Atlas of Ophthalmology

Ocular Ischemic Syndrome (OIS) in Subacute Internal Carotid Artery (ICA) Occlusion (Colour Image, FFA, ERG, MRI angiography)

Retina -> Vascular Diseases (see also: Systemic Immunologic Diseases) -> Arterial Obstructive (Occlusive) Disease of the Eye
57-year-old woman, visual acuity BCVA 0.1 OD, 0.8 OS, intraocular pressure 24 mmHg OD, 20 mmHg OS, Major complaints: subacute painless visual loss in the right eye General medical history: setting of hypertension. Ocular medical history: gradual visual loss, no amaurosis fugax. Laboratory work-up excluded inflammatory arteritis (BKS:5/22,CRP:11,4). Findings: Colour fundus image: at initial visit we found no optic disc pale, no retinal hemorrhages, no disc neovascularization (NV), no retinal NV. Fluorescein angiography: marked retinal circulatory stasis, consistent with OIS, prolonged arm-retinal circulation time, prolonged retinal circulation time and choroid circulation time. Visual fields: marked scotomas at OD ERG: reduced scotopic and photopic signal at OD MRI scan angiography verified occlusion of the right internal carotid artery. Discussion: The ocular ischemic syndrome (OIS) was a complication of a subacute internal carotid artery (ICA) occlusion causing complete interruption of blood flow through the internal carotid artery. In a study (1) with 32 patients with OIS the presenting visual symptoms included iris neovascularization in 87%, gradual or sudden visual loss in 30-40%, optic disc pale in 40%, retinal hemorrhages in 24%, marked retinal circulatory stasis in 21%, amaurosis fugax in 15%, and edematous disc in 8%. The found associated systemic diseases included diabetes mellitus in 56%, arterial hypertension in 50%, coronary artery disease in 38%, and previous stroke or transient ischemic attack in 31%. Occlusion or severe stenosis of the internal carotid artery was seen in 74% on the side of OIS. The diagnosis is crucial to the health of these patients, because OIS may be the presenting sign of serious cerebrovascular and ischemic heart diseases. Literature: (1) Mizener JB, Podhajsky P, Hayreh SS. Ocular ischemic syndrome. Ophthalmology.. 1997 May;104(5):859-64.

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