J Retin.  2023 May;8(1):51-57. 10.21561/jor.2023.8.1.51.

Incongruent Results between Carotid Angiography and Fluorescein Angiography in Patients with Ocular Ischemic Syndrome

• Cheong H
• Kwon K
• Sohn J

• KMID: 2552121
• DOI: http://doi.org/10.21561/jor.2023.8.1.51

Abstract

Purpose
We report two cases of ocular ischemic syndrome (OIS) with incongruent results between carotid angiography and fluorescein angiography (FA).
Case summary
In the first case, a 61-year-old man visited our clinic complaining of amaurosis fugax-like symptoms in the left eye for 1 month. His corrected visual acuity (CVA) was 20/25 in the left eye. Fundus examination did not reveal any abnormalities. Seventeen days after presentation, his CVA had decreased to 20/40. FA showed delayed choroidal filling and arm-to-retina time. Magnetic resonance angiography revealed severe stenosis of the left carotid artery. Carotid stenting was performed immediately. Seventeen days after the intervention, his CVA decreased to finger count of 40 cm, and FA findings showed delayed blood flow. However, carotid angiography revealed good patency of the internal carotid and ophthalmic arteries. In the second case, a 69-year-old man presented to our clinic with eye problems caused by diabetes. He had recently been diagnosed with total occlusion of the left internal carotid artery. Carotid angiography revealed well-developed collateral circulation and no need for carotid intervention. His visual acuity was 20/20 in both eyes. Three months later, his CVA decreased to finger count of 30 cm in the left eye. FA revealed delayed choroidal filling and arm-to-retina time and disc neovascularization. However, carotid angiography showed good flow into the ophthalmic artery.
Conclusions
These cases show that FA may not be correlated with carotid angiography findings in patients with OIS. We suggest that FA is an essential tool for diagnosing OIS, even if carotid angiography shows intact flow into the ophthalmic artery.

Keyword

Carotid angiography; Fluorescein angiography; Ocular ischemic syndrome