Carotid Reconstruction for Ocular Ischemic Syndrome Can We Predict the Visual Outcome?

Ocular ischemic syndrome is a progressive disorder that results from ocular ischemia in occlusive diseases of the carotid system. Ocular manifestations of 16 patients with ocular ischemic syndrome were evaluated retrospectively before and after carotid artery surgery. Although carotid endarterectomy (CEA) and carotid bypass surgery were beneficial to stabilize the ocular manifestations of nine eyes with amaurosis fugax and hypoperfusion retinopathy, ipsilateral blindness due to retinal artery occlusion developed following CEA in one eye. Conversely, carotid artery surgery in ocular ischemic syndrome with iris neovascularization has not been successful in stabilizing the ocular manifestations. As expected, carotid bypass surgery did not resolve neovascular glaucoma due to iris neovascularization in two eyes and was followed by an elevation of normal intraocular pressure in one eye. One eye with iris neovascularization developed an intractable glaucoma following CEA. The presence of iris neovascularization suggests poor visual prognosis after carotid artery surgery. The development of retinal artery occlusion and secondary glaucoma after CEA should be listed as postoperative ocular complications of carotid artery surgery. In conclusion, carotid artery surgery is effective for ocular ischemic syndrome before the onset of iris neovascularization. Presence of iris neovascularization needs careful indication of carotid artery surgery to prevent the elevation of intraocular pressure.