Role of transesophageal echocardiography in the evaluation of patients with retinal artery occlusion

Objective: To evaluate the role of transesophageal echocardiography (TEE) i n detecting cardiac and thoracic aortic sources of retinal emboli. Design: Retrospective observational case series. Participants: The study population consisted of 18 patients who were initia lly seen with retinal artery occlusion (7 central, 11 branch) and underwent TEE as part of the systemic evaluation. Intervention: All patients underwent TEE, consisting of complete two-dimens ional and Doppler color flow examinations. TEE was done immediately after t ransthoracic echo (TTE) examination. The medical records were reviewed. Main Outcome Measure: Detection of a possible cardiac or thoracic aortic so urce of retinal embolus. Results: Cardiac or thoracic aortic pathologic conditions, which were a pos sible source of the retinal emboli, were detected by TEE in 13 of the 18 pa tients (72%). They included aortic arch atheroma (n = 7), mitral annulus ca lcification (n = 4), left atrial appendage thrombus (n = 2), valvular abnor malities (n = 5), left atrial smoke (n 3), and patent foramen ovale (n = 3) . In 11 patients (61%), at least one cardiac or aortic source of emboli det ected by TEE was missed by TTE. Significant carotid artery disease (greater than or equal to 40% stenosis) was present in 3 of 16 patients (17%). Conclusions: TEE is a potentially useful modality for detecting possible so urces of retinal artery emboli and may be considered as an adjunct to the r outine evaluation of affected patients. Ophthalmology 2001;108: 1461-1464 ( C) 2001 by the American Academy of Ophthalmology.