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E. Guyennet, J.-L. Guyomard, E. Barnay, P. Kergosien, A. Cardon, A. Lucas, J.-F. Charlin; Venous Stasis Retinopathy and Carotid Artery Stenosis. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2106.
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The early stage of chronic ocular ischemia often referred to as venous stasis retinopathy (VSR), range between 5% and 21% in series of patients with carotid artery stenosis or occlusion. The chronic form of ocular ischemia is explained by a chronic low perfusion pressure that causes diffuse retinal ischemia, reflected by an increase in circulation time, which initially results in dilatation, irregularity of calibre, and tortuosity of retinal veins. The principal aim of this study was to assess the real prevalence of the VSR and the correlation between the ophthalmoscopic findings and the ophthalmic artery blood flow velocity in patients runned for an endarteriectomy for symptomatic carotid stenosis.
It was a prospective study evaluating by ophthalmoscopy and fluoroangiography the presence of the VSR, before and after the endarterectomy. The visual acuity by the ETDR scale was assessed.The ophthalmic artery blood flow velocity was calculated as well. A matching control group was assessed for the angiographic findings. All the patients were operated on for at least 70% of carotid stenosis. The operating technique was in first intention a carotid bifurcation endarterectomy with prothetic patch closure, and in second intention a carotid-carotid crossover bypass.
32 patients were included in the study; the mean age was 72 years-old (SD: 9.58; 49-89); the sex ratio (M/W): 9; the atheroma risk factors were the excess weight (56%), tabagism (34%), dyslipidemia (69%), diabetes mellitus (22%). The carotid stenoses were bilateral in 28% from the patients, symptomatics in 31%. Only one patient had a ophthalmic artery flow inversion. We found 28% of VSR (22% of microanevrysms, venous dilatations 13%, retinal haemorrhages 23%). With angiofluorography, in 56% there were arteriolosclerosis retinal findings and 13% of choroidal ischemia.Statistical tendency were found for VSR and age, low visual acuity and arteriolosclerosis retinal findings.
On the basis of our findings, we recommend referral of patients with symptomatic CAO to the ophthalmologist on a routine basis, regardless of whether they have had visual symptoms. In patients with VSR, we recommend ophthalmologic follow-up. If VSR is absent, ophthalmologic follow-up is probably not necessary.
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