OPEN FORAMEN OVALE IN PATIENTS WITH ARTER IAL OCCLUSIONS OF THE RETINA AND OPTIC-NERVE

Background: We examined the frequency and significance of persistent f oramen ovale (PFO) in patients with ocular circulatory disturbance. Pa tients and methods: Forty patients with acute arterial occlusions of t he posterior bulb segment were investigated by means of transthoracic and transesophageal echocardiography (TEE). The parallel presence of c erebral ischemia was clarified on the basis of existing CCT findings a nd by additional HMPAO-SPECT investigation. Results: PFO was identifie d in nine of the patients investigated. The probability of paradoxical embolism arises from further findings: eight of those with PFO (89 %) showed echocardiographic signs of right heart strain, indicating prev ious pulmonary embolism, compared with only three of those without PFO (10 %). Five of those with PFO showed a potential source of embolism, two of them with phlebothromboses in their clinical history and three with additional atrial septal aneurysm. Cardiovascular risk factors w ere prevalent in the group without PFO. Both groups had a mean age of approximately 60 years. Signs of cerebral ischemia were present in the SPECT or CT findings for four of the patients with PFO and nine of th ose without. Conclusions: From our findings, it appears highly probabl e that ocular arterial occlusion is caused by paradoxical embolism. PF O should be taken into account in establishing a diagnosis, including diagnosis in elderly patients.