Utilidad de la ecografía Doppler para el estudio de la enfermedad vascular ocular

Is a Carotid Doppler Scan Useful for Managing Patients with Suspected Ocular Ischemic Syndrome?

Purpose

This review aims to understand the value of a carotid Doppler scan (CDS) when managing patients with clinical/suspected ocular ischaemic syndrome (OIS); correlations between internal carotid artery (ICA) stenosis reports; subsequent patterns of referral to vascular experts; and subsequent decisions concerning surgical versus medical management.

Methods

A retrospective review of 402 CDS requests by a single eye center over 4 years (2016-2019) for patients with a clinical suspicion of OIS was conducted. Data analysis included 344 patients who had reported CDS of both ICAs. We also studied referral patterns by ophthalmologists to other specialties.

Results

CDS requests were related to the retina (53.2%), neuro/TIA problems (31.1%), glaucoma (10.5%) and other issues (5.2%). The majority of patients (209/344, 60.8%) had normal CDA results. Of the 688 ICAs reported, 469 (68.2%) were normal, 219 (31.8%) had atheroma present, and only 83 (12.1%) had significant stenosis. Of 83 ICAs with stenosis, 23 (27.7%) had ≥70% stenosis, 24 (28.9%) had 50-69% stenosis, and 25 (30.1%) had <50% stenosis. A total of 60/344 (17.4%) patients were referred to vascular/stroke teams: 15/60 (25%) referred had bilateral disease, and only 2/60 (3.3%) were offered carotid endarterectomy. All referred patients commenced statins and low-dose aspirin.

Conclusion

Our cohort showed a low incidence of ICA stenosis according to CDS reports in patients with suspected OIS. There were very low rates of vascular and endarterectomy referral. Commencement of conservative treatment (mini aspirin+statin) by ophthalmologists could be beneficial even in the early stage of presenting clinical evidence of OIS.