EFFECT OF CAROTID ENDARTERECTOMY ON THE OCULAR CIRCULATION AND ON OCULAR SYMPTOMS UNRELATED TO EMBOLI

Objective: To evaluate haemodynamic changes in the ophthalmic artery a nd the retina following carotid endarterectomy and their effect on the pathophysiology of the eye. Design: Prospective study. Method: Twenty -two consecutive patients with severe carotid stenosis underwent 23 ca rotid endarterectomies and one subclavian-carotid bypass. The followin g measurements were made preoperatively and 3 months after operation; Ophthalmic artery (OA) and retinal arteriole (RA) peak systolic veloci ty (PSV) and peak diastolic velocity (PDV), macular photostress recove ry time, visual acuity, intraocular pressures, colour vision and visua l fields testing. Result: The RA PSV increased by 50% (p = 0.005) and PDV increased by 22% (p = 0.03). The OA PSV increased by 51% (p = 0.00 1). Macular photostress testing decreased from 58 s to 42 s (p = 0.001 ). Visual acuity improved in four and was unchanged in 13 eyes ipsilat eral to the endarterectomy which had abnormal preoperative measurement s. One patient experienced a dramatic increase in the ipsilateral intr aocular pressure associated with visual deterioration. In two patients there was resolution of periorbital pain. Conclusion: Our results dem onstrate an increase in the PSV of the XA and OA following carotid sur gery. There are pathophysiological changes in the eye, which accompany tight stenotic extracranial carotid artery disease and these may be i nfluenced by carotid endarterectomy.