Objectives: The long term neuroopthalmic outcomes following carotid intervention in patients with visual symptoms varies widely based on the underlying etiology of retinal ischemia. Methods: We performed a retrospective review of consecutive patients presenting with retinal ischemia who subsequenly underwent carotid intervention from January 2018 to 2022. Patients were classified into three groups [Group I: Amaurosis fugax (AF), Group II: Ocular Ischemic Syndrome (OIS) and Group III: Central/Branch Retinal Artery Occlusion (C/BRAO)]. Clincial details and the nature of visual symptoms were recorded. Outcomes analyzed were ipsilateral symptom recurrence, visual improvement, stroke rate and survival. Results: There were 90 patients (60 male, 75+ 9 years); 28 patients (31%) in Group I (AF), 7 patients (8%) in Group II(OIS), and 55 patients (61%) in GroupIII (C/BRAO). Presentation was with transient monocular visual loss in 50 patients (56%), with significant difference among the groups (100%, 43%, 31%; Group I, II, & III respectively; p<0.001). Atherosclerotic risk factors other than hyperlipidemia. (100%, 71%, 97%: Group I, II, III; p<0.001) were similar across groups, with similar preoperative antiplatelet (p=0.14) and statin use (p=0.74). Interventions performed were carotid endarterectomy in 64 (71%), carotid artery stenting in 22 (25%), transcarotid artery revascualrisation in 3 (3%) and carotid bypass in 1 patient (1%), similar between groups. Median follow-up was 24 (range 0- 66) months. There was no recurrence of a transient or permanent retinal ischemia event in Group I (AF) and II (OIS). In Group II, 5 of 7 patients presenting with transient symptoms of OIS showed resolution of symptoms and ocular signs. Two patients presenting with permanent vision loss in Group II had no improvement, and visual decline was reported in 2 more patients in Group III. Ipsilateral stroke rate was 3% at 1 and 5 years for the entire group. Survival was 90% and 74% at 1 and 5 years, with no difference between groups (p<0.05) There was 1 late post-operative death from stroke secondary to stent thrombosis(Group III), cause of death was not secondary to cerebrovascular disease in the rest. Conclusions: Neuro-opthalmic outcomes following carotid intervention for visual symptoms is favorable with low symptomatic recurrence following both carotid endarterectomy and carotid artery stenting. Early intervention for OIS is associated with visual improvement and prevention of permanent visual loss.
