Study of regional blood flow dynamics and microcirculation of macula depending on treatment in patients with chronic ischemic retinopathy associated with hemodynamically significant atherosclerotic stenosis of internal carotid artery

   Abstract

   Original article

   Study of regional blood flow dynamics and microcirculation of macula depending on treatment in patients with chronic ischemic retinopathy associated with hemodynamically significant atherosclerotic stenosis of internal carotid artery

   V.V. Tuzlaev, O.V. Kolenko, P.L. Volodin, A.V. Vasiliev, D.V. Breev, Ia.E. Pashentsev

   S. Fyodorov Eye Microsurgery Federal State Institution, Khabarovsk Branch, Khabarovsk, Russian Federation
Far-Eastern State Medical University, Khabarovsk, Russian Federation
Postgraduate Institute for Public Health Specialists, Khabarovsk, Russian Federation
S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russian Federation
Federal Center Cardiovascular Surgery Federal State Budgetary Institution, Khabarovsk, Russian Federation

   Purpose. To evaluate dynamics of regional blood flow and microcirculation of macula depending on treatment in patients with chronic ischemic retinopathy (CIR) associated with hemodynamically significant atherosclerotic stenosis of internal carotid artery (ICA).

   Material and methods. This study included 92 patients (92 eyes) with a severe degree of CIR. Patients were divided into 3 groups according to the type of performed treatment. The 1st group – 32 patients (32 eyes) who underwent only carotid endarterectomy (CEA) of the ICA. The 2nd group consisted of 30 patients (30 eyes), where only panretinal laser coagulation of the retina (PRLC) was performed. The 3rd group included 30 patients (30 eyes), who first underwent PRLC of retinal nonperfusion zones, then after 2 weeks – CEA of the ICA.

   Results. CEA of the ICA in patients with hemodynamically significant atherosclerotic stenosis improves hemodynamic parameters of the eye vessels. CEA of the ICA as a method of CIR treatment allows restoring microcirculation in the macula by 6th month of observation, in 22% of cases it leads to the development of reperfusion in retinal structures. After PRLC, progression of retinopathy was observed in 76% of patients and it led to a slight improvement in macula microcirculation. A session of PRLC in combination with CEA of the ICA made it possible to reduce the period of restoration of macula microcirculation to 3 months and to reduce the frequency of reperfusion processes to 6%.

   Conclusion. The use of PRLC with CEA of the ICA in patients with 3 grade CIR associated with hemodynamically significant stenosis of the ICA allowed to make significant improvement in macular microcirculation and to decrease the frequency of reperfusion symptoms in patients by 3,5 times. Key words: ocular ischemic syndrome, chronic ischemic retinopathy, macula microcirculation, hemodynamics, carotid endarterectomy, panretinal laser coagulation, internal carotid artery

   For citation: Tuzlaev V.V., Kolenko O.V., Volodin P.L., Vasiliev A.V., Breev D.V., Pashentsev Ia.E. Study of regional blood flow dynamics and microcirculation of macula depending on treatment in patients with chronic ischemic retinopathy associated with hemodynamically significant atherosclerotic stenosis of internal carotid artery. Fyodorov Journal of Ophthalmic Surgery. 2024;3(141): 32–39.

   doi: 10.25276/0235-4160-2024-3-32-39

   Corresponding author: Vladislav V. Tuzlaev, naukakhvmntk@mail.ru