Efficacy of carotid endarterectomy in patients with stenosis of carotid arteries and acute vision impairment

Gavrilenko A.V., Kuklin A.V., Kiseleva T.N.*

Department of Vascular Surgery B.V. Petrovsky Russian Research Centre of Surgery, Russian Academy of Medical Sciences, Moscow, Russia
* Ultrasound Department, Moscow Eye Diseases Research Institute named after Helmgoltz, RF Ministry of Public Health and Social Development, Moscow, Russia

The article deals with comparing efficacy (improved function of the eye) of surgical and conservative treatment of patients presenting with atherosclerotic stenosis of carotid arteries and acute vision disorders. The surgery group (carotid endarterectomy) comprised a total of 49 patients and the conservative-treatment group consisted of 50 subjects.

Methods of examination included: determining visual acuity (VA), autorefractometry, direct and reverse ophthalmoscopy under the conditions of mydriasis, contactless computed tomography, computer-assisted static perimetry, assessment of the functional state of the optic nerve (ON) with determination of the parameters of the threshold of electric sensitivity and lability of the optic nerve by phosphene, ultrasonographic scanning of ophthalmic arteries and carotid arteries. The terms of examination were as follows: at baseline, one months and one year after surgery or conservative treatment. The results (by the groups) were as follows: in amaurosis fugas – improvement of VA by 0.1 and more: 15 and 0 (p<0.001), disappearance of fits of amaurosis fugas: 16 and 3 (p<0.001), widening of the fields of vision: 16 and 0 (p<0.001), improvement of the condition of the optic nerve: 16 and 0 (p<0.001), maximal increase of systolic blood velocity in the arteries of the eye (Vs): by 30% and 0. In occlusion of the central retinal artery and its branches – improvement of VA by 0.1 and more: 8 and 1 (p=0.005), widening of the fields of vision: 6 and 2 (p=0.112), improved condition of the optic nerve: 14 and 0 (p<0.001), increase in the Vs: 40% and 0. In acute ischaemic neuropathy – improvement of VA by 0.1 and more: 9 and 2 (p<0.001), widening of the fields of vision: 9 and 3 (p=0.004), improved condition of the optic nerve: 11 and 0 (p<0.001), increased Vs: 40% and 0. Total – improvement of VA by 0.1 and more: 32 and 2 (p<0.001), widening of the fields of vision: 31 and 8 (p<0.001), improved condition of the optic nerve: 41 and 0 (p<0.001), Vs increase: 40% and 0. Carotid endarterectomy effectively improves the functional state of the eye in patients with stenosis of carotid arteries and acute vision impairments.

KEY WORDS: carotid endarterectomy, ocular ischaemic syndrome, amaurosis fugas.

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