss or bilat eral homonymous events. The fre quency of these vi sual dis tur bances var ies from a sin gle to many ep i sodes, which are usu ally fol lowed by com plete re cov ery of vi sion (6,10). Ac cord ing to the lit er a ture, amaurosis fugax and TMCL are re lated most com monly to oc clu sive ca rotid dis ease, although TBVL are oc ca sion ally re lated to vertebrobasilar cir cu la tory dis or ders (1,5,8,9,11,13).…”

Section: Introductionmentioning

confidence: 99%

“…Given the above-men tioned di ag no ses, any con found ing an te rior seg ment pa thol ogy should be ruled out on ex am ina tion. Fol low ing de tailed perimetry, a di lated fundoscopy ex am i na tion should be per formed (10,13). A neurovascular in ves ti ga tion, in clud ing du plex scan ning and echocardiography should be per formed if a cardio gen ic em bolic source is sus pected.…”

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confidence: 99%

“…Brain neuroimaging ei ther com put er ized tomographic angiography or mag netic res onance angiography is use ful in eval u at ing the pres ence of brain vas cu lar pa thol ogy (2,3,11,15). In the event of a patient pre sent ing with TMVL, it is the neuro-oph thal mol ogist who can or der the ini tial in ves ti ga tion and ef fec tively di min ish the pa tient's risk for fur ther ischemic events by ini ti at ing antithrombotic ther apy and re fer ring the pa tient to an in ter nist for an ischemic risk fac tor as sess ment (4,9,10). Data ex ist that the sur gi cal man age ment of pa tients with symp tom atic ca rotid ste no sis in com bi na tion with one or more in ci den tal intracranial aneurysms who meet the required sur gi cal cri te ria is con tro ver sial (8,12,14).…”

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Transient monocular visual loss due to multiple CNS vascular pathology: report of two cases

Tzoukeva

Kirov

Kaprelyan

et al. 2011

SSM

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BACKGROUND: The fre quency of the tran sient mon oc u lar vi sual loss (TMVL), last ing min utes or lon ger, var ies from a sin gle to many ep i sodes, which are usu ally fol lowed by com plete re cov ery of vi sion. TMVL is related most com monly to oc clu sive ca rotid dis ease. The ther apy of pa tients with TMCL is di vided into sur gi cal and med i cal. CASE 1: A 55-year-old fe male was ad mit ted to the clinic, with 4 months his tory of TMVL of the right eye, last ing 2-3 min utes, fol lowed by com plete re cov ery. Neuro-ophthalmological ex am i na tion was normal. Neuroimaging in ves ti ga tions re vealed prox i mal part right in ter nal ca rotid ar tery (ICA) ste no sis of 70%, left ICA ste no sis of 40%, King-King in the mid dle seg ment of ICA, caus ing ste no sis of 14%, and in ci den tal aneurysms of the intracranial part of right ICA and in M2 seg ment of right mid dle ce re bral ar tery. CASE 2: A 74-year-old fe male was ad mit ted to the clinic, with 1 year his tory of TMVL of the right eye, last ing 4-5 minutes, fol lowed by com plete re cov ery. Neuro-ophthalmological ex am i na tion was nor mal. Du plex scaning showed hemodynamically sig nif i cant ste no sis of the right ICA, with King-King in the left. MRI re vealed diffuse vas cu lar pa thol ogy. CONCLUSION: These cases dem on strated a co-occurrance of hemodynamically sig nif i cant ca rotid ar tery oc clu sion with mul ti ple or dif fuse vas cu lar pa thol ogy in pa tients with TMVL. We sug gest that the de tailed his tory, neuro-ophthalmological, and neuroimaging ex am i na tions might be useful to determine the correct etiologic diagnosis and discuss the most effective therapeutic strategy in TMVL patients.

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“…The incidence rate is estimated to be 7.5 cases per million every year. 1 Pain may be present in about 40% of cases.…”

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confidence: 99%

Ocular ischemic syndrome

Hung

Chang

2017

CMAJ

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A 74-year-old man with hypertension and diabetes mellitus presented with a three-month history of intermittent orbital pain and progressive vision loss in his left eye, deteriorating to hand motions. The intraocular pressure was in the normal range at 13 mm Hg. Biomicroscopy showed prominent iris neovasculature ( Figure 1A). Fluorescein angiography disclosed dot hemorrhages in the midperipheral retina, as well as delayed choroidal and retinal perfusion, indicating fundus ischemia. Intravitreal injection of bevacizumab, an anti-vascular endothelial growth factor agent, achieved rapid regression of iris neovasculature within six days ( Figure 1B). For iris neovasculature without retinal vascular diseases, ocular ischemic syndrome should be considered, and total occlusion of the left internal carotid artery was shown on carotid duplex ultrasonography and angiography. Subsequent angioplasty with stenting restored the blood flow (see Appendix 1, available at www.cmaj.ca/lookup/suppl/doi:10.1503/ cmaj.160459/-/DC1). The patient has not had a recurrence of iris neovasculature and serial intraocular pressure measurements have not exceeded 20 mm Hg. At two-year follow-up, he was doing well, although his vision did not recover, because of the prolonged retinal ischemia.Ocular ischemic syndrome is an uncommon but potentially blinding condition that results from severe ocular hypoperfusion. It may represent the first sign of carotid artery stenosis. The incidence rate is estimated to be 7.5 cases per million every year.1 Pain may be present in about 40% of cases.1 Careful examination of the anterior segment with a handheld ophthalmoscope may identify neovascularization of the iris, as it is observed in 87% of cases of this syndrome.2 Because the loss of vision is usually unilateral, 1 examination findings for both eyes should be compared. Fundus fluorescein angiography, carotid duplex ultrasonography, cerebral angiography and magnetic resonance angiography may help in diagnosis. The overall mortality rate for patients with ocular ischemic syndrome is 40% at five years, most commonly from ischemic cardiovascular disease, followed by cerebrovascular disease. This article has been peer reviewed. PRACTICE | CLINICAL IMAGES Ocular ischemic syndromeThe authors have obtained patient consent. Clinical images are chosen because they are particularly intriguing, classic or dramatic. Submissions of clear, appropriately labelled high-resolution images must be accompanied by a figure caption. A brief explanation (300 words maximum) of the educational importance of the images with minimal references is required. The patient's written consent for publication must be obtained before submission. Affiliations

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Ocular Ischemic Syndrome

Cited by 151 publications

References 201 publications

Pearls & Oy-sters: Ocular ischemic syndrome

Pearls & Oy-sters: Ocular ischemic syndrome

Transient monocular visual loss due to multiple CNS vascular pathology: report of two cases

Ocular ischemic syndrome

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