Elsevier

Ophthalmology

Volume 108, Issue 8, August 2001, Pages 1461-1464
Ophthalmology

Role of transesophageal echocardiography in the evaluation of patients with retinal artery occlusion

https://doi.org/10.1016/S0161-6420(01)00641-8Get rights and content

Abstract

Objective

To evaluate the role of transesophageal echocardiography (TEE) in detecting cardiac and thoracic aortic sources of retinal emboli.

Design

Retrospective observational case series.

Participants

The study population consisted of 18 patients who were initially seen with retinal artery occlusion (7 central, 11 branch) and underwent TEE as part of the systemic evaluation.

Intervention

All patients underwent TEE, consisting of complete two-dimensional and Doppler color flow examinations. TEE was done immediately after transthoracic echo (TTE) examination. The medical records were reviewed.

Main outcome measure

Detection of a possible cardiac or thoracic aortic source of retinal embolus.

Results

Cardiac or thoracic aortic pathologic conditions, which were a possible source of the retinal emboli, were detected by TEE in 13 of the 18 patients (72%). They included aortic arch atheroma (n = 7), mitral annulus calcification (n = 4), left atrial appendage thrombus (n = 2), valvular abnormalities (n = 5), left atrial smoke (n = 3), and patent foramen ovale (n = 3). In 11 patients (61%), at least one cardiac or aortic source of emboli detected by TEE was missed by TTE. Significant carotid artery disease (≥40% stenosis) was present in 3 of 16 patients (17%).

Conclusions

TEE is a potentially useful modality for detecting possible sources of retinal artery emboli and may be considered as an adjunct to the routine evaluation of affected patients.

Section snippets

Patients

Between July 1996 and December 1998, 22 patients were seen at the Department of Ophthalmology of Rabin Medical Center with retinal artery occlusion. Eighteen of them underwent TTE and TEE in the Echocardiography Unit as part of the routine systemic evaluation. The medical records were reviewed for current findings on electrocardiography, Doppler examination of carotid arteries, coagulation status, and for medical history. The four patients who did not undergo TEE included one patient who was

Results

The patient characteristics are shown in Table 1. There were 12 males and 6 females, with a mean age of 64.1 ± 10.3 years (range, 48–81 years). Six patients (33%) were less than 60 years of age. Eleven patients had branch retinal artery occlusion, and seven patients had central occlusion.

Review of the patients’ medical records revealed the following data: 11 patients (61%) had known cardiac pathology; 8 had a history of ischemic heart disease (4 had undergone coronary artery bypass surgery),

Discussion

Studies have shown that in the elderly the most common cause of retinal artery occlusion is an embolus caused by atheromatous plaque in the carotid artery.4 Severe stenosis of the ipsilateral carotid artery has been demonstrated in 45% of patients with retinal embolic events.5, 6 The causes in younger patients are diverse and most commonly include cardiac disorders (cardiac valvular heart disease,7, 8, 9, 10 left atrial myxoma11) and various hypercoagulable states leading to thrombosis.12

Acknowledgements

The authors wish to thank Mrs. Gloria Ginzach and Mrs. Marian Propp for their editorial and secretarial assistance.

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