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J.S. Brown, J. Litwin, R.C. Mudumbai; Visual Sequelae of Ophthalmic Artery Aneurysms . Invest. Ophthalmol. Vis. Sci. 2006;47(13):780.
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Ophthalmic artery aneurysms (OAA) are of particular importance in ophthalmology because they can present with isolated visual loss or cranial nerve deficits. The last major review of the clinical presentation of patients with OAA occurred in 1990 by Day (1) while the last review of visual sequelae occurred in 1981 by Drake (2). In the interim there have been considerable advances in imaging and in treatment options, which may lead to earlier detection and less morbidity. The purpose of this study is to determine if there have been changes in the clinical characteristics or in the pre– and post–operative visual function in patients with OAA since this was last reviewed.
Retrospective review of medical records from a tertiary referral center between 1/98 and 1/04 of patients with OAA.
There were 36 patients identified with OAA. The mean age at presentation was 55.3 (range 26–74), 33 (92%) were female, and the clinical presentation included subarachnoid hemorrhage (SAH) in 16/36 (44%), visual disturbance in 8/36 (22%) (decreased vision, diplopia, scintillating scotoma) and was asymptomatic in 9/36 (25%). These results are similar to Day’s cohort where 69/80 (86%) were female, the mean age was 54, and the clinical presentation included SAH in 23/80 (29%), visual deficits in 24/80 (30%), and 28/80 (33%) were asymptomatic. 16 patients had preoperative ophthalmic examination and 9 patients required post–operative examination. Comparing our cohort to Drakes revealed that the demographic characteristics have not changed and there is a similar distribution of ruptured to unruptured aneurysms (25% vs. 22%). However, our cohort had fewer giant aneurysms (25% vs. 88%), less bilateral visual acuity deficits (0 vs. 61%), visual field deficits (6% vs. 61%) and optic disc pallor (6% vs. 56%). Post–operative outcomes revealed fewer patients with visual acuity or field improvement and a similar number with a worsening of their visual deficits.
We reviewed demographic characteristics and ophthalmic characteristics/complications of OAA repair in our cohort of 36 patients, which has not been commented upon since the last major review 25 years ago. The demographics and presentation of OAA seem to have remained unchanged while the severity of pre–operative visual complications has decreased. These differences might be secondary to advances in imaging and treatment leading to earlier detection and surgical intervention. 1. Day AL: Aneurysms of the ophthalmic segment. J. Neurosurg 72:677–691, 1990.
2. Ferguson GG, Drake CG: Carotid–ophthalmic aneurysms: visual abnormalities in 32 patients and the results of treatment. Surg Neurol 16:1–8, 1981.
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