[Carotid surgery for ophthalmic manifestations. Early and late results]

Two hundred and twelve cases of carotid surgery performed on patients presenting ipsilateral ischemic monophthalmic symptoms were retrospectively studied (OPH group). Among these, 125 had presented isolated ophthalmic pre-operative symptoms (OPHEX group) and 87 both ophthalmic and encephalic ischemic symptoms (OPHNEX group). During the same period, 702 cases of isolated carotid surgery were performed upon atherosclerotic patients without ipsilateral ischemic monophthalmic pre-operative symptoms (NOPH group). Among the cases of this latter group, 147 were performed upon asymptomatic patients (ASY group). 514 had presented isolated encephalic pre-operative symptoms (ENC group) and 41 had presented contralateral ischemic symptoms. The OPHNEX group presented a significantly increased peri-operative mortality and morbidity rate compared to the OPHNEX group (peri-operative deaths, lethal strokes, cardiac peri-operative morbidity) and compared to the ENC group than in the ASY group. The OPHNEX group presented a significantly increased long term mortality and morbidity rate compared to the OPHEX group (lethal strokes, all deaths). In the follow up, the OPH group presented, compared to the NOPH group, lower rates of non lethal stroke but higher rates of ophthalmic ischemic events (ipsi or contralateral) and higher rates of cardiac deaths. OPHEX, OPHNEX, ASY, ENC and NOPH groups presented significant differences as regards the general cardio-vascular and metabolic context, the macroscopy of carotid lesions operated upon, the topography and diffusion of other atherosclerotic lesions.