RECOVERY FROM OCULAR ISCHEMIC SYNDROME AFTER TREATMENT WITH VERAPAMIL

Vasospasm has been implicated as a cause of amaurosis fugax, which can be controlled by administration of the calcium channel blockers nifed ipine or verapamil. However, vasospasm has not previously been thought to be involved in chronic ocular ischemia. We report a patient with o cular ischemic syndrome, which may have had vasospasm as a contributin g cause, since the patient also developed amaurosis fugax despite dail y aspirin therapy. An 80-year-old man with chronic open-angle glaucoma developed chronic ocular ischemia characterized by progressively decr eased visual acuity, pain, rubeosis, and hypotony, as well as transien t visual dimming. Medical evaluation revealed no evidence of carotid s tenosis, thromboembolism, or vasculitis as the cause of ocular ischemi a. When the calcium channel blocker verapamil was administered, the ep isodes of transient visual dimming ceased immediately. In addition, so on thereafter, visual acuity improved, the rubeosis partially regresse d, and the hypotony reversed. This case indicates that the calcium cha nnel blocker verapamil may be effective in treating cases of ocular is chemic syndrome, when vasospasm is a contributing cause.