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Ocular Ischemic Syndrome

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Albert and Jakobiec's Principles and Practice of Ophthalmology
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Abstract

Ocular ischemic syndrome (OIS) typically occurs when atherosclerotic disease leads to reduced ocular arterial inflow, ischemia, and vision loss and ocular sequelae. In this chapter we summarize the epidemiology and typical clinical and imaging findings of OIS. Along with discussion of workup is how to distinguish between the similar entities of central retinal vein occlusion (CRVO) and diabetic retinopathy. Finally, we review systemic and ocular treatments for OIS.

The authors would like to gratefully acknowledge Demetrios Vavvas, MD, PhD (MEEI), and Ruwan Amila Silva (Stanford) for their contributions to the images for this chapter.

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References

  1. Hedges TR. Ophthalmoscopic findings in internal carotid artery occlusion. Am J Ophthalmol. 1963;55:1007–12.

    Article  PubMed  Google Scholar 

  2. Kearns TP, Hollenhorst RW. Venous-stasis retinopathy of occlusive disease of the carotid artery. Proc Staff Meet Mayo Clin. 1963;38:304–12.

    CAS  PubMed  Google Scholar 

  3. Brown GC, Magargal LE. The ocular ischemic syndrome. Clinical, fluorescein angiographic and carotid angiographic features. Int Ophthalmol. 1988;11(4):239–51.

    Article  CAS  PubMed  Google Scholar 

  4. Mendrinos E, Machinis TG, Pournaras CJ. Ocular ischemic syndrome. Surv Ophthalmol. 2010;55(1):2–34.

    Article  PubMed  Google Scholar 

  5. Mosca L, Barrett-Connor E, Wenger NK. Sex/gender differences in cardiovascular disease prevention: what a difference a decade makes. Circulation. 2011;124(19):2145–54.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Sturrock GD, Mueller HR. Chronic ocular ischaemia. Br J Ophthalmol. 1984;68(10):716–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Terelak-Borys B, Skonieczna K, Grabska-Liberek I. Ocular ischemic syndrome – a systematic review. Med Sci Monit. 2012;18(8):RA138–44.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Magargal LE, Sanborn GE, Zimmerman A. Venous stasis retinopathy associated with embolic obstruction of the central retinal artery. J Clin Neuroophthalmol. 1982;2(2):113–8.

    CAS  PubMed  Google Scholar 

  9. Costa VP, Kuzniec S, Molnar LJ, Cerri GG, Puech-Leão P, Carvalho CA. Collateral blood supply through the ophthalmic artery: a steal phenomenon analyzed by color Doppler imaging. Ophthalmology. 1998;105(4):689–93.

    Article  CAS  PubMed  Google Scholar 

  10. Sivalingam A, Brown GC, Magargal LE. The ocular ischemic syndrome. III. Visual prognosis and the effect of treatment. Int Ophthalmol. 1991;15(1):15–20.

    Article  CAS  PubMed  Google Scholar 

  11. Duker JS, Belmont JB. Ocular ischemic syndrome secondary to carotid artery dissection. Am J Ophthalmol. 1988;106(6):750–2.

    Article  CAS  PubMed  Google Scholar 

  12. Sakthiswary R, Syazarina SO, Shaharir SS, Said MSM, Hanom F. Blindness in a pulseless young woman: lessons learned. Ocul Immunol Inflamm. 2012;20(4):309–11.

    Article  PubMed  Google Scholar 

  13. Hamed LM, Guy JR, Moster ML, Bosley T. Giant cell arteritis in the ocular ischemic syndrome. Am J Ophthalmol. 1992;113(6):702–5.

    Article  CAS  PubMed  Google Scholar 

  14. Imrie FR, Hammer HM, Jay JL. Bilateral ocular ischaemic syndrome in association with hyperhomocysteinaemia. Eye. 2002;16(4):497–500.

    Article  CAS  PubMed  Google Scholar 

  15. Hong IH, Ahn JK, Chang S, Park SP. Diagnostic efficacy of total homocysteine and C-reactive protein for ocular ischemic syndrome. Eye. 2011;25(12):1650–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Effeney DJ, Krupski WC, Stoney RJ, Ehrenfeld WK. Fibromuscular dysplasia of the carotid artery. Aust N Z J Surg. 1983;53(6):527–31.

    Article  CAS  PubMed  Google Scholar 

  17. Tang Y, Luo D, Peng W, Huang F, Peng Y. Ocular ischemic syndrome secondary to carotid artery occlusion as a late complication of radiotherapy of nasopharyngeal carcinoma. J Neuroophthalmol. 2010;30(4):315–20.

    Article  PubMed  Google Scholar 

  18. Salinas-La Rosa CM. Malignant transformation of optic nerve melanocytoma into melanoma associated with ocular ischemic syndrome and oculocardiac reflex: case report and review of the literature. Semin Ophthalmol. 2017;32(2):253–6.

    Article  PubMed  Google Scholar 

  19. Papavasileiou E, Sobrin L, Papaliodis GN. Ocular ischemic syndrome presenting as retinal vasculitis in a patient with moyamoya syndrome. Retin Cases Brief Rep. 2015;9(2):170–2.

    Article  PubMed  Google Scholar 

  20. Dhobb M, Ammar F, Bensaid Y, Benjelloun A, Benabderrazik T, Benyahia B. Arterial manifestations in Behçet’s disease: four new cases. Ann Vasc Surg. 1986;1(2):249–52.

    Article  CAS  PubMed  Google Scholar 

  21. Sadun AA, Sebag J, Bienfang DC. Complete bilateral internal carotid artery occlusion in a young man. J Clin Neuroophthalmol. 1983;3(1):63–6.

    CAS  PubMed  Google Scholar 

  22. Huang Z-L, Lin K-H, Lee Y-C, Sheu M-M, Tsai R-K. Acute vision loss after intravitreal injection of bevacizumab (avastin) associated with ocular ischemic syndrome. Ophthalmologica. 2010;224(2):86–9.

    Article  CAS  PubMed  Google Scholar 

  23. Mizener JB, Podhajsky P, Hayreh SS. Ocular ischemic syndrome. Ophthalmology. 1997;104(5):859–64.

    Article  CAS  PubMed  Google Scholar 

  24. Bullock JD, Falter RT, Downing JE, Snyder HE. Ischemic ophthalmia secondary to an ophthalmic artery occlusion. Am J Ophthalmol. 1972;74(3):486–93.

    Article  CAS  PubMed  Google Scholar 

  25. Winterkorn JM, Beckman RL. Recovery from ocular ischemic syndrome after treatment with verapamil. J Neuroophthalmol. 1995;15(4):209–11.

    Article  CAS  PubMed  Google Scholar 

  26. Hayreh SS, Zimmerman MB. Amaurosis fugax in ocular vascular occlusive disorders: prevalence and pathogeneses. Retina. 2014;34(1):115–22.

    Article  PubMed  Google Scholar 

  27. Aasen J, Kerty E, Russell D, Bakke SJ, Nyberg-Hansen R. Amaurosis fugax: clinical, Doppler and angiographic findings. Acta Neurol Scand. 1988;77(6):450–5.

    Article  CAS  PubMed  Google Scholar 

  28. Donnan GA, Sharbrough FW, Whisnant JP. Carotid occlusive disease. Effect of bright light on visual evoked response. Arch Neurol. 1982;39(11):687–9.

    Article  CAS  PubMed  Google Scholar 

  29. Kerty E, Eide N. Chronic ocular ischaemia. Acta Ophthalmol. 1989;67(4):386–92.

    Article  CAS  Google Scholar 

  30. Perera S, Ali H, Hoffman J, Ceccherini A. A case of dry eye secondary to ocular ischemic syndrome due to carotid artery occlusion. Cont Lens Anterior Eye. 2015;38(3):226–7.

    Article  PubMed  Google Scholar 

  31. Chen CS, Miller NR. Ocular ischemic syndrome: review of clinical presentations, etiology, investigation, and management. Compr Ophthalmol Update. 2007;8(1):17–28.

    PubMed  Google Scholar 

  32. Klijn CJM, Kappelle LJ, van Schooneveld MJ, Hoppenreijs VPT, Algra A, Tulleken CAF, et al. Venous stasis retinopathy in symptomatic carotid artery occlusion: prevalence, cause, and outcome. Stroke. 2002;33(3):695–701.

    Article  PubMed  Google Scholar 

  33. Campo RV, Reeser FH. Retinal telangiectasia secondary to bilateral carotid artery occlusion. Arch Ophthalmol. 1983;101(8):1211–3.

    Article  CAS  PubMed  Google Scholar 

  34. Brown GC. Macular edema in association with severe carotid artery obstruction. Am J Ophthalmol. 1986;102(4):442–8.

    Article  CAS  PubMed  Google Scholar 

  35. Bogousslavsky J, Pedrazzi PL, Borruat FX, Regli F. Isolated complete orbital infarction: a common carotid artery occlusion syndrome. Eur Neurol. 1991;31(2):72–6.

    Article  CAS  PubMed  Google Scholar 

  36. Nguyen HV, North V, Oellers P, Husain D. Saturday night retinopathy after intranasal heroin. J Vitreo Retin Dis. 2018;2(4):227–31.

    Article  Google Scholar 

  37. Kang HM, Lee CS, Lee SC. Thinner subfoveal choroidal thickness in eyes with ocular ischemic syndrome than in unaffected contralateral eyes. Graefes Arch Clin Exp Ophthalmol. 2014;252(5):851–2.

    Article  PubMed  Google Scholar 

  38. Willerslev A, Li XQ, Cordtz P, Munch IC, Larsen M. Retinal and choroidal intravascular spectral-domain optical coherence tomography. Acta Ophthalmol. 2014;92(2):126–32.

    Article  PubMed  Google Scholar 

  39. Wang H, Wang Y, Li H. Multimodality imaging assessment of ocular ischemic syndrome. J Ophthalmol. 2017;2017(1):4169135–9.

    PubMed  PubMed Central  Google Scholar 

  40. Feucht N, Zapp D, Reznicek L, Lohmann CP, Maier M, Mayer CS. Multimodal imaging in acute retinal ischemia: spectral domain OCT, OCT-angiography and fundus autofluorescence. Int J Ophthalmol. 2018;11(9):1521–7.

    PubMed  PubMed Central  Google Scholar 

  41. Lupidi M, Fiore T, Cerquaglia A, Coscas G, Cagini C. Depth-resolved imaging of papillary vitreoretinal neovascularization: OCT-angiography assessment in ocular ischemic syndrome. Retina. 2017;37(4):e42–4.

    Article  PubMed  Google Scholar 

  42. Banchini E, Franchi A, Magni R, Villani LG, Lodigiani L, Cordella M, et al. Carotid occlusive disease: an electrophysiological macular investigation. J Cardiovasc Surg. 1987;28(5):524–7.

    CAS  Google Scholar 

  43. Castaldo JE, Nicholas GG, Gee W, Reed JF. Duplex ultrasound and ocular pneumoplethysmography concordance in detecting severe carotid stenosis. Arch Neurol. 1989;46(5):518–22.

    Article  CAS  PubMed  Google Scholar 

  44. Neale ML, Chambers JL, Kelly AT, Connard S, Lawton MA, Roche J, et al. Reappraisal of duplex criteria to assess significant carotid stenosis with special reference to reports from the North American Symptomatic Carotid Endarterectomy Trial and the European Carotid Surgery Trial. J Vasc Surg. 1994;20(4):642–9.

    Article  CAS  PubMed  Google Scholar 

  45. Sivalingam A, Brown GC, Magargal LE, Menduke H. The ocular ischemic syndrome. II. Mortality and systemic morbidity. Int Ophthalmol. 1989;13(3):187–91.

    Article  CAS  PubMed  Google Scholar 

  46. Hwang JM, Girkin CA, Perry JD, Lai JC, Miller NR, Hellmann DB. Bilateral ocular ischemic syndrome secondary to giant cell arteritis progressing despite corticosteroid treatment. Am J Ophthalmol. 1999;127(1):102–4.

    Article  CAS  PubMed  Google Scholar 

  47. Hayreh SS, Zimmerman MB. Ocular arterial occlusive disorders and carotid artery disease. Ophthalmol Retina. 2017;1(1):12–8.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Kearns TP. Differential diagnosis of central retinal vein obstruction. Ophthalmology. 1983;90(5):475–80.

    Article  CAS  PubMed  Google Scholar 

  49. Barnett HJ, Taylor DW, Eliasziw M, Fox AJ, Ferguson GG, Haynes RB, et al. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. 1998;339(20):1415–25.

    Article  CAS  PubMed  Google Scholar 

  50. Kawaguchi S, Sakaki T, Kamada K, Iwanaga H, Nishikawa N. Effects of superficial temporal to middle cerebral artery bypass for ischaemic retinopathy due to internal carotid artery occlusion/stenosis. Acta Neurochir. 1994;129(3–4):166–70.

    Article  CAS  PubMed  Google Scholar 

  51. Edwards MS, Chater NL, Stanley JA. Reversal of chronic ocular ischemia by extracranial-intracranial arterial bypass: case report. Neurosurgery. 1980;7(5):480–3.

    Article  CAS  PubMed  Google Scholar 

  52. Shibuya M, Suzuki Y, Takayasu M, Sugita K. Effects of STA-MCA anastomosis for ischaemic oculopathy due to occlusion of the internal carotid artery. Acta Neurochir. 1990;103(1–2):71–5.

    Article  CAS  PubMed  Google Scholar 

  53. Hauch TL, Busuttil RW. Yoshizumi MO. A report of iris neovascularization: an indication for carotid endarterectomy. Surgery. 1984;95(3):358–62.

    CAS  PubMed  Google Scholar 

  54. Hegland O, Kurz MW, Munk PS, Larsen JP. The effect of statin therapy on the progression of carotid artery stenosis in relation to stenosis severity. Acta Neurol Scand. 2010;121(1):11–5.

    Article  CAS  PubMed  Google Scholar 

  55. Carter JE. Panretinal photocoagulation for progressive ocular neovascularization secondary to occlusion of the common carotid artery. Ann Ophthalmol. 1984;16(6):572–6.

    CAS  PubMed  Google Scholar 

  56. Johnston ME, Gonder JR, Canny CL. Successful treatment of the ocular ischemic syndrome with panretinal photocoagulation and cerebrovascular surgery. Can J Ophthalmol. 1988;23(3):114–9.

    CAS  PubMed  Google Scholar 

  57. Klais CM, Spaide RF. Intravitreal triamcinolone acetonide injection in ocular ischemic syndrome. Retina. 2004;24(3):459–61.

    Article  PubMed  Google Scholar 

  58. Amselem L, Montero J, Diaz-Llopis M, Pulido JS, Bakri SJ, Palomares P, et al. Intravitreal bevacizumab (Avastin) injection in ocular ischemic syndrome. Am J Ophthalmol. 2007;144(1):122–4.

    Article  CAS  PubMed  Google Scholar 

  59. Choi EY, Lee SC, Kim M. Optical coherence tomography angiography before and after bevacizumab injection in ocular ischemic syndrome. Retina. 2018;38(3):e23–5.

    Article  PubMed  Google Scholar 

  60. Kofoed PK, Munch IC, Larsen M. Profound retinal ischaemia after ranibizumab administration in an eye with ocular ischaemic syndrome. Acta Ophthalmol. 2010;88(7):808–10.

    Article  PubMed  Google Scholar 

  61. Jo YJ, Min JK, Woo JM, Yim JH. Acute vision loss associated with retinal circulatory disturbances after intravitreal injection of bevacizumab. J Ocul Pharmacol Ther. 2013;29(1):79–83.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to David M. Wu .

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Nguyen, H.V., Wu, D.M. (2021). Ocular Ischemic Syndrome. In: Albert, D., Miller, J., Azar, D., Young, L.H. (eds) Albert and Jakobiec's Principles and Practice of Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-319-90495-5_36-1

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  • DOI: https://doi.org/10.1007/978-3-319-90495-5_36-1

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