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Achraf khabou, Nadine Manasseh, Benjamin Wolff, Mickael Obadia, Jose Alain Sahel, Michel Paques; Retinal Complications Of Occlusion And Carotid Stenosis. Invest. Ophthalmol. Vis. Sci. 2012;53(14):956.
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The incidence of ophthalmological complications of carotid occlusions is not known. Recent progress in retinal imaging could allow for a better detection of early signs of chronic ischemia. Here we documented the incidence of ophthalmological complications by fundus photographs and optical coherence tomography (OCT) in patients with severe carotid stenosis or occlusion.
We prospectively studied patients referred for ophthalmological work-up of symptomatic occlusion or carotid stenosis (>70%). Fundus examination and high resolution OCT, cerebral imaging data including magnetic resonance angiogram imaging (MRA) and transcranial Doppler ultrasonography were reviewed.
30 patients (10 women and 20 men, mean age 60 +/- 11 years) diagnosed with carotid occlusion (17 cases) and severe stenosis >70% (13 cases) were included. A venous stasis retinopathy was found in 2 eyes. OCT depicted atrophy of the inner nuclear layer in 2 eyes. Angiography (n=7) revealed a major delay in the filling of retinal vessels in one eye and a blood retinal barrier breakdown in 3 eyes. One eye presented with a retinal cholesterol emboli.
Chronic ocular hypoperfusion related to carotid occlusion is well tolerated even in the presence of neurological symptoms. Infraclinical abnormalities such as inner nuclear atrophy and/or blood-retinal barrier breakdown can be detected despite a normal eye fundus. These signs may therefore be early indicators of a bad metabolic tolerance to chronic ischemia. Ocular workup of carotid artery occlusion should therefore incorporate high resolution OCT.
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