OCULAR ISCHEMIC SYNDROME

Purpose: The purpose of the study is to investigate the clinical featu res and management of ocular ischemic syndrome (OIS) and factors influ encing its development. Intervention: The following interventions were used: detailed medical and ocular histories, complete ophthalmic eval uation including fluorescein angiography, internal carotid artery eval uation by duplex ultrasonography, and/or aortic arch angiography, mana gement, and follow-up. Main outcome Measures: The following outcome me asures were considered: visual acuity, visual fields, intraocular pres sure, anterior segment neovascularization and other abnormalities, len s, optic disc, retinal and choroidal changes, carotid artery stenosis or occlusion, diabetes mellitus, arterial hypertension, coronary arter y disease, and cerebrovascular disease. Results: Mean age of the 32 pa tients (39 eyes) with OIS was 68 +/- 8 years. Presenting visual sympto ms included amaurosis fugax (15%): and/or gradual (28%) or sudden (41% ) visual loss. At initial visit, eyes with OIS had visual acuity less than or equal to 20/400 in 64%, iris neovascularization (NV) in 87%, a ngle NV in 59%, intraocular pressure from 4 to 60 mmHg (median, 18 mmH g), optic disc pale (40%) and/or cupped (19%) or edematous (8%), disc NV (13%), retinal NV (3%), marked retinal circulatory stasis (21%), an d retinal hemorrhages (24%). Associated systemic diseases in these pat ients included diabetes mellitus (56%), arterial hypertension (50%), c oronary artery disease (38%), and previous stroke or transient ischemi c attack (31%); the incidence of diabetes, coronary artery disease, an d cerebrovascular disease was much higher in patients with OIS than in the comparable general population, especially that of diabetes. Occlu sion or severe stenosis (80%-99%) of the internal carotid artery was s een in 74% on the side of OIS. Conclusions: Ocular ischemic syndrome h as a poor visual prognosis. However, the ophthalmologist's diagnosis m ay be crucial to the health of these patients, because OIS may be the presenting sign of serious cerebrovascular and ischemic heart diseases .