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J. S. Brown, G. Britz, R. C. Mudumbai; Treatment of Ophthalmic Artery Aneurysms (OAA): Visual Sequellae of Coiling and Clipping. Invest. Ophthalmol. Vis. Sci. 2007;48(13):929.
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The last review of the visual sequellae of patients with OAAs occurred in 1990. Advances in treatment options like coiling (CL) may alter the ophthalmic complications of treatment. We reviewed the clinical characteristics of patients with OAAs and compared the visual outcomes from treatment with CL vs. clipping (CP).
Retrospective review of medical records from a major tertiary referral center between 1/96-11/05 of patients with OAAs.
Of 2404 patients identified with aneurysms, 250 were found to have at least one OAA. 31 subjects were excluded. Of the 219 subjects accepted, 183 (83%) were female. The mean age was 53.3 years (range 13-85). 69 (32%) subjects presented because of a symptomatic OAA: 48 (22%) ruptured; 1 endocrine dysfunction; 4 cranial neuropathy; 16 (7%) vision loss. 150 (69%) were found to have an OAA incidentally: 76 (35%) nonspecific neurological complaints; 40 (18%) subarachnoid hemorrhage (SAH) from another aneurysm; 12 (5.5%) positive family history; 13 (6%) incidentally discovered on imaging. 32 (14.5%) subjects presented with visual sequellae (visual field/acuity deficit, cranial neuropathies, optic nerve pallor) from their OAAs and 41 (18.5%) developed visual sequellae post-treatment. Of the 267 OAAs in 219 subjects, 155 (71%) were treated. 38 (24.5%) were CL and 112 (72.5%) CP. Baseline characteristics between the two groups differed slightly. Average age was 50.3 (CP) vs. 58.8 (CL) groups. 20 (20%) subjects in the CP group presented with visual sequellae vs. 1 (3%) subject in the CL group. Coiling was performed during the latter part of the study period whereas clipping was performed throughout. Operative complications occurred in both groups: CP: 7 intraoperative aneurysm ruptures, 1 emergent clip adjustment; CL: 1 proximal occlusion of the ophthalmic artery, 1 peri-operative SAH, 1 premature coil deployment, 1 broken coil, 3 coil loops protruding into the parent vessel, 2 conversions to clipping. Post-operative visual sequellae developed in 39 (35.5%) CP subjects vs. 0 CL subjects.
Our 219 OAA patients represent the largest such group ever compiled and the first compiled after the advent of coiling. We reviewed demographic and neuroophthalmic characteristics and complications of OAA repair. The demographics remain unchanged while pre-operative visual complications have decreased, which may be secondary to earlier detection. Importantly, a significant difference exists in the risk of visual complications between CP and CL techniques in the treatment of OAAs and argues for the creation of appropriate intervention selection criteria.
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