Venous stasis retinopathy in symptomatic carotid artery occlusion: prevalence, cause, and outcome.
OBJECTIVE
Chronic ocular ischemia is a rare form of ischemia of the eye in patients with carotid artery occlusion (CAO). The early and often asymptomatic stage of chronic ocular ischemia is referred to as venous stasis retinopathy (VSR). The aim of this study was to gain insight into the prevalence, cause, and outcome of VSR in patients with symptomatic CAO.


METHODS
In 110 patients with symptomatic CAO, we prospectively investigated the frequency of VSR, the association between the presence of VSR and impaired cerebral blood flow, and the proportion of patients who developed clinically manifest chronic ocular ischemia with ischemia of the anterior eye segment or blindness.


RESULTS
At study entry, VSR was found in 32 patients (29%; 95% CI, 21 to 38), particularly in those with symptoms classically associated with a hemodynamic cause, such as limb shaking (relative risk, 2.4; 95% CI, 1.0 to 5.9). Patients with VSR had lower pulsatility indexes in the ophthalmic artery in case of reversed flow, lower cerebral CO2 reactivity, and lower cerebropetal blood flow than patients without VSR. On follow-up (mean, 29 months), clinically manifest chronic ocular ischemia developed in 4 patients (annual rate, 1.5%; 95% CI, 0.4 to 3.8); it tended to occur more often in patients in whom VSR was present at study entry (relative risk, 7.3; 95% CI, 0.8 to 68).


CONCLUSIONS
One third of patients with symptomatic CAO has VSR on ophthalmoscopy. VSR is associated with an impaired flow state of the brain. Development of clinically manifest chronic ocular ischemia is rare.
Klijn
Catharina J M
CJ
University Department of Neurology, University Medical Center Utrecht and the Rudolf Magnus Institute for Neurosciences, Utrecht, The Netherlands. c.j.m.klijn@neuro.azu.nl
Kappelle
L Jaap
LJ
van Schooneveld
Mary J
MJ
Hoppenreijs
Vincent P T
VP
Algra
Ale
A
Tulleken
Cornelis A F
CA
van Gijn
Jan
J
D001783:Blood Flow Velocity; D016893:Carotid Stenosis / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D002548:Cerebral Revascularization; D002560:Cerebrovascular Circulation; D018450:Disease Progression; D016894:Endarterectomy, Carotid; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging; D009887:Ophthalmoscopy; D015995:Prevalence; D011446:Prospective Studies; D012164:Retinal Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D012171:Retinal Vessels / Q000503:physiopathology; D017585:Ultrasonography, Doppler, Transcranial