Long-term ophthalmologic symptoms after treatment of intracranial aneurysms by ophthalmic artery-covering flow diverter

Abstract

Background

Ophthalmic complications after ophthalmic-covering flow diversion (OCFD) for intracranial aneurysms have been rarely reported with a large variability. A large systematic investigation of visual symptoms after OCFD has yet to be performed. This study aimed to explore ophthalmological symptoms and associated predicting factors in patients treated with OCFD.

Methods

Consecutive patients receiving flow diversion (FD) treatment with or without ophthalmic artery (OA) coverage (n = 257) (January 2015–January 2021) were contacted for a telephone interview with a standardized 5-item questionnaire. Answers from patients with OCFD (n = 127) and a control group (n = 60) of FD-treated aneurysms without OCFD were collected and compared.

Results

The rate of new ipsilateral visual symptoms was 37% in the OCFD and 3.2% in the control group (p < 0.0001). After adjusting for age and gender, OCFD was significantly associated with a higher risk of visual symptoms (aOR 7.2; 95%CI [2.43–21.3], p = 0.0004), compared to controls. The most common symptoms were blurry vision (15.7%), phosphenes (14.9%) and vision loss (11.8%). After a mean follow-up of 5.4 years 7.1% had persistent symptoms. Logistic regression identified OA slow flow/occlusion on angiograms as a reliable predictor of the risk of phosphenes and vision loss, respectively.

Conclusion

OCFD is associated with new visual symptoms in up to 37% of patients, that are persistent in 7.1%. Phosphenes and vision loss may be predicted based on the patency of the OA on angiographic runs. These data should be considered when covering OA with flow diverter, and the patients appropriately informed.