CAROTID RECONSTRUCTION FOR OCULAR ISCHEMIC SYNDROME - CAN WE PREDICT THE VISUAL OUTCOME

Ocular ischemic syndrome is a progressive disorder that results from o cular ischemia in occlusive diseases of the carotid system. Ocular man ifestations of 16 patients with ocular ischemic syndrome were evaluate d retrospectively before and after carotid artery surgery. Although ca rotid endarterectomy (CEA) and carotid bypass surgery were beneficial to stabilize the ocular manifestations of nine eyes with amaurosis fug ax and hypoperfusion retinopathy, ipsilateral blindness due to retinal artery occlusion developed following CEA in one eye. Conversely, caro tid artery surgery in ocular ischemic syndrome with iris neovasculariz ation has not been successful in stabilizing the ocular manifestations . As expected, carotid bypass surgery did not resolve neovascular glau coma due to iris neovascularization in two eyes and was followed by an elevation of normal intraocular pressure in one eye. One eye with iri s neovascularization developed an intractable glaucoma following CEA. The presence of iris neovascularization suggests poor visual prognosis after carotid artery surgery. The development of retinal artery occlu sion and secondary glaucoma after CEA should be listed as postoperativ e ocular complications of carotid artery surgery. In conclusion, carot id artery surgery is effective for ocular ischemic syndrome before the onset of iris neovascularization. Presence of iris neovascularization needs careful indication of carotid artery surgery to prevent the ele vation of intraocular pressure.