Vascular Retinal Event Secondary to Ocular Ischemic Syndrome, Improved With QIAPI 1: Case Report

Abstract

Ocular ischemic syndrome (OIS) is a rare condition, which is caused by ocular hypoperfusion due to stenosis or occlusion of the common or internal carotid arteries. Atherosclerosis is the major cause of changes in the carotid arteries. Since OIS is associated with atherosclerosis, patients usually have other related co-morbidities. Hypertension is found in 73% of the patients and diabetes mellitus in 56%. The first case of OIS was reported in 1963 by Hedges as a case with retinal hemorrhages and venous dilatation in a patient with complete occlusion of the internal carotid artery (ICA). The only therapy is to treat the neovascular complications. Recent studies suggest that OIS is associated with a significant risk of cerebrovascular, ocular, and systemic morbidity. OIS has a poor visual prognosis. It is imperative that the clinician be aware of the signs and symptoms of carotid disease to facilitate prompt diagnosis and appropriate referral, because OIS may be the presenting sign of serious ischemic cerebrovascular and ischemic heart disease. The 5-year mortality rate in OIS patients is as high as 40%. Most deaths are due to cardiac disease Controversy in the management of OIS arises from the fact that most patients reported in the literature are part of small retrospective series or case reports. Besides the uncertainty about the physio-pathogenic of the disease. Pan-retinal photocoagulation (PRP) is the accepted treatment for retinal ischemia predisposing to neovascularization due to retinal ischemia supposedly triggers the production of angiogenic growth factors. However, the main stimulus to abnormal angiogenesis is hypoxia more than ischemia, and opposite the best antiangiogenic factor is high levels of oxygen in tissues. Thereby, our discovery about the unexpected capacity of several organic molecules of the human body that can take the oxygen from intracellular water, like in plants, open a new way to treat these difficult cases, improving the prognosis.