Visual outcomes after carotid reconstructive surgery for ocular ischemia.

AIMS: This study aimed to determine the influence of carotid artery surgery on ocular functions and ocular blood flow in patients with ocular ischaemic syndrome (OIS) in the late postoperative period. METHODS: One hundred and eighty patients with OIS were operated on; 104 of them suffered from acute forms of the ischaemic disease and 76 patients had chronic forms of ocular ischaemia. Before surgery and in the course of 6 months and 12 months afterwards, all the patients were examined. Visual acuity, electrophysiological investigations (the threshold of electrical sensitivity (TES) and the level of liability of optic nerve (LON)) and blood flow in orbital vessels were assessed. RESULTS: After surgery visual acuity increased in patients with the acute forms of OIS (P<0.05). TES and LON also improved (P<0.01). Mean indices of blood-flow velocities in the ophthalmic artery, the central retinal artery and the posterior ciliary arteries increased at 6 and 12 months after surgery (P<0.05). There was ocular blood flow acceleration and decrease of vasoresistance in orbital arteries in both groups of patients. CONCLUSIONS: Carotid artery surgery effectively improved ocular blood flow in patients with acute and chronic forms of OIS in the late post operative period.

[Current approach for hypertension retinopathy screening and diagnosis].

Literature review is devoted to early diagnosis and screening of hypertension retinopathy (HR). The data of large epidemiological trials are presented, they prove an association of HR with stroke, coronary heart disease, risk stratification of these conditions is estimated, besides effect of blood pressure level on HR signs onset is studied. Pathophysiology of main clinical stages of retina impairment in arterial hypertension is discussed. Early diagnosis using ophthalmoscopy, fundus photo, hemodynamics and hydrodynamics studies is of great importance. Using classification clinicians can control and monitor patients without HR signs, screen risk factors of cardiovascular diseases in patients with mild HR. According to classification the following stages are presented: no HR signs, mild and moderate stages and malignant HR.

[A case of vasoocclusive retinal damage in moya-moya disease].

Retinal vessel occlusion and eye haemodynamics damage is described in moya-moya disease, a rare occlusive cerebrovascular condition characterized by progressing stenosis and occlusion of cerebral arteries with collateral development in basal vascular system. Data concerning neuroophthalmological features, diagnostic and treatment methods are presented. Necessity of MR-tomography and MR-angiography in ischemic retinal damage is emphasized.

[Changes in the organ of vision in pathological tortuosity and atherosclerotic stenosis of the carotid arteries].

Pathological tortuosity of the carotid arteries is a cause of not only cerebral circulatory disorders, but also visual impairments. There are nonspecific and specific signs of circulatory disorders in the anterior ocular segment - bulbar conjunctiva. In pathological tortuosity of the carotid arteries visual impairments are divided into transient, acute, and chronic. Transient impairments include amaurosis fugax, ocular and orbital pains; acute impairments involve ischemic uveitis, acute retinal ischemia, acute ischemic oculopathy, anterior and posterior ischemic optic neuropathy; chronic visual impairments comprise ischemic uveal, chorioidal, retinal, and ocular neuropathy. Noninvasive ultrasound techniques involving carotid duplex scanning and color Doppler mapping of ocular and orbital vessels are the most objective studies of patients with visual impairments in pathological tortuosity of the carotid arteries.

[Pathological kinking of carotid arteries as a risk factor for age-related macular degeneration].

The present work was aimed at studying clinical symptoms and the incidence rate of age-related macular degeneration (ARMD) in patients diagnosed with pathological kinking of carotid arteries. A total of 63 patients presenting with pathological kinking of carotid arteries were examined. Of these, 58 were found to have age-related macular degeneration manifesting itself by degenerative alterations in the retinal pigment epithelium (RPE) in 14 (24.14%) patients, hard retinal drusen in 22 (37.93%) patients, and by a combination of hard retinal drusen with evidence of RPE degeneration in 22 (37.93%) subjects. Besides the conventional ophthalmologic methods of examination including the determination of visual acuity under standard conditions of illumination, biomicroscopy, both direct and indirect ophthalmoscopy, perimetry, and tonometry, all patients were subjected to ultrtasonographic Doppler mapping of the ophthalmic arteries, as well as colour duplex scanning (CDS) of the brachiocephalic arteries, transcranial Doppler ultrasonography and helical computed tomography. The obtained findings revealed that 92% of the examined patients presenting with pathological kinking of the internal carotid arteries had symptoms of non-exudative forms of ARMD and signs of blood flow deficiency in the ophthalmic arteries. In this connection, it appears appropriate to carry out colour duplex scanning of the brachiocephalic arteries in order to reveal pathological kinking of the carotid arteries and decide upon further treatment policy.