[25, 56–58]. This generally consists of 1,500–2,000 500-mm burns with the argon green laser. Unlike the situation when iris neovascularization occurs secondary to diabetic retinopathy, in which there is regression in a majority of cases with full scatter panretinal photocoagulation, approximately 36% of ocular ischemic syndrome eyes will demonstrate regression of the iris neovascularization after full scatter treatment [25]. If the anterior chamber angle is completely closed by fibrovascular tissue and there is no posterior segment neovascularization, panretinal photocoagulation is probably not indicated unless a glaucoma filtering procedure is being considered, as higher success rates of filtration surgery have been reported when PRP has been performed [58].

While there is little in the reported literature regarding the management of macular edema secondary to this condition, Klais and Spaide [59] recently reported excellent clinical resolution of fluid and dramatic improvement in vision in a patient treated with intravitreal triamcinolone acetonide. Intravitreal bevacizumab has been utilized to successfully treat iris neovascularization occurring secondary to the OIS, although longterm data are lacking [60].

Controversies and Perspectives

The greatest controversy concerns the effect of reversal of the carotid artery stenosis by endarterectomy or stenting. Clinical trial data are lacking in regard to visual results obtained following carotid surgical interventions. Since the visual prognosis is grim if the patient already has iris neovascularization, it seems important that vascular surgery be undertaken at an earlier time. Obtaining noninvasive carotid studies should be considered in the appropriate clinical scenario, preferably prior to the development of iris neovascularization.

While somewhat controversial, oral rosuvastatin has been shown to decrease atherosclerosis in coronary patients [61]. This form of therapy might well benefit those with the atherosclerosis encountered with the OIS.

Focal Points

•The OIS is associated with dilated and beaded retinal veins that are not tortuous, while nonischemic central retinal vein obstruction is associated with dilated, beaded veins that are tortuous.

•The OIS is the most common cause of spontaneous arterial pulsations.

•Among the fluorescein angiographic signs associated with the OIS, delayed choroidal filling is the most specific. Increased arteriovenous transit time is the least specific.

•In patients with carotid stenosis and diabetic retinopathy, it can be difficult to differentiate which disease accounts for the ocular changes.

•Light digital pressure on the upper lid typically produces dramatic spontaneous retinal arterial pulsations in OIS eyes, while the same or greater pressure in nonischemic central retinal vein obstruction fails to produce retinal arterial pulsations.

•If the clinical symptoms and signs of the OIS are present and a severe carotid stenosis is absent, obstruction of the ophthalmic may be present.

•The effect of high dose oral rosuvastatin, which has been shown to reverse coronary atherosclerosis, may be of benefit for the treatment of the atherosclerosis associated with the OIS.

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