The influence of both severe chronic carotid stenosis and carotid endarterectomy (CEA) on ocular tissue has been poorly evaluated. The goal of this study was to measure subfoveal choroidal thickness (SFCT), before and after CEA, in patients with severe carotid stenosis. Consecutive patients (n = 36) with severe carotid stenosis were prospectively included. Patients (n = 19) were followed up at 1 and 3 months after CEA. The SFCT was measured bilaterally using enhanced depth imaging optical coherence tomography (EDI-OCT). Preoperatively, the median SFCT of the ipsilateral eye did not differ significantly from the contralateral eye (223 vs 236 µm; P = .75). In the ipsilateral eye, the mean SFCT was significantly higher at 1 month postsurgery and the effect was maintained at 3 months (226.3 ± 17.1 at 3 months vs 210.8 ± 16.5 µm at baseline; P < .001). For the contralateral eye, the increase in SFCT reached statistical significance at 3 months (220.1 ± 11.3 at 3 months vs 214.8 ± 11.5 µm at baseline; P = .04). The mean SFCT significantly increased bilaterally after CEA, with a more noticeable effect in the ipsilateral eye. Further studies are required to determine whether EDI-OCT could be useful as a potential marker of ophthalmologic outcomes.
MozaffarianDBenjaminEJGoAS; Writing Group Members. Executive summary: heart disease and stroke statistics—2016 update: a report from the American Heart Association. Circulation. 2016;133(4):447–454.
2.
FeiginVLLawesCMBennettDAAndersonCS. Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol. 2003;2(1):43–53.
3.
MarshJDKeyrouzSG. Stroke prevention and treatment. J Am Coll Cardiol. 2010;56(9):683–691.
4.
BiousseV. Carotid disease and the eye. Curr Opin Ophthalmol. 1997;8(6):16–26.
5.
ArthurAAlexanderABalSSivadasanAAaronS. Ophthalmic masquerades of the atherosclerotic carotids. Indian J Ophthalmol. 2014;62(4):472–476.
6.
HayrehSS. Orbital vascular anatomy. Eye (Lond). 2006;20(10):1130–1144.
7.
NicklaDLWallmanJ. The multifunctional choroid. Prog Retin Eye Res. 2010;29(2):144–168.
8.
YamamotoTMoriKYasuharaT. Ophthalmic artery blood flow in patients with internal carotid artery occlusion. Br J Ophthalmol. 2004;88(4):505–508.
9.
European StrokeOTenderaMAboyansV. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2011;32(22):2851–2906.
10.
MatsubaraSMoroiJSuzukiA. Analysis of cerebral perfusion and metabolism assessed with positron emission tomography before and after carotid artery stenting. Clinical article. J Neurosurg. 2009;111(1):28–36.
11.
YunTJSohnCHHanMH. Effect of carotid artery stenting on cerebral blood flow: evaluation of hemodynamic changes using arterial spin labeling. Neuroradiology. 2013;55(3):271–281.
12.
CardiaGPorfidoDGuerrieroS. Retinal circulation after carotid artery revascularization. Angiology. 2011;62(5):372–375.
13.
GiannoukasADParaskevasKIBulbuliaR. Ocular defects as surrogate end-points in trials comparing carotid endarterectomy and stenting. Eur J Vasc Endovasc Surg. 2014;48(1):105–106.
14.
GiannoukasADKotoulaMSpanosK. Opthalmic outcomes should be included in future randomized control trials comparing carotid artery stenting vs. carotid endarterectomy in asymptomatic carotid disease. Int Angiol. 2015;34(6):503–505.
MargolisRSpaideRF. A pilot study of enhanced depth imaging optical coherence tomography of the choroid in normal eyes. Am J Ophthalmol. 2009;147(5):811–815.
17.
KimYTKangSWBaiKH. Choroidal thickness in both eyes of patients with unilaterally active central serous chorioretinopathy. Eye (Lond). 2011;25(12):1635–1640.
18.
ImamuraYFujiwaraTMargolisR. Enhanced depth imaging optical coherence tomography of the choroid in central serous chorioretinopathy. Retina. 2009;29(10):1469–1473.
19.
RishiPRishiEMathurGRavalV. Ocular perfusion pressure and choroidal thickness in eyes with polypoidal choroidal vasculopathy, wet-age-related macular degeneration, and normals. Eye (Lond). 2013;27(9):1038–1043.
20.
YamazakiTKoizumiHYamagishiTKinoshitaS. Subfoveal choroidal thickness after ranibizumab therapy for neovascular age-related macular degeneration: 12-month results. Ophthalmology. 2012;119(8):1621–1627.
21.
ChungSEKangSWLeeJHKimYT. Choroidal thickness in polypoidal choroidal vasculopathy and exudative age-related macular degeneration. Ophthalmology. 2011;118(5):840–845.
22.
MarukoIIidaTSuganoYOjimaAOgasawaraMSpaideRF. Subfoveal choroidal thickness after treatment of central serous chorioretinopathy. Ophthalmology. 2010;117(9):1792–1799.
23.
DemirokGTopalakYBasaranMMAtaçGKÖztürkSSengünA. Correlation of ocular pulse amplitude, choroidal thickness, and internal carotid artery Doppler ultrasound findings in normal eyes. Semin Ophthalmol. 2016:1–5.
24.
KimDYSilvermanRHChanRV. Measurement of choroidal perfusion and thickness following systemic sildenafil (Viagra((R))). Acta Ophthalmol. 2013;91(2):183–188.
25.
VanceSKImamuraYFreundKB. The effects of sildenafil citrate on choroidal thickness as determined by enhanced depth imaging optical coherence tomography. Retina. 2011;31(2):332–335.
26.
BarnettHJMTaylorDWHaynesRB; North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991;325:445–453.
27.
ShaoLXuLChenCX. Reproducibility of subfoveal choroidal thickness measurements with enhanced depth imaging by spectral-domain optical coherence tomography. Invest Ophthalmol Vis Sci. 2013;54(1):230–233.
28.
MrejenSSpaideRF. Optical coherence tomography: imaging of the choroid and beyond. Surv Ophthalmol. 2013;58(5):387–429.
29.
OuyangYHeussenFMMokwaN. Spatial distribution of posterior pole choroidal thickness by spectral domain optical coherence tomography. Invest Ophthalmol Vis Sci. 2011;52(9):7019–7026.
30.
DingXLiJZengJ. Choroidal thickness in healthy Chinese subjects. Invest Ophthalmol Vis Sci. 2011;52(13):9555–9560.
31.
WeiWBXuLJonasJB. Subfoveal choroidal thickness: the Beijing Eye Study. Ophthalmology. 2013;120(1):175–180.
32.
AkcayBIKardesEMacinS. Evaluation of subfoveal choroidal thickness in internal carotid artery stenosis. J Ophthalmol. 2016;2016:5296048.
33.
UsuiSIkunoYAkibaM. Circadian changes in subfoveal choroidal thickness and the relationship with circulatory factors in healthy subjects. Invest Ophthalmol Vis Sci. 2012;53(4):2300–2307.
34.
MoschosMMNitodaELaiosKLadasDSChatziralliIP. The impact of chronic tobacco smoking on retinal and choroidal thickness in Greek population. Oxid Med Cell Longev. 2016;2016:2905789.
35.
KantarciFATatarMGColakHN. A pilot study of choroidal thickness in long-term smokers. Retina. 2016;36(5):986–991.
36.
SogawaKNagaokaTTakahashiA. Relationship between choroidal thickness and choroidal circulation in healthy young subjects. Am J Ophthalmol. 2012;153(6):1129–1132.e1.
37.
ParaskevasKIMikhailidisDPVeithFJSpenceJD. Definition of best medical treatment in asymptomatic and symptomatic carotid artery stenosis. Angiology. 2016;67(5):411–419.
