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(Stroke. 2002;33:695.)
© 2002 American Heart Association, Inc.

Original Contributions

Venous Stasis Retinopathy in Symptomatic Carotid Artery Occlusion

Prevalence, Cause, and Outcome

Catharina J.M. Klijn, MD; L. Jaap Kappelle, MD; Mary J. van Schooneveld, MD; Vincent P.T. Hoppenreijs, MD; Ale Algra, MD; Cornelis A.F. Tulleken, MD Jan van Gijn, FRCP

From the University Departments of Neurology (C.J.M.K., L.J.K., A.A., J. van G.), Ophthalmology (M.J. van S., V.P.T.H.), and Neurosurgery (C.A.F.T.), and the Julius Center for General Practice and Patient Oriented Research (A.A.), University Medical Center Utrecht and the Rudolf Magnus Institute for Neurosciences, Utrecht, the Netherlands.

Correspondence to C.J.M. Klijn, MD, Department of Neurology, C03.236, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, Netherlands. E-mail c.j.m.klijn{at}neuro.azu.nl

Background and Purpose— Chronic ocular ischemia is a rare form of ischemia of the eye in patients with carotid artery occlusion (CAO). The early and often asymptomatic stage of chronic ocular ischemia is referred to as venous stasis retinopathy (VSR). The aim of this study was to gain insight into the prevalence, cause, and outcome of VSR in patients with symptomatic CAO.

Methods— In 110 patients with symptomatic CAO, we prospectively investigated the frequency of VSR, the association between the presence of VSR and impaired cerebral blood flow, and the proportion of patients who developed clinically manifest chronic ocular ischemia with ischemia of the anterior eye segment or blindness.

Results— At study entry, VSR was found in 32 patients (29%; 95% CI, 21 to 38), particularly in those with symptoms classically associated with a hemodynamic cause, such as limb shaking (relative risk, 2.4; 95% CI, 1.0 to 5.9). Patients with VSR had lower pulsatility indexes in the ophthalmic artery in case of reversed flow, lower cerebral CO₂ reactivity, and lower cerebropetal blood flow than patients without VSR. On follow-up (mean, 29 months), clinically manifest chronic ocular ischemia developed in 4 patients (annual rate, 1.5%; 95% CI, 0.4 to 3.8); it tended to occur more often in patients in whom VSR was present at study entry (relative risk, 7.3; 95% CI, 0.8 to 68).

Conclusions— One third of patients with symptomatic CAO has VSR on ophthalmoscopy. VSR is associated with an impaired flow state of the brain. Development of clinically manifest chronic ocular ischemia is rare.

Key Words: carotid artery occlusion • chronic ocular ischemia • venous stasis retinopathy

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