Carotid endarterectomy restores decreased vision due to chronic ocular ischemia
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ORIGINAL ARTICLE - VASCULAR NEUROSURGERY - ISCHEMIA
Carotid endarterectomy restores decreased vision due to chronic ocular ischemia Shinsuke Yoshida 1 & Soichi Oya 1 & Hiroto Obata 2 & Naoaki Fujisawa 1 & Tsukasa Tsuchiya 1 & Takumi Nakamura 1 & Masahiro Indo 1 & Masaaki Shojima 1 & Toru Matsui 1 Received: 28 August 2020 / Accepted: 30 September 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Background The therapeutic effect of carotid endarterectomy (CEA) on visual disturbance caused by chronic ocular ischemia due to carotid artery stenosis has not been validated. This prospective observational study aims to investigate whether CEA is associated with an increase in ocular blood flow (OBF) and postoperative visual improvement. Methods In total, 41 patients with carotid artery stenosis treated by CEA between March 2015 and September 2018 were enrolled in this study. OBF was evaluated by laser speckle flowgraphy, which can measure the mean blur ratio (MBR) which is well correlated to the absolute retinal blood flow. Visual acuity was assessed before and after CEA by subjective improvement and objective visual assessment using CSV-1000, an instrument used to test contrast sensitivity. Results OBF increased after CEA on the operated side (mean MBR 33.5 vs 38.2, p < 0.001) but not on the non-operated side (mean MBR 37.8 vs 37.5, p = 0.50). After CEA, 23 patients (56.1%) reported subjective visual improvement on the operated side. The mean CSV-1000 score among the patients with increased OBF after CEA (5.44 vs 5.88, p = 0.04) but not among those without increased OBF (5.48 vs 5.95, p = 0.09). The mean CSV-1000 scores increased significantly after CEA in 18 patients with decreased vision and decreased OBF (4.51 vs 5.37, p < 0.001), but not in the 23 patients without those (6.19 vs 6.31, p = 0.6). Conclusion CEA may successfully reverse visual dysfunction caused by chronic ocular ischemia due to carotid artery stenosis by increasing OBF. Keywords Carotid endarterectomy . Chronic ocular ischemia . Laser speckle flowgraphy . Ocular blood flow . Visual improvement
Introduction Cervical carotid stenosis increases the risk of ipsilateral ischemic stroke, which can be managed by carotid revascularization. The therapeutic effect of carotid endarterectomy (CEA) Presentation at a conference: A part of this study was previously presented at the 87th Annual Meeting of the American Association of Neurological Surgeons (AANS), San Diego, California, April 2019. This article is part of the Topical Collection on Vascular Neurosurgery Ischemia * Soichi Oya [email protected] 1
Department of Neurosurgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
2
Ophthalmology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
for stroke prevention has been validated in terms of not only secondary [3, 8] but also primary prevention [9]. Regarding other potential therapeutic effects of CEA, postoperative cognitive improvement has also been discussed [6, 10, 18, 19, 26]. CEA als
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