Ocular ischemic syndrome

Retinography (Clarus 700, Zeiss): deep peripheral (blot) hemorrhages and microaneurysms in 360º of both eyes

Four months after surgery, the hemorrhages have disappeared, although some microaneurysms are still observed

FAG (Clarus 700, Zeiss): numerous peripheral microaneurysms in both eyes

Description

An 80-year-old male presents with floaters in both eyes.

Visual acuity is 20/25 in both eyes. Examination of the anterior segment is unremarkable. Fundus examination reveals multiple dot and blot hemorrhages and what appear to be microaneurysms in the 360° periphery of both eyes. Fluorescein angiography confirms the presence of numerous peripheral microaneurysms in 360° in both eyes. No macular edema is observed on OCT. In addition to ruling out DM, hypertension, and blood dyscrasias, the patient is referred to a vascular surgeon who, on Doppler ultrasound of the supra-aortic trunks, finds severe stenosis in both internal carotid arteries. The diagnosis of bilateral ocular ischemic syndrome is confirmed. Four months after endarterectomy surgery, the hemorrhages have disappeared, with some microaneurysms persisting.

Comments

Ocular ischemic syndrome is a rare disease associated with severe carotid occlusive disease (stenosis or occlusion) that produces ocular hypoperfusion. The symptoms and signs that appear are secondary to choroidal and retinal ischemia. In fluorescein angiography, delayed choroidal and retinal filling, peripheral microaneurysms, and, in 15% of cases, macular edema are observed. The diagnosis is confirmed by Doppler ultrasound of the carotid arteries (common and internal). The treatment of carotid stenosis is the responsibility of the vascular surgeon, with the ophthalmologist being responsible for treating complications arising from ocular ischemia if they occur.

Description

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Indication