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Temporary Visual Disturbance of a Patient with Decreased Ocular Perfusion

Matthiessen E. T., Zeitz O., Preuss J., Richard G., Klemm M.,
Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Augenheilkunde (Hamburg)

Purpose: Temporary visual disturbances of older patients are often unexplained. Despite the clarification of primarily ocular diseases such as ARMD and Cataract the genesis keeps being unclear.
Case report: An 80 year old patient presented temporary blurred vision on both eyes. This problem occurred basically during reading and manual work. The best corrected visual acuity was 1.0 and Nieden II for near vision. The anterior eye segment as well as the posterior eye segment was age-specific. A convergence insufficiency or a reduced retinal visual acuity could not be found. For the clarification of an ocular perfusion disorder we examined the perfusion of the ophthalmic artery with color Doppler imaging. As the complaints were depending on the pose of the head we performed the color Doppler imaging in normal (primary) head pose and in the reading pose of the patient. Finally in primary head pose in which the complaints decreased. In every position 10 measurements of the peak systolic velocity were taken. The evaluation with the t-test of paired values one could identify significant differences of the perfusion depending on the head pose. Whilst in primary position a systolic peak velocity of 24.9 cm/s (SD: 0.62) was observed, the peak flow in reading position counted 18.97 (SD: 0.80). Repeating the measurements in the primary position the peak velocity increased again to a higher value of 23.9 cm/s (SD: 1.28). In the following color Doppler imaging examination of the carotids a kinking syndrome could be observed.
Conclusions: Temporary visual disturbance should always be clarified, also regarding any ocular perfusion disturbances. An exclusively color Doppler imaging examination of the carotids is usually however insufficient. A kinking syndrome of the carotids is frequent at the higher age, normally without neurological symptoms, and does not justify necessarily an operation indication. Only the verification of a decreased ocular perfusion by the examination of the ocular perfusion by color Doppler imaging could led to a surgery indication for an ACI-Plastic.