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Visual Outcomes in Patients Undergoing Carotid Revascularization for Ocular Ischemic Syndrome

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Posterboard#: B0102

Abstract Number: 2571 - B0102

AuthorBlock: Michael Ryan1, Ayman Naseri1,2, Salomeh Keyhani3
1Ophthalmology, UCSF, San Francisco, California, United States; 2Ophthalmology, San Francisco VAMC, San Francisco, California, United States; 3Medicine, San Francisco VAMC, San Francisco, California, United States;

DisclosureBlock: Michael Ryan, None; Ayman Naseri, None; Salomeh Keyhani, None;

Purpose
The role of carotid artery imaging and revascularization for the treatment of ophthalmic disease remains controversial. This is especially true in patients without evidence of a transient ischemic attack (TIA) or retinal artery occlusion (RAO). In an effort to better understand the utility of carotid imaging and revascularization in this population, this study describes the visual and anatomic outcomes in patients who underwent carotid artery imaging and subsequent revascularization for a diagnosis of ocular ischemic syndrome (OIS).

Methods
This is an IRB-approved retrospective cohort study. Patient charts were reviewed and abstracted by trained abstractors. Five-year overall survival was calculated. Pre- and post-procedure visual acuity was compared using the paired t-test. The presence or absence of neovascularization pre- and post-procedure was comparted using McNemar’s test. The severity of patient's retinopathy was catogorized on a 4-point ordinal scale (none, mild, moderate, severe) and was compared pre- and post-procedure using the Wilcoxon signed-rank test.

Results
Fifty-four patients met eligibility criteria and were included in the study. Ninety-eight percent were male with a mean age of 73 years. Five-year overall survival in the cohort was 61%. There was no statistically significant difference in pre- and post-procedure visual acuity (p=0.80, paired t-test). There was no statistically significant difference in the proportion of eyes with neovascularization pre- or post-procedure (p=0.90, McNemar’s test). There was a statistically significant improvement in the severity of patient’s retinopathy, with a mean improvement of one step on a 4-point ordinal scale (Figure 1, p<0.001, Wilcoxin signed-rank).

Conclusions
Patients with OIS who undergo carotid artery revascularization see an improvement in the severity of their retinopathy. However, this is of uncertain benefit given a lack of improvement in either visual acuity or rates of neovascularization. The issue is further complicated by the high rate of mortality in this population and the periprocedural morbidity associated with revascularization procedures. Given that the patients included in this study did not have evidence of embolic disease (i.e., TIA or RAO), more judicious use of carotid imaging may be warranted.

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