July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Visual Outcomes in Patients Undergoing Carotid Revascularization for Ocular Ischemic Syndrome
Author Affiliations & Notes
  • Michael Ryan
    Ophthalmology, UCSF, San Francisco, California, United States
  • Ayman Naseri
    Ophthalmology, UCSF, San Francisco, California, United States
    Ophthalmology, San Francisco VAMC, San Francisco, California, United States
  • Salomeh Keyhani
    Medicine, San Francisco VAMC, San Francisco, California, United States
  • Footnotes
    Commercial Relationships   Michael Ryan, None; Ayman Naseri, None; Salomeh Keyhani, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 2571. doi:
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      Michael Ryan, Ayman Naseri, Salomeh Keyhani; Visual Outcomes in Patients Undergoing Carotid Revascularization for Ocular Ischemic Syndrome. Invest. Ophthalmol. Vis. Sci. 2019;60(9):2571.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : The role of carotid artery imaging and revascularization for the treatment of ophthalmic disease remains controversial. This is especially true in patients without evidence of a transient ischemic attack (TIA) or retinal artery occlusion (RAO). In an effort to better understand the utility of carotid imaging and revascularization in this population, this study describes the visual and anatomic outcomes in patients who underwent carotid artery imaging and subsequent revascularization for a diagnosis of ocular ischemic syndrome (OIS).

Methods : This is an IRB-approved retrospective cohort study. Patient charts were reviewed and abstracted by trained abstractors. Five-year overall survival was calculated. Pre- and post-procedure visual acuity was compared using the paired t-test. The presence or absence of neovascularization pre- and post-procedure was comparted using McNemar’s test. The severity of patient's retinopathy was catogorized on a 4-point ordinal scale (none, mild, moderate, severe) and was compared pre- and post-procedure using the Wilcoxon signed-rank test.

Results : Fifty-four patients met eligibility criteria and were included in the study. Ninety-eight percent were male with a mean age of 73 years. Five-year overall survival in the cohort was 61%. There was no statistically significant difference in pre- and post-procedure visual acuity (p=0.80, paired t-test). There was no statistically significant difference in the proportion of eyes with neovascularization pre- or post-procedure (p=0.90, McNemar’s test). There was a statistically significant improvement in the severity of patient’s retinopathy, with a mean improvement of one step on a 4-point ordinal scale (Figure 1, p<0.001, Wilcoxin signed-rank).

Conclusions : Patients with OIS who undergo carotid artery revascularization see an improvement in the severity of their retinopathy. However, this is of uncertain benefit given a lack of improvement in either visual acuity or rates of neovascularization. The issue is further complicated by the high rate of mortality in this population and the periprocedural morbidity associated with revascularization procedures. Given that the patients included in this study did not have evidence of embolic disease (i.e., TIA or RAO), more judicious use of carotid imaging may be warranted.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

 

Histogram demonstrating the degree of improvement in patients' retinopathy following carotid artery revascularization.

Histogram demonstrating the degree of improvement in patients' retinopathy following carotid artery revascularization.

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