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Tsong Kwong, Moin Mohamed; Carotid Doppler Ultrasound in Ophthalmology: A study of indications and outcomes. Invest. Ophthalmol. Vis. Sci. 2013;54(15):31.
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Carotid dopplers are a common tool in the assessment of internal carotid artery (ICA) patency and blood flow. ICA stenosis can lead to ocular ischaemia and potentially life threatening cerebrovascular accidents. Management ranges from simple antiplatelet therapy and risk factor modification in mild stenoses to surgical endarterectomy in severe cases. There is however a paucity of published data regarding the range of clinical indications as well as the usefulness of performing this investigation from an ophthalmological perspective. This study aims to identify the range of ophthalmic indications and determine the proportion of patients requiring further surgical management.
This retrospective study was designed to assess data from consecutive patients referred for Carotid Doppler over a 2 year period from January 2009. Case note analysis was performed to collect demographic information, clinical indications, Doppler scan results and details of further management.
40 patients included in the study, average age of 69(range 27-92) with male preponderance (78% male). The 4 most common indications were suspected ocular ischaemia (40%), amaurosis fugax (12.5%), retinal artery occlusion (12.5%) and bilateral temporary visual loss (10%). The majority of requests originated from medical retina clinic (27 of 40). 30 of 40 patients had minor plaques (16-49% stenosis), 4 had moderate stenoses (50-79% stenosis) and 6 were reported to have severe stenoses (>80%). The average age of patients with severe stenosis was 76 yrs with 4 out of 6 patients having suspected ocular ischaemic syndrome. 5 of the 6 patients with severe stenoses were referred for vascular input and 1 patient was referred to the stroke service.
25% of scanned patients were determined to have moderate to severe stenosis of the ICA. Approximately 1 patient in every 7 will have more than 80% stenosis and therefore will require further specialist input. We feel that with the advantage of Doppler being a relatively cheap, quick and painless investigation, it is an important tool when wanting to avoid the potentially devastating consequences of untreated stenoses.
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