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J.V. Arnold, R. Ascione, A. Ghosh, A. Shah, M. Potts, G.D. Angelini; Retinal Changes During Coronary Surgery With or Without Cardiopulmonary Bypass: A Prospective Randomised Study . Invest. Ophthalmol. Vis. Sci. 2005;46(13):3279.
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© ARVO (1962-2015); The Authors (2016-present)
Objective:To compare the retinal changes between conventional and beating heart coronary surgery. Methods: Patients were randomised to off–pump coronary artery bypass grafting (OPCAB) or conventional coronary artery bypass grafting with cardiopulmonary bypass (CABG–CPB). Retinal changes were assessed by fluorescein angiography during surgery, logmar visual acuity, and disc photography before and after surgery.. Cerebral microemboli were also detected with cranial doppler ultrasound. Data were analysed using regression and Fisher exact tests. Results: 20 patients were recruited (10 per group). Fluorescein angiography and post–operative visual acuity could not be obtained for one patient. Retinal changes were detected in 5 of the 9 CABG–CPB but none in the OPCAB patients (risk difference 55%, 95% CI 23% to 88%, p=0.01 Fisher’s exact test). Disc abnormalities were detected in 1 of the 10 CABG–CPB but none of the OPCAB patients. There was no difference in post–operative visual acuity (OPCAB 0.06 worse, 95% CI –0.09 to 0.21, p=0.42). Doppler ultrasound HITS were 20 times more frequent in the CABG–CPB than the OPCAB group (95% CI 9.1 to 45, p<0.0001). ). Retinal changes were associated with cerebral microembolisation (emboli were 14.7 times more frequent if the fluorescein was abnormal, 95% CI 3.5 to 62, p=0.001) Conclusions: Transient retinal embolisation occurs frequently in CABG–CPB patients, but rarely in OPCAB patients. Retinal microemboli are associated with cerebral microemboli.
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