Retinal Artery Occlusion Associated With a Patent Foramen Ovale: Diagnostic Role of Transcranial Doppler Sonography

Abstract

Purpose: : To evaluate the prevalence of patent foramen ovale (PFO) detected by contrast-enhanced Transcranial Doppler Sonography (TCD) and Trans-Thoracic Echocardiography in a consecutive unselected cohort of patients with retinal artery occlusion.

Methods: : The study population consisted of 23 consecutive patients with a diagnosis of central and branch retinal artery occlusion. All the patients underwent contrast-enhanced Transcranial Doppler Sonography (TCD) and Transtoracic Echocardiography (TTE) as a part of systemic evaluation.

Results: : . In 11 patients (47.8 %) a bilateral absence of the temporal bone acoustic window was present. In the remaining 12 patients (52.2 %) the prevalence of right-to-left shunt (RLS), as detected by TCD was 41.6%. Contrast enhanced TTE confirmed the presence of PFO in 33.3% of the patients. In the 8.3 % of patients in which TTE did not confirm the presence of PFO, a, extracardiac condition probably accounted for the presence of RLS.

Conclusions: : Nearly half of all patients with retinal artery occlusion have a right-to-left shunt due to a patent foramen ovale suggesting that retinal artery occlusion and patent foramen ovale have higher coincidences than expected by chance only. The use of TCD in the detection of patent foramen ovale is limited in old patients because of a bilateral absence of temporal bone acoustic window. In patients undergoing both TCD and TTE these two techniques show an almost perfect concordance in PFO detection in patiens with retinal artery occlusion.

Keywords: vascular occlusion/vascular occlusive disease • ischemia • imaging/image analysis: clinical