Treatment of Ocular Ischemic Syndrome
The most definitive treatment for OIS appears to be carotid artery stenting and endarterectomy, although visual acuity outcomes are variable. Unfortunately, these procedures are ineffective when there is 100% obstruction, which is often the case. Extracranial to intracranial bypass surgery has been attempted but has been shown to be ineffective for preventing loss of vision or stroke. In eyes with iris neovascularization and low or normal IOP as a result of impaired ciliary body perfusion and decreased aqueous formation, carotid reperfusion can lead to increased aqueous formation and a severe rise in IOP. Full-scatter PRP results in regression of anterior segment neovascularization in approximately two-thirds of cases. Anti-VEGF therapy has also been shown to cause regression of anterior segment neovascularization in patients with OIS.
Brown GC, Sharma S. Ocular ischemic syndrome. In: Schachat AP, Wilkinson CP, Hinton DR, Sadda SR, Wiedemann P, eds. Ryan’s Retina. 6th ed. Philadelphia: Elsevier/Saunders; 2018:chap 62.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.