Hamit Serdar BAŞBUĞ, Caner ARSLAN, Fatih KANTARCI, Kamil Hasan TÜZÜN, Pınar SULTAN, Macit BİTARGİL, Elmar BAYRAKTAROV, Kazım BEŞİRLİ

Karotis endarterektomi yapılan hastalarda retinal vasküler değişikliklerin karşılaştırılması

Amaç: Bu çalışmada, karotis endarterektomi (KEA) planlanan hastalarda oküler iskemi ve ameliyat sonrası orbital arterlerde oluşan akım değişiklikleri incelenerek göz ve oküler iskeminin bu akım değişikliklerinden nasıl etkilendiği araştırıldı.Çalışmaplanı:Kasım 2011 - Mayıs 2012 tarihleri arasında kritik karotis arter darlığı nedeni ile KEA planlanan 30 hasta (23 erkek, 7 kadın, ort. yaş 68.1±7.61 yıl; dağılım 47-82 yıl) prospektif olarak değerlendirildi. Fundus muayenesi, görme keskinliği ölçümü, göz içi basınç ölçümü ve fundus kamerası ile renkli fundus görüntü çekimleri ameliyat öncesinde yapıldı. Santral retinal arter (SRA) ve oftalmik arter (OA) akımları orbital renkli Doppler ultrasonografi (RDUS) yardımı ile ölçüldü. Aynı işlemler ameliyat sonrası dönemde tekrar edilerek bulgular kıyaslandı. Bu akım bulguları karotis arter darlığı olmayan 20 gönüllüden (14 erkek; 6 kadın, ort. yaş 47.5±9.9 yıl) oluşan kontrol grubunun bulgularıyla kıyaslandı.Bul gu lar: Otuz hastanın 10'unda (%33.3) oküler iskemik sendrom (OİS) başlangıç bulguları vardı. Oküler iskemik sendrom başlangıç bulguları olan hastaların KEA öncesi retinal arter pik sistolik hız (PSV) değerleri, OİS başlangıç bulgusu olmayan hasta ve kontrol grubuna göre anlamlı şekilde düşüktü. Bu hastaların hepsinde KEA sonrası retinal arter PSV değerlerinde anlamlı artış kaydedildi. Oküler iskemik sendrom başlangıç bulgusu olan 10 hastanın beşinde (%50) görme keskinliğinde artış kaydedilirken beşinde değişiklik olmadı.So nuç: Ciddi karotis arter darlığı oküler iskemiye, retinal embolilere ve OİS'ye neden olabilmektedir. Bu patolojiler orbital RDUS ve retinal fotografi yoluyla ortaya konulabilmektedir. Karotis endarterektomi azalmış oküler kan akımını düzelterek oküler iyileşmeye katkıda bulunabilir.

Comparing retinal vascular changes in patients who underwent carotid endarterectomy

Background: This study aims to investigate ocular ischemia in patients who were candidates for carotid endarterectomy (CEA) and postoperative flow changes in orbital arteries, and demonstrate the impact of these flow changes on the eye and ocular ischemia. Methods: Thirty patients (23 males, 7 females; mean age 68.1±7.61 years; range 47 to 82 years) who were planned to undergo CEA due to critical carotid artery stenosis between November 2011 and May 2012 were analyzed prospectively. Fundus examination, visual acuity measurement and intra ocular pressure measurement were performed, and color fundus images were taken with fundoscopy preoperatively. Central retinal artery (CRA) and ophthalmic artery (OA) flows were measured with orbital color Doppler ultrasound (RDUS). The same procedures were repeated postoperatively, and findings were compared. These flow findings were compared with findings of a control group which was composed of 20 volunteers (14 males; 6 females, mean age 47.5±9.9 years) without carotid artery stenosis. Results: Ten out of 30 patients (33.3%) had initial findings of ocular ischemic syndrome (OIS). Pre-CEA retinal artery peak systolic velocity (PSV) values of patients with initial findings of OIS were significantly lower compared to values of patients without initial findings of OIS and the control group. Significantly increased post- CEA retinal artery PSV values were detected for all these patients. While increased visual acuity was detected in five of the 10 patients (50%) with initial findings of OIS, there was no change in five patients. Conclusion: Severe carotid artery stenosis may lead to ocular ischemia, retinal embolus, and OIS. These pathologies can be demonstrated via orbital RDUS and retinal photography. Carotid endarterectomy may regulate the reduced ocular blood flow, and support ocular healing.

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