K 284
Prevention of recurrences of arterial occlusions of the posterior eye poleV. Bau, A. Krause
Background: Arterial occlusions of the retina and the optic nerve have furthermore an unfavourable prognosis. In literature and own studies the incidence of recurrences are in the range of 10 to 13 %. Only an extensive investigation and therapy of reasons facilitates the prevention of recurrences (vascular occlusion in 2nd eye). There are only mainly new studies with small number of patients.
Patients and methods: In our study we analysed the frequency of general vascular disorders in 61 patients with retinal arterial occlusions (26%), anterior ischaemic optic neuropathy (67%), arteriitis temporalis (2%) und amaurosis fugax (5%), which were treated on the department of ophthalmology of Martin-Luther-University, Halle/S., Germany, from 1/1998 to 11/1999.
Results: Doppler sonography of extracranial vessels (n=55): plaques/stenosis 33% (surgical indications 9%). Transoesophageale/ transthoracale echocardiography (n=41): valvular heart disease 19% (surgical indications: 2%), aortal plaques 10%, hyperthrophic cardiomyopathy 7%, intracardial thrombosis 7% . Laboratory screening: hyperlipidaemia, hyperhomocysteinaemia 61%. Cardiovascular diseases: hypertension 74% (new discovered 12%), chronic ischaemic heart disease/hypertensive cardiomyopathy/heart failure 39% (new discovered 12%), diabetes mellitus 31% (new discovered 2%), peripherial vascular disease 7%, cerebrovascular disease 18% (CT/MRT)
Conclusions: Preventions of recurrences following interdisciplinary investigations (general practitioner, internist, surgeon, gynecologist): surgery of vascular stenosis and other embolic sources, optimal adjustment of diabetes mellitus, drug therapy of cardiovascular disease, optimizing of the rheological parameters, long-time therapy of arteriitis temporalis, if necessary interruption of hormonal contraception. Every patient without risk factors: echocardiography ( persistent foramen ovale?). Arterial occlusions of the posterior eye pole are due to general vascular disorders. In summary, our study suggests the important role of general vascular screening in risk patients.
Department of ophthalmology, Martin-Luther-University, Magdeburger Straße 8, D-06097 Halle/Saale