Ocular Ischemic Syndrome Treatment & Management

Updated: Jun 10, 2019
  • Author: Tahira M Scholle, MD; Chief Editor: Andrew G Lee, MD  more...
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Treatment

Medical Care

Ocular Treatments for Ocular Ischemic Syndrome

Topical steroids, such as prednisolone, and cycloplegics are used to treat anterior-segment inflammation and pain.

Panretinal photocoagulation (PRP) is used to treat neovascularization of the iris, optic nerve, or retina. PRP was reported to cause regression of neovascularization in about one third of patients with ocular ischemic syndrome. The low rate of regression after PRP is attributed to the fact that choroidal ischemia alone (rather than retinal ischemia) is sufficient to cause neovascularization in some patients with ocular ischemic syndrome. PRP is most beneficial prior to development of neovascular glaucoma, as the visual prognosis is poor once this has developed. [2, 16, 26, 14]

If neovascular glaucoma develops, intraocular pressure-lowering drops are used. Prostaglandin analogues and pilocarpine are generally avoided to prevent worsening of inflammation. Glaucoma surgery may be needed if medical therapy does not control IOP.

If cystoid macular edema is present, intravitreal steroids and or intravitreal anti-VEGF agents can be used; however, multiple injections may be needed, and vision may be significantly limited by ischemia. [27]

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Surgical Care

Carotid Endarterectomy

Carotid endarterectomy is recommended for symptomatic stenosis of 50%-99% if the perioperative risk of stroke or death is less than 6%. [28] A small number of publications have reported on the ophthalmic outcome of carotid endarterectomy in patients with ocular ischemic syndrome, and the data presented are inconclusive. [29] Visual acuity is stabilized or improved in about 25% of eyes following endarterectomy. Endarterectomy is likely more beneficial for visual prognosis if performed prior to the development of neovascularization. [30]

Carotid Artery Stenting

Carotid artery stenting, an alternative to endarterectomy, is used in patients who are at high risk for complications after endarterectomy, such as patients with previous neck radiation or radical neck surgery, patients with high carotid stenosis, or patients with congestive heart failure, unstable angina, or recent myocardial infarction. [10]

Extracranial-Intracranial Arterial Bypass Surgery

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 endarterectomy is precluded.

Ocular Surgery

For the treatment of neovascular glaucoma, implantation of glaucoma drainage valves may be needed. In cases with poor visual prognosis, diode cyclophotocoagulation (dCPC) is an option.

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Consultations

Consultations may include the following:

  • Cardiology
  • Vascular surgery
  • Neurology
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Diet

Limited dietary fat, salt, and sugar can help control vascular risk factors such as atherosclerosis, hypertension, and diabetes.

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