Clinical significance of retinal emboli during diagnostic and therapeutic cardiac catheterization in patients with coronary artery disease.
BACKGROUND
Cardiac catheterization may cause retinal embolization, a risk factor for cerebrovascular emboli and stroke. We describe the incidence of clinically silent and apparent retinal emboli following diagnostic and interventional coronary catheterization and associated risk factors.


METHODS
Three hundred selected patients attending a tertiary referral center for diagnostic and therapeutic cardiac catheterization were studied. Retinal examination and examination of the visual field and acuity were done before and after catheterization by a retinal specialist.


RESULTS
There were 5 case of retinal embolus before catheterization, and 19 patients (incidence 6.3%) developed new retinal arteriolar emboli after catheterization. Only 1 patient developed clinically apparent changes in vision. Two conventional risk factors (age and hypertension) were significantly associated with new retinal emboli. The risk of retinal emboli was also significantly associated with operator expertise.


CONCLUSIONS
Retinal embolism was found after coronary catheterization in 6.3% of our patients. This finding indicates that the retinal, and possibly the cerebral circulation, may be compromised more frequently than is clinically apparent as a complication of coronary catheterization. Age and hypertension are independent predictors of retinal embolism.
Department of Cardiology, Shiraz University of Medical Sciences,Shiraz, Iran. kojurij@yahoo.com
Javad
J
Kojuri
Morteza
M
Mehdizadeh
Hamed
H
Rostami
Danial
D
Shahidian
D000367:Age Factors; D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D004617:Embolism / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012164:Retinal Diseases / Q000453:epidemiology / Q000209:etiology / Q000473:pathology*; D012171:Retinal Vessels / Q000473:pathology*; D012307:Risk Factors
J Invasive Cardiol. 2007 Jan;19(1):40-5
17297185
Catheter Cardiovasc Interv. 2002 Jul;56(3):320-7
12112883
Circulation. 2005 Dec 20;112(25):3833-8
16365207
J Am Coll Cardiol. 2008 Mar 4;51(9):906-11
18308158
Radiology. 2005 Apr;235(1):177-83
15731373
Neurology. 1998 Jul;51(1):318-9
9674837
J Am Coll Cardiol. 2003 Jul 16;42(2):217-8
12875754
Jpn Heart J. 2002 Mar;43(2):187-92
12025906
Neurology. 2000 May 23;54(10):2023-4
10822453
Stroke. 2008 Nov;39(11):3086-7
18703808
Lancet. 1999 Nov 6;354(9190):1594-7
10560674
Stroke. 2000 Oct;31(10):2508-10
11022086
Lancet. 1986 Oct 11;2(8511):837-9
2876281
Invest Ophthalmol Vis Sci. 2005 Jun;46(6):2133-9
15914634
Arch Ophthalmol. 1999 Aug;117(8):1063-8
10448750
Stroke. 2008 Apr;39(4):1371-9
18309171
Neurology. 2001 Apr 10;56(7):975-7
11294941
Pediatr Cardiol. 2008 Jul;29(4):830-3
18094913
Stroke. 2007 Aug;38(8):2370-52
17585084
Ann Intern Med. 1995 Feb 15;122(4):249-53
7825759