Ocular ischemic syndrome in diabetic patients

Purpose: Diabetes mellitus aggravates carotid occlusive disease, that can m anifest as ocular ischemic syndrome (OIS). Ocular manifestations and visual prognosis of OIS in diabetic patients were retrospectively analyzed. Methods: Twenty-three consecutive diabetic patients with OIS were divided i nto two groups according to the presence of iris neovascularization, and th e clinical features were reviewed. Results: In the first group, 14 eyes of 12 diabetic patients (11 men and 1 woman) had no iris neovascularization. Two patients had bilateral OIS. The ages in this group ranged from 50-75 years. Four eyes with optic atrophy or ischemic optic neuropathy had severe visual loss. Six eyes with hypoperfus ion retinopathy or retinal vein obstruction and 2 eyes with cataract had mi ld visual loss. Each eye with amaurosis fugax or retinal neovascularization had no visual deterioration. Asymmetrical retinopathy was observed in 2 pa tients. Carotid surgery stabilized and resolved amaurosis fugax and hypoper fusion retinopathy. In the second group, 11 eyes of 11 patients had iris ne ovascularization. The patients were all male and their ages ranged from 53- 77 years. All eyes with iris neovascularization had severe visual deteriora tion. In 5 patients, asymmetrical ocular manifestation was observed. Caroti d reconstruction surgery and ophthalmological treatment were not successful for recovering a satisfactory visual outcome in OIS. Conclusion: The features of OIS in diabetic patients mimic diabetic retinop athy and manifest with asymmetrical ocular findings. Iris neovascularizatio n is an indicator of poor visual prognosis. It is essential to recognize th e early stages of OIS associated with diabetes mellitus. Jpn J Ophthalmol 1 999;43:31-35 (C) 1999 Japanese Ophthalmological Society.