Progressive bilateral ocular ischemic syndrome despite previously performed carotid endarterectomy

The ocular ischemic syndrome (OIS) is a rare condition with vision-threatening potentials. It is characterized by chronic ischemia of the anterior and/or posterior segment of the eye primarily caused by severe carotid artery occlusive diseases. In this article, we present a case of a 67-year-old male patient presented with the gradual diminution of vision in the right eye for 6 months. The patient had undergone a right internal carotid artery (ICA) endarterectomy (CEA) twice before. On the day of admission, intraocular pressure (IOP) was 34 mm Hg in the right eye (RE) and 20 mm Hg in the left eye (LE). On anterior segment examination, neovascularization of iris in the right eye was noted. On fundoscopy dilated retinal veins, attenuated retinal arteries, blot hemorrhages, cotton wool spots and microaneurysms were present. The patient underwent the appropriate investigations including computed tomography angiography (CTA) of carotid arteries, fundus fluorescence angiography (FFA) and Doppler ultrasound (DUS) of ophthalmic and central retinal arteries, which were all consistent with a diagnosis of bilateral OIS. Intraocular pressure was pharmacologically reduced and stabilized. Subsequently, panretinal photocoagulation (PRP) of peripheral capillary nonperfusion areas was performed in both eyes.