Ocular Ischemic Syndrome Treatment & Management
- Author: Igal Leibovitch, MD; Chief Editor: Hampton Roy, Sr, MD more...
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 
Ocular filtering procedures and implantation of glaucoma drainage valves to treat neovascular glaucoma
Systemic treatments may include the following:
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)
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.
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.
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.
Consultations may include the following:
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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