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Ocular Ischemic Syndrome Treatment & Management

  • Author: Igal Leibovitch, MD; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Mar 17, 2015
 

Medical Care

Ocular treatments

Ocular treatment may include the following:

  • Panretinal photocoagulation to treat neovascularization of the iris, optic nerve, or retina. It was reported to cause regression of neovascularization in about one third of patients with ocular ischemic syndrome (OIS). [2, 19, 20]
  • Topical medication to lower intraocular pressure
  • Cyclodiathermy and cyclocryotherapy to lower intraocular pressure
  • Intravitreal steroids - Possible adjunct therapy in cases of recurrent cystoid macular edema in OIS [21]
  • Ocular filtering procedures and implantation of glaucoma drainage valves to treat neovascular glaucoma

Systemic treatments

Systemic treatments may include the following:

  • Antiplatelet therapy
  • Thrombolytic therapy: Potential benefits of thrombolytic therapy include fast dissolution of physiologically compromising pulmonary emboli, faster recovery, prevention of recurrent thrombus formation, and rapid restoration of hemodynamic disturbances.
  • Steroids (when giant cell arteritis is suspected)
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Surgical Care

Carotid endarterectomy

A small number of publications have reported on the ophthalmic outcome of carotid endarterectomy in patients with OIS, and the data presented are not conclusive.[22]

Carotid endarterectomy has been shown to benefit symptomatic patients with a nondisabling stroke, amaurosis fugax, and a hemispheric transient ischemic attack whose carotid stenosis is 70-99%.

The North American Symptomatic Carotid Endarterectomy Trial Collaborators found a 2-year stroke rate of 9% in such patients who underwent endarterectomy versus a 26% rate in those treated with antiplatelet therapy alone. Stabilization or improvement of visual acuity occurs in about 25% of eyes following endarterectomy.[23]

Superficial temporal artery to middle cerebral artery anastomoses

Bypass procedures, such as superficial temporal artery to middle cerebral artery anastomoses (STA-MCA), have been tried in patients with 100% carotid obstruction in whom a thrombus has propagated distally and an endarterectomy is precluded.

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Consultations

Consultations may include the following:

  • Cardiology
  • Cardiovascular surgery
  • Neurology
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Diet

A strict, low-fat diet is recommended. A low-salt and low-sugar diet is recommended for patients with hypertension and diabetes.

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Contributor Information and Disclosures
Author

Igal Leibovitch, MD Consulting Staff, Oculoplastic and Orbital Division, Department of Ophthalmology, Tel-Aviv Medical Center, Israel

Igal Leibovitch, MD is a member of the following medical societies: American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Coauthor(s)

Sherif M El-Harazi, MD, MPH Private Practice in Ophthalmology

Sherif M El-Harazi, MD, MPH is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Cataract and Refractive Surgery, International Society of Refractive Surgery

Disclosure: Nothing to disclose.

Diego Calonje, MD Consulting Staff, Department of Ophthalmology, Private Practice

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Steve Charles, MD Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine

Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Macula Society, Retina Society, Club Jules Gonin

Disclosure: Received royalty and consulting fees for: Alcon Laboratories.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

V Al Pakalnis, MD, PhD Professor of Ophthalmology, University of South Carolina School of Medicine; Chief of Ophthalmology, Dorn Veterans Affairs Medical Center

V Al Pakalnis, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, South Carolina Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the assistance of Ryan I Huffman, MD, with the literature review and referencing for this article.

References
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