Opportunities and Prospects in Treatment of Chronic Ocular Ischemic Syndrome Associated with Hemodynamically Significant Internal Carotid Artery Stenosis

Abstract

Purpose. In prospective research to assess clinical efficacy of different surgical treatments for patients with chronic ocular ischemic syndrome (COIS) associated with hemodynamically significant internal carotid artery stenosis (ICAS).Material and methods. The research included 20 patients with 3rd degree severity COIS. Patients were divided into 3 groups due to type of their treatment. 1st group – 7 patients; only carotid endarterectomy (CE) of ICAS was performed; 2nd group – 6 patients; panretinal photocoagulation (PRP) of retina was performed; 3rd group – 7 patients; combined treatment: PRP of retinal capillary non-perfusion areas was performed by the 1st stage, then after 2 weeks by the 2nd stage CE was performed. All patients underwent standard and specialized ophthalmologic examination methods. Assessment of blood flow in brachiocephalic vessels, vessels of eye was performed by ultrasound scan, spiral computed tomography, fundus fluorescein angiography.Results. Monitoring of groups of patients for 1 year depending on type of treatment of COIS, allowed us to determine tactics of patients management and features of the postoperative period. CE at hemodynamically significant ICAS caused positive dynamic in intraocular blood flow, which contributed to improvement and preservation of best corrected visual acuity in 71% of patients; preventive PRP of retina, before performing reconstructive surgery of ICAS, optimized and reduced the time of visual recovery. PRP of retina as independent method of treatment of COIS, complicated by neovascular glaucoma, caused full or partial regression of neovascularization in iris, which increased possibilities of its effective treatment.Conclusion. Combined staged treatment of COIS associated with hemodynamically significant stenosis, which including PRP of retina and CE of ICAS, allows to stop the progression of ischemia in retina and to avoid complications, leading to loss of vision, and can be recommended for use in clinical practice for the treatment of COIS. PRP of retina can be use to stabilize process at impossible to perfomed CE. Surgical reconstruction of the ICAS, despite restoration of blood flow in ophthalmic artery, can aggravate processes of ischemic damage to the neurosensory layer of the retina with decreased vision.

Keywords

• ocular ischemic syndrome
• internal carotid artery
• stenosis
• panretinal photocoagulation
• rubeosis iris