Medical and statistical characteristics of ocular ischemic syndrome in patients with hemodynamically significant stenosis of the internal carotid artery: a cross-sectional study

BACKGROUND: One of the unresolved problems in the treatment of patients with ocular ischemic syndrome is the limited amount of data on regional features of its manifestations. AIM: To study the medical and statistical characteristics of ocular ischemic syndrome associated with hemodynamically significant atherosclerotic stenosis of the internal carotid artery in patients of Khabarovsk Krai. METHODS: A multicenter cross-sectional study with retrospective data analysis was conducted. The inclusion criterion was unilateral internal carotid artery stenosis of at least 70% according to the generally accepted North American Symptomatic Carotid Endarterectomy Trial classification. The frequency and presence of various manifestations of ocular ischemic syndrome were analyzed, the types of its course were quantified, and the staging of chronic ischemic retinopathy was examined. Additionally, concomitant vascular somatic pathology was assessed using discharge summaries and outpatient records. RESULTS: Using continuous sampling, 728 patients with hemodynamically significant atherosclerotic internal carotid artery stenosis of at least 70% were selected for the study. Various clinical manifestations of ocular ischemic syndrome were identified in 458 patients (62.9%). Signs of the acute type of its course were observed in 108 patients (23.6%). In particular, unilateral anterior ischemic optic neuropathy occurred in 61 eyes (56.5%), occlusion of the central retinal artery and its branches in 27 eyes (25%), and amaurosis fugax in 20 eyes (18.5%). The primary chronic type of ocular ischemic syndrome was registered in 350 patients (76.4%). At the same time, chronic ischemic optic neuropathy was noted in 54 eyes (15.4%), and chronic ischemic retinopathy in 296 eyes (84.6%). In turn, stage I chronic ischemic retinopathy was detected in 86 patients (86 eyes), stage II in 70 patients (70 eyes), and stage III in 140 patients (140 eyes). CONCLUSIONS: As a result of the analysis of the medical and statistical characteristics, ocular ischemic syndrome associated with hemodynamically significant atherosclerotic internal carotid artery stenosis was detected in 62.9% of cases. The primary chronic type of course, manifested by chronic ischemic retinopathy (84.6%), is diagnosed most often. The high prevalence of ocular ischemic syndrome, with predominance of its chronic forms, necessitates a multidisciplinary approach in the management of these patients. That is why, to ensure the most comprehensive medical and social rehabilitation of patients with ocular ischemic syndrome, timely and high-quality diagnosis by a vascular surgeon and ophthalmologist is necessary.