Ocular Ischemic Syndrome

Purpose: The purpose of the study is to investigate the clinical features and management of ocular ischemic syndrome (OIS) and factors influencing its development. Intervention: The following interventions were used: detailed medical and ocular histories, complete ophthalmic evaluation including fluorescein angiography, internal carotid artery evaluation by duplex ultrasonography, and/or aortic arch angiography, management, and follow-up. Main Outcome Measures: The following outcome measures were considered: visual acuity, visual fields, intraocular pressure, anterior segment neovascularization and other abnormalities, lens, optic disc, retinal and choroidal changes, carotid artery stenosis or occlusion, diabetes mellitus, arterial hypertension, coronary artery disease, and cerebrovascular disease. Results: Mean age of the 32 patients (39 eyes) with OIS was 68 ±8 years. Presenting visual symptoms included amaurosis fugax (15%) and/or gradual (28%) or sudden (41%) visual loss. At initial visit, eyes with OIS had visual acuity less than or equal to 20/400 in 64%, iris neovascularization (NV) in 87%, angle NV in 59%, intraocular pressure from 4 to 60 mmHg (median, 18 mmHg), optic disc pale (40%) and/or cupped (19%) or edematous (8%), disc NV (13%), retinal NV (3%), marked retinal circulatory stasis (21 %), and retinal hemorrhages (24%). Associated systemic diseases in these patients included diabetes mellitus (56%), arterial hypertension (50%), coronary artery disease (38%), and previous stroke or transient ischemic attack (31 %);the incidence of diabetes, coronary artery disease, and cerebrovascular disease was much higher in patients with OIS than in the comparable general population, especially that of diabetes. Occlusion or severe stenosis (80%–99%) of the internal carotid artery was seen in 74% on the side of OIS. Conclusions: Ocular ischemic syndrome has a poor visual prognosis. However, the ophthalmologist's diagnosis may be crucial to the health of these patients, because OIS may be the presenting sign of serious cerebrovascular and ischemic heart diseases.