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To compare prevalence of carotid artery disease and its various types of lesions in different types of ocular arterial occlusive disorders.
614 consecutive patients (728 eyes) with ocular arterial occlusive disorders.
At first visit, all patients had a detailed ophthalmic and medical history, comprehensive ophthalmic evaluation, and carotid artery evaluation (by Doppler/angiography) on the side of ocular arterial occlusion, and echocardiography. The same ophthalmic evaluation was performed at each follow-up visit. Ocular arterial occlusive disorders were divided into central (CRAO) and branch (BRAO) retinal artery occlusion, ocular ischemic syndrome (OIS), non-arteritic anterior ischemic optic neuropathy (NA-AION) and amaurosis fugax (AF).
Carotid artery and echocardiographic abnormalities, and incidence of transient ischemic attack (TIA)/stroke and myocardial ischemia.
The study consists of a cohort of 266 eyes with NA-AION, 203 with CRAO, 127 with BRAO, 80 with OIS and 52 with AF. Carotid artery stenosis on the involved side was worse in AF and OIS compared to BRAO, CRAO, and NA-AION (p<0.0001). Presence of carotid artery plaques on the involved side was significantly higher in OIS, AF, and CRAO compared to NA-AION (p=0.002, p=0.003, and p=0.0003, respectively). Echocardiography revealed an embolic source in 61% of CRAO and 53% of BRAO compared to only 3% of NA-AION patients (p<0.0001). TIA/stroke before or after onset of ocular condition occurred in 17% of OIS, 11% of AF, 7% of CRAO, 6% of NA-AION, and 3% of BRAO patients. Kaplan-Meier estimate of the incidence of TIA /stroke within 3 months after onset was 6% (95% CI: 2%, 17%) for OIS, 3% (95% CI: 0.4%, 19%) for AF, and 1% (95% CI: 0.3%, 4.1%) for CRAO. Report of myocardial ischemia before or after onset of ocular condition was 52% in AF, 22% in OIS, 22% in BRAO, 21% in CRAO, and 6% in NA-AION patients.
The incidence of carotid artery stenosis and plaques, cardiac embolic source, TIA/stroke and myocardial ischemia differ among various ocular arterial occlusive disorders. The role of embolism and hemodynamic disturbances caused by carotid artery disease in these disorders is discussed.
Findings of our detailed studies on NA-AION are summarized elsewhere.1 Based on those studies, following diagnostic criteria were used:
Following well-established diagnostic criteria were used.
Following diagnostic criteria were used.
Our detailed study5 of 39 eyes with OIS showed following diagnostic criteria of OIS.
Based on our detailed study6 of amaurosis fugax in ocular vascular occlusive disorders, we used the following diagnostic criteria.
For this, the patients at the initial visit were referred for consultation to the vascular surgery department for carotid evaluation and to the cardiology department for cardiac evaluation.
TIA/stroke events before or after onset of ocular condition was reported in 6% (n=11) of NA-AION, 11% (n=5) of amaurosis fugax, 3% (n=4) of BRAO, 7% (n=14) of CRAO, and 17% (n=11) of OIS patients. For TIA/stroke after onset, the Kaplan-Meier estimate of the incidence of TIA/stroke within 3 months after onset was 3% (95% CI: 0.4%, 19%) for amaurosis fugax, 1% (95% CI: 0.3%, 4.1%) for CRAO, and 6% (95% CI: 2%, 17%) for OIS. Among BRAO and NA-AION patients, each had 2 patients who had a stroke/TIA more than 5 years after the onset.
Our study of 728 eyes in 614 consecutive patients with various ocular arterial occlusive disorders showed among them different incidences of carotid artery stenosis and plaques, and transient ischemic attack/stroke and myocardial ischemia.
Supported by grant EY-1151 from the National Institutes of Health.
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The authors have no conflict of interest.