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Non-DR Retinal Vascular Diseases
Published in Ching-Yu Cheng, Tien Yin Wong, Ophthalmic Epidemiology, 2022
Sobha Sivaprasad, Luke Nicholson, Shruti Chandra
Ocular ischemic syndrome is a condition characterized by ocular signs secondary to severe and chronic arterial hypoperfusion. Severe carotid artery disease (stenosis or occlusion) is usually the most common cause for ocular hypoperfusion in these eyes. One of the first descriptions of this disease came in the year 1963 when Hedges described it in a 48-year-old woman with complete obstruction of her left internal carotid artery (121). The ophthalmoscopy findings were described as peripheral hemorrhages with dilated retinal veins and Hedges attributed these findings to retinal hypoxia. In the same year Kearns and Hollenhorst described a case with similar signs in the presence of advanced carotid artery stenosis and named it venous stasis retinopathy (122). They reported about 5% of their patients with unilateral stenosis occlusion of the carotid artery had features of venous stasis retinopathy.
Vascular Regeneration for Ischemic Retinopathies: Hope from Cell Therapies
Published in Current Eye Research, 2020
Pietro Maria Bertelli, Edoardo Pedrini, Jasenka Guduric-Fuchs, Elisa Peixoto, Varun Pathak, Alan W. Stitt, Reinhold J. Medina
Ocular ischemic syndrome (OIS) is an eye disease caused by the occlusion of the carotid artery, either common or internal.32,33 OIS is more prevalent in men than women and it is correlated to the incidence of atherosclerosis.33 The number of people affected by OIS is underestimated, due to inaccurate diagnosis, because of similarities with DR and RVO.33 The main hallmark of the disease is decreased blood flow in the ophthalmic artery. As a consequence, low perfusion in the retina leads to ocular ischemia.32 Due to OIS, patients present pathology in both anterior and posterior segment of the eye, with the former being more common than the latter. When the anterior segment is affected, signs of ischemia include fixed and dilated pupil, and at a later stage, corneal edema and neovascularization of the iris.33,34 The posterior segment shows decrease in venous and arterial size, with vessel leakage, hemorrhages and macular edema.32,34 Neovascularization in OIS is caused by increased VEGF, which occurs more at the level of the optic disc than in the retina.34 Accordingly, OIS was often correlated to ischemic optic neuropathy.32–34
Ocular manifestations of giant cell arteritis
Published in Expert Review of Ophthalmology, 2019
David F. Skanchy, Aroucha Vickers, Claudia M. Prospero Ponce, Andrew G. Lee
The ocular ischemic syndrome (OIS) is characterized by variable findings of anterior segment ischemia (e.g. corneal edema, cataract, ocular hypotony or glaucoma, or uveitis) as well as evidence for posterior segment (e.g. retinal, choroidal, or optic nerve) ischemia, and secondary neovascularization. Although OIS is typically due to ipsilateral internal carotid artery disease, GCA can also cause OIS. Increased metabolic demand on photoreceptors secondary to light or other physiologic changes, such as postural changes [56], can lead to recurrent episodes of retinal claudication, amaurosis fugax, and ocular pain [55]. During sleep there is a physiologic drop in blood pressure which can also cause transient ischemia and may explain the higher incidence of patients presenting with symptoms of GCA upon waking up in the morning [57].
Transient vision loss: a neuro-ophthalmic approach to localizing the diagnosis
Published in Expert Review of Ophthalmology, 2018
Helen Chung, Jodie M. Burton, Fiona E. Costello
The fundus examination should be approached with a view to looking at the integrity of the optic nerve and retina in patients with TVL. Individuals with raised ICP often show evidence of papilledema and absent spontaneous venous pulsations. Optic disc drusen as a form of pseudopapilledema can also cause transient visual obscurations (TVOs) by crowding the optic nerve head. Patients with elevated intraocular pressures may demonstrate glaucomatous cupping. Subclinical evidence of cotton wools spots can be seen in cases of active giant cell arteritis (GCA) prior to manifestations of more permanent vision loss, including anterior ischemic optic neuropathy and central retinal artery occlusion. Narrowed retinal arteries, dilated retinal veins, mid-peripheral retinal hemorrhages, and neovascularization of the optic disc and retina may be found in ocular ischemic syndrome.