Ocular signs of carotid stenosis in ipsi‐ and contralateral eyes before and after carotid endarterectomy: a prospective study.

Purpose: We describe hypoperfusion‐related and embolic ocular signs of carotid stenosis (CS) before and six months after carotid endarterectomy (CEA) in a CS population. Methods: We enrolled prospectively 70 CEA patients (81% male, mean age 69) and 41 non‐medicated control subjects (76%, 68), from March 2015 to December 2018, assessing intraocular pressure (IOP), best‐corrected visual acuity (BCVA) in logMAR units and performing a bio‐microscopy examination. Results: Main index symptoms included amaurosis fugax (Afx) (29, 41%) and hemispheric TIA (17, 24%), and 17 (24%) were asymptomatic. Of the 70, 17 patients (24%, 95% CI 16‐36) showed ocular signs of CS. Of four embolic (Hollenhorst plaques) findings, one small macular plaque disappeared postoperatively. Four had hypoperfusion, that is ocular ischaemic syndrome (OIS), requiring panretinal photocoagulation: one for multiple mid‐peripheral haemorrhages, two for iris neovascularization and one for neovascular glaucoma (NVG); only the NVG proved irreversible. Nine (de novo in three) showed mild OIS, that is only few mid‐peripheral haemorrhages, ranging pre‐ /postoperatively in ipsilateral eyes from one to eleven (median two)/ one to two (median one), and in contralateral eyes from three to nine (median five)/ one to six (median three). Pre‐ and postoperative median BCVA was 0 or better, and mean IOP was normal, except in the NVG patient. Temporary visual impairment from 0 to 0.3 occurred in one eye soon after CEA due to ocular hyperperfusion causing macular oedema. Conclusions: Ocular signs of CS are common in CEA patients, ranging from few mid‐peripheral haemorrhages to irreversible NVG. Clinicians should be aware of these signs in detecting CS. [ABSTRACT FROM AUTHOR]