[Transient retinopathy after acute myocardial infarction treated by reperfusion therapy: clinical background and manifestation].
OBJECTIVE
The severe inflammatory reaction caused by acute myocardial infarction and reperfusion affects both the heart and other remote organs. The occurrence of retinopathy was evaluated in patients with acute myocardial infarction who underwent reperfusion therapy.


METHODS
We investigated 29 patients with first acute myocardial infarction who underwent successful reperfusion therapy within 24 hr of the onset. Ophthalmic examinations including visual acuity test and ocular fundoscopy were performed within 3 days, 2 weeks, and then monthly up to 3 months after the onset of acute myocardial infarction. Plasma levels of intercellular adhesion molecule-1(ICAM-1), interleukin-6 and high sensitivity C-reactive protein were measured on admission.


RESULTS
Soft exudates around the optic disc appeared in 17(58.6%) of the 29 patients, among whom 5 also developed superficial hemorrhages(17.2%). The retinopathy became most remarkable between 1 to 2 months after the onset of acute myocardial infarction and then faded away without any specific treatment. None of the patients had impairment of visual acuity, although 4 of the 17 patients with retinopathy complained of either blurred vision or metamorphopsia. Hypertension and/or diabetes mellitus tended to be more common in the retinopathy group than in the non-retinopathy group(59% vs 33%, p = 0.096). Plasma ICAM-1 levels were significantly higher than in the non-retinopathy group than in the retinopathy group(p = 0.017). There was no significant difference in plasma levels of interleukin-6 and high sensitivity C-reactive protein between the two groups.


CONCLUSIONS
Retinopathy may occur after reperfusion for acute myocardial infarction. The dominant manifestation is transient soft exudates reflecting spotty retinal ischemia, probably due to microvascular obstruction.
Katayama
Takuji
T
Department of Integrated Medicine 1, Omiya Medical Center, Jichi Medical School, Amanuma-cho 1-847, Saitama 330-8503.
Yasu
Takanori
T
Kinoshita
Nozomi
N
Kakehashi
Akihiro
A
Ueba
Hiroto
H
Hashimoto
Shigemasa
S
Kobayashi
Nobuhiko
N
Tsuruya
Yoshio
Y
Kubo
Norifumi
N
Fujii
Mikihisa
M
Kuroki
Masatoshi
M
Kawakami
Masanobu
M
Saito
Muneyasu
M
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000628:therapy; D015425:Myocardial Reperfusion / Q000009:adverse effects*; D012164:Retinal Diseases / Q000209:etiology*