A case of neovascular glaucoma secondary to ocular ischemia

Objective@#To present a case of neovascular glaucoma secondary to ocular ischemic syndrome following an uncomplicated phacoemulsification@*Methods@#This is a case description of a 74-year-old male who developed blurred vision and increased intraocular pressure (IOP) two months after an uncomplicated phacoemulsification cataract surgery with posterior chamber lens implantation of the left eye. There was iris neovascularization with absence of retinal dot/blot hemorrhages or neovascularization. The fluorescein angiogram (FA) showed delayed choroidal fluorescence and arteriovenous time. IOP-lowering medications and intravitreal injection of aflibercept were given. Carotid doppler test showed 70% stenosis of the ipsilateral artery but a subsequent magnetic resonance angiography (MRA) did not show evidence of significant stenosis. @*Results@#At his last consultation, visual acuity improved to counting fingers. IOP was maintained at 12 mmHg with one anti-glaucoma medication.@*Conclusion@#Ocular ischemia can confound the outcome of an uncomplicated cataract surgery. Doppler scans are usually chosen as the first-line exam for those suspected of carotid stenosis but, at times, may have contradictory results with MRA.

Recent advances in the diagnosis and management of Takayasu arteritis complicated with ocular ischemic syndrome / 中华眼底病杂志

Takayasu arteritis (TA) is a rare, chronic non-specific vasculitis that can lead to ocular hypoperfusion. As a result, ocular ischemic syndrome (OIS), which prominently manifests as Takayasu retinopathy, may develop subsequently. Ocular manifestations mainly consist of progressive painless vision loss and amaurosis fugax in TA patients complicated with OIS. However, due to the lack of specific clinical characteristics, it is of great significance to improve the timely diagnosis aided by multimodal imaging, especially fundus fluorescein angiography. Early diagnosis of OIS is essential for reversal of ocular ischemia and better prognosis of TA patients. Management of OIS patients associated with Takayasu arteritis requires a combination of systemic and ophthalmic treatment. Therefore, the optimal individualized regiment should be determined by disease activity and progression, which are addressed by multi-disciplinary team assessment. Ophthalmologists should further understand the clinical features and the importance of regular ophthalmologic examinations during the disease course, thus to improve the overall survival and visual outcomes.

Analysis of visual loss after non-ocular surgery / 国际眼科杂志(Guoji Yanke Zazhi)

@#Visual loss after non-ocular surgery(VLNOS)includes postoperative visual loss and perioperative visual loss after non-ocular surgery. The former accident consists of the blindness during a surgery or after a surgery, and the latter accident shows the acute visual loss in perioperative period. VLNOS can be appeared in a prone spinal surgery, cardiopulmonary bypass surgery, head and neck surgery, and facial micro-plastic injection treatment, which is a rare, extremely serious complication. VLNOS is divided into predictable and unpredictable condition. Doctors of related subjects have pay attention to VLNOS, and begin to study the possible reasons, and take positive precautions.

Clinical Features of Ocular Ischemic Syndrome and Risk Factors for Neovascular Glaucoma

PURPOSE: We aimed to examine the clinical features and prognosis of ocular ischemic syndrome and to investigate the risk factors for the development of neovascular glaucoma (NVG). METHODS: The medical records from 25 patients (25 eyes) who were diagnosed with ocular ischemic syndrome were retrospectively analyzed. We recorded the length of time between symptom onset and diagnosis, visual acuity, intraocular pressure, clinical findings of the anterior and posterior segments of the eye, fluorescein angiography, systemic diseases, smoking history, and the extent of any ipsilateral carotid artery stenosis. The risk factors for NVG in patients with ocular ischemic syndrome were investigated. RESULTS: The mean age was 67.9 ± 12.5 years, and 21 men and 4 women were included in this study. At initial examination, the mean logarithm of the minimum angle of resolution (logMAR) was 2.02 ± 1.26, and the mean intraocular pressure was 21.0 ± 10.3 mmHg. Among 25 eyes of the 25 patients, NVG occurred in 17 eyes after a mean period of 12.6 ± 14.0 months. The length of time between symptom onset and diagnosis (p = 0.025) and the extent of ipsilateral carotid artery stenosis (p = 0.032) were identified as significant risk factors for NVG. At the final follow-up, the mean logMAR visual acuity was 3.13 ± 1.24, showing a poor prognosis regardless of whether NVG occurred. CONCLUSIONS: Overall, the prognosis for ocular ischemic syndrome is very poor. The risk of NVG increases with the length of time between symptom onset and diagnosis, as well as with the severity of ipsilateral carotid artery stenosis.

Orbital Apex Syndrome after Uneventful Phacoemulsification

PURPOSE: We report a case of orbital apex syndrome associated with ocular ischemic syndrome after unenventful cataract surgery. CASE SUMMARY: A 74-year-old female came to our clinic with vision loss, ptosis, total ophthalmoplegia and ocular pain in the left eye after cataract surgery. On radiologic examination, diffuse hypertrophy of the extraocular muscles and a crowded orbital apex were observed. Additionally, the arm to retina and choroidal filling times were delayed on fluorescence angiography. Based on these findings, the patient was diagnosed with ocular ischemia complicated by orbital apex syndrome. After prompt pulse steroid therapy, improvement in extraocular muscle and pupil movement, ptosis and proptosis were observed; however, visual acuity failed to return to baseline. CONCLUSIONS: We report a rare case of orbital apex syndrome associated with ocular ischemic syndrome after cataract surgery, indicating the orbital apex syndrome may occur in healthy patients after uneventful cataract surgery.

Ocular and Systemic Manifestation of Amaurosis Fugax: Six-Year Observational Study

PURPOSE: To investigate the prevalence of ocular and systemic disease causing amaurosis fugax and to discuss the ocular and systemic manifestation of each disease. METHODS: Consecutive patients who had amaurosis fugax were retrospectively studied from 2007 to 2013. Carotid evaluation using Doppler was performed in all patients. Ocular and medical histories were taken and bilateral ophthalmic evaluation performed. RESULTS: This study included 35 patients. The mean age of patients was 63 years and 27 patients were male; 29 unilateral and 6 bilateral eyes were involved. Associated systemic disease included hypertension (54.3%) and diabetes mellitus (34.2%). The most frequent cause of amaurosis fugax was retinal artery occlusion (28.6%) followed by ocular ischemic syndrome (22.9%), other vascular diseases (11.4%), and retinal vein occlusion (5.7%). The remaining 31.4% patients with amaurosis fugax had no vascular disease. Clinically significant stenosis of the internal carotid artery was observed in 16 patients (45.7%) and 6 of these patients (37.5%) had retinal artery occlusion disease. CONCLUSIONS: Prevalence and clinical manifestation of amaurosis fugax is very complex. Patients with transient visual disturbance are at risk for retinal artery occlusion, ocular ischemic syndrome and other diseases which cause visual loss. Therefore, careful history taking and urgent systemic and ophthalmic evaluations should be performed.

Ocular ischemic syndrome: A classical presentation of an uncommon condition.

We report a 47-year-old male who presented with acute monoocular vision loss, and had classical signs of global ocular ischemia in the right eye. Fundus fl uorescein angiography demonstrated delayed choroidal fi lling and no perfusion of retinal vasculature. Carotid Doppler and computed tomogram (CT) angiography studies revealed extensive bilateral atherosclerotic disease involving the carotid circulation. Ophthalmologists must be aware of the possibility of this potentially fatal condition, which is extremely rare. An astute clinical diagnosis, targeted workup for systemic associations and a prompt referral may turn out to be life-saving.

Ophthalmic masquerades of the atherosclerotic carotids.

Patients with carotid atherosclerosis can present with ophthalmic symptoms. These symptoms and signs can be due to retinal emboli, hypoperfusion of the retina and choroid, opening up of collateral channels, or chronic hypoperfusion of the globe (ocular ischemic syndrome). These pathological mechanisms can produce many interesting signs and a careful history can bring out important past symptoms pointing toward the carotid as the source of the patient’s presenting symptom. Such patients are at high risk for an ischemic stroke, especially in the subsequent few days following their first acute symptom. It is important for clinicians to be familiar with these ophthalmic symptoms and signs caused by carotid atherosclerosis for making an early diagnosis and to take appropriate measures to prevent a stroke. This review elaborates the clinical features, importance, and implications of various ophthalmic symptoms and signs resulting from atherosclerotic carotid artery disease.

Establish of animal model of ocular ischemic syndrome / 中华实验眼科杂志

Ocular ischemic syndrome(OIS) is a disease seen in cardiology,ophthalmology,neurology and neurosurgery,which is characteristic by brain and ocular symptoms caused by carotid artery obstruction or stenosis.The diagnosis of OIS may be difficult because of its variable presentations and its concealed onset.What is more,its pathogenesis is not completely clear,and therefore its treating efficacy is dissatisfactory so far.The current study on OIS is focused on experimental research.So establishment of suitable animal model is important.Recently years,the creating method of OIS model made a great progress.The selection of model animals,extablishing methods of models and comparison of various models were summarized.

Treatment of Acute Central Retinal Artery Occlusion with Ocular Ischemic Syndrome

PURPOSE: We report a case of treatment of acute central retinal artery occlusion (CRAO) with ocular ischemic syndrome (OIS). CASE SUMMARY: A 72-year-old man presented with acute loss of vision in the right eye on that day. At initial examination, visual acuity tested positive for light sensitivity in the right eye. Fundus examination demonstrated a visible embolus at the central retinal artery overlying the optic disc head and a cherry-red spot in the fovea. Fluorescein angiography revealed that filling of the choroidal circulation was delayed, and the arteriovenous transit time was even further delayed. Carotid angiography showed marked stenosis within the right internal carotid artery. Laboratory tests included blood tests for hypercoagulability evaluation, for which the results were non-specific. To treat acute CRAO with OIS in the right eye, transluminal Nd:YAG laser embolectomy (TYE) was performed twice, and carotid angioplasty with stenting was conducted within the stenosed internal carotid artery. One month after the TYE procedure and carotid stenting, the patient's visual acuity improved to 0.06 and the arteriovenous transit time was within normal limits on fluorescein angiography. CONCLUSIONS: The visual prognosis in eyes with CRAO plus an associated choroidal circulatory disturbance is extremely poor. However, we experienced and reported a case of CRAO with OIS treated successfully through a prompt TYE procedure and carotid angioplasty with stenting.

A Case of Neovascular Glaucoma Secondary to Ocular Ischemic Syndrome in a Patient with Moyamoya Disease

PURPOSE: To report a case of neovascular glaucoma secondary to ocular ischemic syndrome in a patient with moyamoya disease, who was successfully treated with trabeculectomy. CASE SUMMARY: A 45-year-old woman suffered from slowly decreased vision in the right eye 3 months previously. Ocular pain with conjunctival injection of the right eye and headache developed 2 months earlier. She was diagnosed with moyamoya disease and had an encephaloduroarteriosynangiosis at the neurosurgery. The patient complained of persistent conjunctival injection and decreased vision of the right eye after surgery. At the initial visit, best corrected visual acuity (BCVA) of the right eye was 0.1 and intraocular pressure (IOP) was 42 mm Hg. Slit lamp examination revealed neovascularization of the iris and gonioscopy showed a 360degrees peripheral anterior synechiae. Fluorescein angiography demonstrated prolonged arteriovenous transit time in the right eye. On the electroretinogram, the amplitude of both a and b waves decreased in the right eye more than in the left eye. On the magnetic resonance angiography, narrowing of the right internal carotid artery was observed. The patient was diagnosed with neovascular glaucoma due to ocular ischemic syndrome caused by moyamoya disease. Panretinal photocoaguration, intravitreal bevacizumab injection and trabeculectomy with mitomycin-C soaking was performed in the right eye. At 8 months after surgery, BCVA of the right eye was 0.1, IOP was 17 mm Hg without antiglaucoma medication and bleb was maintained in good condition. CONCLUSIONS: The patient's results indicate that neovascular glaucoma can occur secondary to ocular ischemic syndrome caused by moyamoya disease.

Acute Visual Loss after Intravitreal Bevacizumab Injection in a Patient with Ocular Ischemic Syndrome

PURPOSE: To report a patient with ocular ischemic syndrome who suffered from sudden decrease in visual acuity after bevacizumab injection. CASE SUMMARY: A 70-year-old patient visited the Department of Ophthalmology due to progressively decreasing visual acuity in the right eye. Corrected visual acuity in his right eye was 0.1 on the first visit; ocular ischemic syndrome was suspected. Despite panretinal photocoagulation, severe iris neovascularization was still present in the right eye. Intravitreal bevacizumab injection was performed to regress the iris neovascularization. One day after injection, iris neovascularization regressed significantly, however, visual acuity was decreased to finger counting. CONCLUSIONS: In ocular ischemic syndrome, bevacizumab injection for reduction of iris neovascularization should be carefully considered due to possibility of acute visual loss.

Acute Visual Loss after Intravitreal Bevacizumab Injection in a Patient with Ocular Ischemic Syndrome

PURPOSE: To report a patient with ocular ischemic syndrome who suffered from sudden decrease in visual acuity after bevacizumab injection. CASE SUMMARY: A 70-year-old patient visited the Department of Ophthalmology due to progressively decreasing visual acuity in the right eye. Corrected visual acuity in his right eye was 0.1 on the first visit; ocular ischemic syndrome was suspected. Despite panretinal photocoagulation, severe iris neovascularization was still present in the right eye. Intravitreal bevacizumab injection was performed to regress the iris neovascularization. One day after injection, iris neovascularization regressed significantly, however, visual acuity was decreased to finger counting. CONCLUSIONS: In ocular ischemic syndrome, bevacizumab injection for reduction of iris neovascularization should be carefully considered due to possibility of acute visual loss.

Ocular Ischemic Syndrome Successfully Treated With Carotid Angioplasty and Stenting

PURPOSE: To report a case of ocular ischemic syndrome successfully treated with delayed carotid angioplasty and stenting (CAS). CASE SUMMARY: A 52-year-old male was admitted to our hospital because of amaurosis fugax-like symptoms in the right eye for several months. His visual acuity was 0.8 in the right eye and he did not have rubeosis iridis. Neovascularization of the disc, narrowing of the retinal artery and multiple retinal hemorrhages were diagnosed by fundus examination. Fluorescein angiography showed delayed choroidal filling, a delayed arm-to-retina time, prolongation of arteriovenous transit time, neovascularization of the disc, retinal capillary nonperfusion, and staining of the retinal vessels. MR angiography showed severe stenosis in the proximal portion of the right carotid artery. We diagnosed this case as ocular ischemic syndrome. The patient was recommended carotid angioplasty and stenting at the severely narrowed portion of the right carotid artery, but it was postponed about six months after diagnosis because of personal problems. At the final follow-up, 24 months after stenting, the amaurosis fugax symptoms had disappeared, the patient had an improved visual acuity of 1.0, and the new vessels on the disc changed to fibrous tissue. Fluorescein angiography showed resolution of the delayed arm-to-retina time and prolongation of the arteriovenous transit time, disappearances of the leakage around the disc and the retinal capillary nonperfusion.

Síndrome isquémico ocular / Ocular ischemic syndrome

El síndrome isquémico ocular es caracterizado por síntomas y signos oculares secundarios a la estenosis severa y prolongada ipsilateral de la arteria carótida interna extracraneal o de la arteria carótida común, ocasionalmente, se ha asociado a la oclusión de la arteria oftálmica. En general, se considera un diagnóstico poco usual y constituye la tercera causa más común de glaucoma neovascular con pobre pronóstico visual. Hallazgos oculares incluyen disminución progresiva de la visión, inflamación del segmento anterior, neovascularización del iris y del ángulo iridocorneal, glaucoma neovascular y retinopatía por hipoperfusión periférica. Describimos un paciente con severa estenosis carotídea ipsilateral y disminución progresiva de la visión por la isquemia ocular. Se realiza una revisión sobre el manejo de esta condición tan controversial

Ocular ischemic syndrome is characterized by ocular symptoms and signs that are secondary to prolonged and severe ipsilateral stenosis of extracranial internal carotid artery or of the common carotid artery; occasionally, ipsilateral ophthalmic artery obstruction can also be responsible. It is generally considered as an unusual diagnosis, and the 3rd most common cause in neovascular glaucoma with poor visual prognosis. Ocular findings include gradual onset of decreased vision, inflammation of the anterior segment, iris and iridocorneal angle neovascularization, neovascular glaucoma and peripheral hypoperfusion retinopathy. Here is a patient with l severe ipsilateral carotid stenosis and progressive visual loss due to ocular ischemia. A literature review on the best management of this so controversial condition was made

Clinical Features of Ophthalmic Artery Hypoperfusion

PURPOSE: The purpose of the study is to investigate the clinical features and relation of systemic disease of ophthalmic artery hypoperfusion (OAH). METHODS: We reviewed the records of 20 eyes of 19 ophthalmic artery hypoperfusionpatients who were followed up for 1month or more. The clinical outcome were reviewed, retrospectively. RESULTS: The patients' chief complain was sudden visual loss (14 eyes, 70.0%) and at initial visit, eyes with OAH had mean visual acuity more than or equal 0.5 in 55.0%. The most common ocular sign is the retinal hemorrhage and choroidal infarction and the most associated systemic disease in these patients is the hypertension in 63.2%. Normal patency or mild changes of the internal carotid artery was seen in 75.0% on the side of OAH. CONCLUSIONS: Ophthalmic artery hypoperfusion has a comparatively good visual prognosis. However, the ophthalmologist's diagnosis may be crucial to the health of these patients, because OAH includes ocular ischemic syndrome that may be the presenting sign of serious cerebrovascular and ischemic heart disease.

A Case of Neovascular Glaucoma Caused by Carotid Stenosis

Neovascular glaucoma (NVG) occurs when new fibrovascular tissues proliferate onto the chamber angle and obstruct the trabecular meshwork. We report a 62-year-old man who presented with progressive monocular visual loss that supervened on NVG. MR angiography and duplex sonography indicated stenosis of the right proximal internal carotid artery (ICA). A carotid endarterectomy was performed. But visual acuity was not improved. We suggest that early detection of NVG is critical for the prevention of visual loss and that rubeosis iridis and chemosis may be the clue to the presence of underlying carotid stenosis.

Color Doppler Imaging to Diagnose Ocular Disorders

Color Doppler imaging(CDI) facilitates the study of orbital vasculature by color encoding the Doppler frequency shifts of blood flow, superimposing this color on B-scan anatomic detail. In a patient with ocular ischemic syndrome, maximal systolic velocity of the ophthalmic artery in the ischemic eye was reduced markedly when compared with the contralateral control eye. CDI revealed no detectable blood flow velocities within the mass in cavernous hemangioma of the orbit. In a patient with carotid-cavernous fistula, CDI demonstrated a typical low-resistance blood flow pattern of the arterialized vein. Noninvasive CDI may be helpful diagnostic aid for disorders of the eye and orbit.

A Case of Ocular Ischemic Syndrome Associated with Right Internal Carotid Artery Obstruction

Ocular ischemic syndrome(OIS) occurs secondary to severe carotid artery obstruction and includes various ocular signs and symptoms such as conreal edema, rubeosis iridis, neovascular glaucoma, hypoperfusion retinopathy, and choroidal perfusion disturbance. It is often missed or misdiagnosed in the early stage because of its very diverse and sometimes subtle initial presentations. Furthermore it is more difficult to differentiate the ocular ischemic syndrome from diabetic retinopathy or central retinal vein oclusion in early presentations. The early diagnosis is crucial for the care of this patient because OIS usually has a poor visual prognosis in the late stage and may be the presenting sign of serious cerebrovascular and ischemic heart disease. We have experienced a case of ocular ischemic syndrome in a 45 year old man with diabetic retinopathy and hypertensive retinopathy who presented with a neovascular glaucoma associated with ipsilateral internal carotid artery obstruction.

A Case of Ocular Ischemic Syndrome Associated with Internal Carotid Artery Obstruction with Atheroma Diagnosed by Doppler Ultrasonography

The ocular ischemic syndrome includes the ocular symptoms and sins secondary to severe carotid artery obstruction and is characterized by rubeosis iridis, anterior uveitis, retinal hemorrhage, cherry red spot, and neovascularization of the disc and/or retina. Recently, the authors have experienced a case of ocular ischemic syndrome in a 82 years old woman, who had neovascular glaucoma associated with ipsilateral internal carotid artery obstruction. Diagnosis was made by doppler ultrasonographic finding of atheroma of internal carotid artery.