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Retina (Philadelphia, Pa.) Jan 2014To investigate systematically the prevalence of amaurosis fugax (AF) in various ocular vascular occlusive disorders individually and to discuss the pathogeneses of each.
PURPOSE
To investigate systematically the prevalence of amaurosis fugax (AF) in various ocular vascular occlusive disorders individually and to discuss the pathogeneses of each.
METHODS
The study comprised patients with central retinal artery occlusion (271 eyes), branch retinal artery occlusion (169 eyes), ocular ischemic syndrome (39 eyes), central retinal vein occlusion (864 eyes), hemi-central retinal vein occlusion (67 eyes), branch retinal vein occlusion (285 eyes), nonarteritic anterior ischemic optic neuropathy (946 eyes), and giant cell arteritis with visual loss (147 eyes). At first visit, all patients had a detailed ophthalmic and medical history and comprehensive ophthalmic evaluation and systemic evaluation.
RESULTS
Prevalence of AF was 12.18% in central retinal artery occlusion, 14.20% in branch retinal artery occlusion, 15.38% in ocular ischemic syndrome, 4.86% in central retinal vein occlusion, 37.84% in central retinal vein occlusion with cilioretinal artery occlusion, 13.43% in hemi-central retinal vein occlusion, 0.35% in branch retinal vein occlusion, and 2.54% in nonarteritic anterior ischemic optic neuropathy. In giant cell arteritis, 32.4% of patients with ocular involvement had a history of AF or 26.5% of the involved eyes. Amaurosis fugax in central retinal artery occlusion, branch retinal artery occlusion, and nonarteritic anterior ischemic optic neuropathy is mostly because of transient embolism. The pathogenesis of AF in each ocular vascular occlusive disorder is discussed.
CONCLUSION
Prevalence and pathogenesis of AF in various ocular vascular occlusive disorders varies widely. Amaurosis fugax may be the presenting symptom in these disorders and that always requires urgent evaluation.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amaurosis Fugax; Blood Pressure; Female; Giant Cell Arteritis; Humans; Intraocular Pressure; Male; Middle Aged; Optic Neuropathy, Ischemic; Prevalence; Prospective Studies; Retinal Artery Occlusion; Retinal Vein Occlusion; Young Adult
PubMed: 23632956
DOI: 10.1097/IAE.0b013e31829234b5 -
Journal of Stroke and Cerebrovascular... Jul 2019Amaurosis fugax (AmF) is defined as transient monocular visual loss secondary to retinal ischemia. In most patients presenting with AmF, the attack of visual loss occurs...
Amaurosis fugax (AmF) is defined as transient monocular visual loss secondary to retinal ischemia. In most patients presenting with AmF, the attack of visual loss occurs in the same eye. A 64-year-old woman experienced transient visual loss in her right eye. Three days after that, an attack happened on the left side. In total, she had 5 episodes of AmF in 2 months. AmF occurred on both sides at different times, and so may be referred to as "Alternating AmF". Diffusion-weighted magnetic resonance imaging showed high-intensity lesions in various parts of brain, and laboratory examination revealed elevated D-dimer and ovarian tumor marker. We suspected Trousseau syndrome and found a giant ovary tumor. After removal of the tumor, no recurrence was observed. When a patient with alternating AmF is encountered, screening for malignancy is essential.
Topics: Adenocarcinoma, Clear Cell; Amaurosis Fugax; Biomarkers, Tumor; Blood Coagulation; Cerebral Angiography; Diffusion Magnetic Resonance Imaging; Female; Fibrin Fibrinogen Degradation Products; Humans; Magnetic Resonance Angiography; Middle Aged; Ovarian Neoplasms; Recurrence; Syndrome; Thromboembolism; Thrombophilia; Treatment Outcome
PubMed: 31097325
DOI: 10.1016/j.jstrokecerebrovasdis.2019.04.018 -
Clinical and Applied... Jul 2005The aim of this study was to prospectively assess associations between amaurosis fugax, inherited thrombophilia, and acquired thrombophilia. Thrombophilia and...
The aim of this study was to prospectively assess associations between amaurosis fugax, inherited thrombophilia, and acquired thrombophilia. Thrombophilia and hypofibrinolysis were studied in 11 cases (eight women, three men; all white) with amaurosis fugax, 57 +/- 17 years old, selected by the absence of abnormal brain magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), magnetic resonance venography (MRV), ipsilateral internal carotid artery plaque, atrial fibrillation, or cardiac thrombus. Cases were compared to 78 healthy adult white controls (53 +/- 18 years old) for serologic measures, and by polymerase chain reaction to 248 healthy white controls (78 adults, 170 children) for gene mutations. All 11 cases had one or more familial thrombophilic coagulation disorder including one heterozygous for the G1691A factor V Leiden mutation, two with low free protein S, four with high factor VIII, three with resistance to activated protein C, three homozygous for the C677T methylenetetrahydrofolate reductase (MTHFR) mutation, two compound C677T-A1298C MTHFR heterozygotes, and three with hypofibrinolytic 4G4G homozygosity for the PAI-1 gene. The case with factor VIII of 160% had two other thrombophilias (compound MTHFR C677T-A1298C heterozygosity, resistance to activated protein C), and hypofibrinolytic high Lp(a). Thrombophilic C677T MTHFR homozygosity or compound C677T-A1298C heterozygosity was present in five of 10 (50%) cases vs. 30 of 248 (12%) controls, Fisher's p (p(f)) = .005. Thrombophilic factor VIII was high in four of 10 (40%) cases vs. 0 of 38 controls, p(f) = .001. Thrombophilic hyperestrogenemia in five of the eight women (four exogenous estrogen, one pregnant) may have interacted with inherited thrombophilia-hypofibrinolysis, promoting thrombus formation. In cases selected by the absence of abnormal brain magnetic resonance imaging, significant ipsilateral internal carotid artery plaque, atrial fibrillation, or cardiac thrombus, we speculate that amaurosis fugax can be caused by reversible (by anticoagulation) retinal artery thrombi associated with heritable thrombophilia and/or hypofibrinolysis, often augmented by estrogen-driven acquired thrombophilia.
Topics: Adult; Aged; Amaurosis Fugax; Amino Acid Substitution; Brain; Child; Factor VIII; Female; Genetic Carrier Screening; Homozygote; Humans; Magnetic Resonance Imaging; Male; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Plasminogen Activator Inhibitor 1; Polymorphism, Single Nucleotide; Reference Values; Thrombophilia
PubMed: 16015408
DOI: 10.1177/107602960501100301 -
Retina (Philadelphia, Pa.) Dec 2015
Topics: Amaurosis Fugax; Fluorescein Angiography; Humans; Male; Middle Aged; Retinal Artery Occlusion
PubMed: 26049618
DOI: 10.1097/IAE.0000000000000607 -
International Medical Case Reports... 2016A 68-year-old female with no significant past medical history presented with loss of vision in the lower half of her left eye that lasted <5 minutes. No abnormalities...
A 68-year-old female with no significant past medical history presented with loss of vision in the lower half of her left eye that lasted <5 minutes. No abnormalities were found on ocular or physical exam. Computed tomography angiography and carotid ultrasound were performed, which confirmed the diagnosis as amaurosis fugax with two abnormalities leading to the transient retinal vessel occlusion. First, it was found that the patient has a congenital vascular anomaly, which consisted most notably of a right-sided aortic arch. This vascular anomaly also consisted of abnormal branching of the left subclavian and common carotid arteries, predisposing the patient to turbulent blood flow and increased risk of the formation of an atherosclerotic plaque at the origin of the common carotid artery. This is an abnormal location for a plaque leading to amaurosis fugax compared to the most common location at the carotid bifurcation. Endarterectomy was not performed because of the difficult location of the plaque and tortuosity of the vessel. Rather, medical intervention with antiplatelet and lipid-lowering therapy was initiated to lower the risk of future retinal or cerebral thromboembolic events.
PubMed: 27445507
DOI: 10.2147/IMCRJ.S106627 -
Annals of Vascular Surgery May 1992A 10 year retrospective study of 103 patients with amaurosis fugax was done. Sixty-two patients with symptoms of amaurosis fugax underwent arteriography, which...
A 10 year retrospective study of 103 patients with amaurosis fugax was done. Sixty-two patients with symptoms of amaurosis fugax underwent arteriography, which demonstrated ulcerated carotid plaque in 36 and hemodynamically significant stenoses (greater than 75% diameter reduction) in 26. These 62 patients underwent carotid endarterectomy. The other 41 patients who had proven ulcerated plaque (33 patients) or hemodynamic stenoses (eight patients) were not treated surgically and served as a control series. No strokes or deaths occurred in the immediate postoperative period. Follow-up of the 62 operated patients extending to 10 years (mean 4.2 years), revealed one (1.6%) patient with recurrent amaurosis fugax symptoms, two (3.2%) with transient ischemic attacks, and one (1.6%) with a stroke in the operated hemisphere. In the nonoperated group, despite aspirin or warfarin treatment, four (9.7%) patients had ongoing amaurosis fugax symptoms, and two (4.8%) developed transient ischemic attacks that led to carotid endarterectomy. One (2.4%) other patient developed sudden, permanent monocular blindness, and two (4.8%) suffered hemispheric strokes, one of which was fatal. The cumulative morbidity (ongoing ocular or transient ischemic attack symptoms, perioperative and late stroke) in the operated group was 6.4% (four patients), while the cumulative morbidity in the nonoperated group was significantly higher at 21.9% (nine patients) (p = 0.02). When patients present with symptoms of amaurosis fugax and have demonstrable carotid bifurcation disease, carotid endarterectomy is recommended. Amaurosis fugax should be regarded as a harbinger of monocular blindness and stroke.
Topics: Adult; Aged; Aged, 80 and over; Blindness; Carotid Stenosis; Cerebrovascular Disorders; Endarterectomy, Carotid; Female; Humans; Ischemic Attack, Transient; Male; Middle Aged; Recurrence; Retrospective Studies; Treatment Outcome
PubMed: 1610660
DOI: 10.1007/BF02000275 -
The British Journal of Ophthalmology Dec 1986
Topics: Aged; Blindness; Female; Humans; Hyphema; Male; Middle Aged; Pilocarpine
PubMed: 3801373
DOI: 10.1136/bjo.70.12.933-a -
Nihon Rinsho. Japanese Journal of... Nov 2006
Review
Topics: Aged; Amaurosis Fugax; Cerebral Infarction; Humans; Middle Aged
PubMed: 17471638
DOI: No ID Found -
Heart Disease and Stroke : a Journal... 1993
Review
Topics: Blindness; Carotid Artery Diseases; Carotid Stenosis; Cerebrovascular Disorders; Embolism; Endarterectomy, Carotid; Humans; Intracranial Arteriosclerosis; Ischemic Attack, Transient; Ophthalmic Artery
PubMed: 8137039
DOI: No ID Found -
Survey of Ophthalmology 1997A 36-year-old healthy woman developed amaurosis fugax of the right eye lasting 1 minute. Work-up revealed right carotid stenosis thought most compatible with an...
A 36-year-old healthy woman developed amaurosis fugax of the right eye lasting 1 minute. Work-up revealed right carotid stenosis thought most compatible with an atherosclerotic plaque. A carotid endarterectomy was performed which corroborated the radiologic diagnosis. An embolic event from ipsilateral carotid artery disease should be considered as a cause of amaurosis fugax even in the young.
Topics: Adult; Arteriosclerosis; Blindness; Carotid Arteries; Carotid Stenosis; Endarterectomy; Female; Humans; Radiography
PubMed: 9220571
DOI: 10.1016/s0039-6257(97)00020-9