鼻咽癌长期放射治疗后双眼缺血综合征1例

目的：报道1例因接受放射治疗后出现双侧颈总动脉完全闭塞和双眼缺血综合征(ocular ischemic syndrome,OIS)的患者。 方法：病例报告。1例57岁男性患者主诉左眼一过性黑矇伴有眼部和眶周疼痛6mo,诊断为双侧OIS,依次给予双侧全视网膜光凝(panretinal photocoagulation,PRP)、白内障手术、颈动脉内膜剥脱术和Ahmed青光眼阀植入术。 结果：经过PRP和白内障超声乳化手术治疗,双侧眼部病情稳定。但患者行双侧颈动脉内膜剥脱术后出现眼压升高,视力降至指数。 结论：鼻咽癌放射治疗后出现的双侧颈总动脉完全闭塞和双眼OIS的治疗比较困难,预后不佳。     

The development and management of neovascular glaucoma.

Patients with neovascular glaucoma (NVG) often present with neovascularisation of the iris (NVI) already established and prompt energetic treatment of these patients is needed to reverse or stabilise the condition with possible retention of some visual function. In this series if the ocular media were still clear panretinal photocoagulation (PRP) caused regression of NVI in about 60% of cases and if a persistent rise in intraocular pressure (IOP) were still present this could be dealt with by drainage operation, Molteno implant or cyclophotocoagulation. If the media were already opaque or NVI did not regress then a Molteno implant or cyclophotocoagulation was used to reduce the IOP, preserving corneal endothelial function so that a comfortable eye could be obtained. Some regression of the NVI process was likely with time if the IOP were controlled by surgical treatment. Of 32 patients reviewed here, 20 patients developed NVG following a central retinal vein occlusion; in six patients NVG followed diabetic proliferative retinopathy, in five it followed arterial occlusion, and in one it followed an old traumatic retinal detachment. In those patients where NVG followed venous or arterial occlusion the common risk factors were always present. Patients were usually under treatment for their systemic condition but this treatment should be reviewed.     

The development and management of neovascular glaucoma

Patients with neovascular glaucoma (NVG) often present with neovascularisation of the iris (NVI) already established and prompt energetic treatment of these patients is needed to reverse or stabilise the condition with possible retention of some visual function. In this series if the ocular media were still clear panretinal photocoagulation (PRP) caused regression of NVI in about 60% of cases and if a persistent rise in intraocular pressure (IOP) were still present this could be dealt with by drainage operation, Molteno implant or cyclophotocoagulation. If the media were already opaque or NVI did not regress then a Molteno implant or cyclophotocoagulation was used to reduce the IOP, preserving corneal endothelial function so that a comfortable eye could be obtained. Some regression of the NVI process was likely with time if the IOP were controlled by surgical treatment. Of 32 patients reviewed here, 20 patients developed NVG following a central retinal vein occlusion; in six patients NVG followed diabetic proliferative retinopathy, in five it followed arterial occlusion, and in one it followed an old traumatic retinal detachment. In those patients where NVG followed venous or arterial occlusion the common risk factors were always present. Patients were usually under treatment for their systemic condition but this treatment should be reviewed.     

The efficacy of panretinal photocoagulation for neovascularization of the iris after central retinal artery obstruction

Panretinal photocoagulation (PRP) is widely used for a variety of ischemic ocular conditions. In diseases that produce neovascularization of the iris (NVI), such as diabetes mellitus and central retinal vein obstruction, a judiciously timed PRP can reduce the incidence of neovascular glaucoma. Neovascularization of the iris can occur after central retinal artery obstruction (CRAO) as well. In this article, the authors report the outcome of 17 patients who received PRP to treat rubeosis iridis secondary to CRAO. Eleven of the 17 patients (65%) showed regression of NVI after PRP. Although the uncontrolled and retrospective nature of this study precludes drawing definitive conclusions from these data, PRP appears to be effective in reducing the incidence of neovascular glaucoma, if it is delivered before the development of elevated intraocular pressure (IOP). Once neovascular glaucoma occurs, additional modalities appear to be necessary in order to adequately control the elevated IOP.     

Early panretinal photocoagulation for ERG‐verified ischaemic central retinal vein occlusion

Purpose: We have previously shown that photopic cone b‐wave implicit time ≥35.0 ms in 30 Hz flicker electroretinography (ERG) predicts ocular neovascularization (NV) in central retinal vein occlusion (CRVO). Here, we evaluate the effects of early panretinal photocoagulation (PRP) in patients with ERG‐verified ischaemic CRVO. Methods: Patients with CRVO, admitted to our department between 2000 and 2008, were classified as having ischaemic or non‐ischaemic CRVO based on the ERG‐results. In a first group of 71 patients, 18 patients had ischaemic CRVO and were assigned to standard treatment that is regular examinations and PRP as soon as NV was found. In a consecutive group of 65 patients, 18 patients with ischaemic CRVO received early PRP. In this group, ERG was performed on average 6 weeks after the first symptoms of CRVO. The patients underwent PRP as soon as possible after the ERG‐examination, and the treatment was completed within one to three sessions. Results: Twelve patients in the standard treatment group developed neovascular glaucoma during a mean period of 5 months after the CRVO. In the early treatment group, one patient developed subtle iris rubeosis 7 months after PRP. Otherwise, none of the patients showed any signs of ocular NV, and the intraocular pressure remained within normal range, without the necessity of supplementary medication, during a mean follow‐up of 41 months. Conclusions: This study indicates that ocular NV in patients with CRVO can be predicted by photopic 30 Hz flicker ERG and that early PRP in ERG‐verified ischaemic CRVO could be suggested as standard treatment.     

Intravitreal bevacizumab (Avastin) injection in ocular ischemic syndrome

PURPOSE: To determine whether bevacizumab may improve anatomic and visual outcomes in patients with ocular ischemic syndrome (OIS). DESIGN: Interventional case reports. METHODS: Two patients with OIS presenting with unilateral ocular pain, iris neovascularization, and macular edema. Intravitreal injection of bevacizumab (1.25 mg). The main outcome measures were postinjection best-corrected visual acuity (BCVA), intraocular pressure (IOP), angiographic findings, and optical coherence tomography (OCT) findings and complications. RESULTS: One week after treatment, both patients demonstrated regression of the iris neovascularization and improvement of the macular edema, with no changes in BCVA and IOP. One eye was reinjected at four months. After three and seven months, no significant or systemic adverse events were observed, and no signs of new iris neovascularization were present. CONCLUSIONS: Intravitreal bevacizumab may be useful for the treatment of eyes with iris neovascularization and macular edema secondary to OIS.     

Visual outcomes after carotid reconstructive surgery for ocular ischemia

Aims

This study aimed to determine the influence of carotid artery surgery on ocular functions and ocular blood flow in patients with ocular ischaemic syndrome (OIS) in the late postoperative period.

Methods

One hundred and eighty patients with OIS were operated on; 104 of them suffered from acute forms of the ischaemic disease and 76 patients had chronic forms of ocular ischaemia. Before surgery and in the course of 6 months and 12 months afterwards, all the patients were examined. Visual acuity, electrophysiological investigations (the threshold of electrical sensitivity (TES) and the level of liability of optic nerve (LON)) and blood flow in orbital vessels were assessed.

Results

After surgery visual acuity increased in patients with the acute forms of OIS (P<0.05). TES and LON also improved (P<0.01). Mean indices of blood-flow velocities in the ophthalmic artery, the central retinal artery and the posterior ciliary arteries increased at 6 and 12 months after surgery (P<0.05). There was ocular blood flow acceleration and decrease of vasoresistance in orbital arteries in both groups of patients.

Conclusions

Carotid artery surgery effectively improved ocular blood flow in patients with acute and chronic forms of OIS in the late post operative period.     

Vascular endothelial growth factor is elevated in ocular fluids of eyes harbouring uveal melanoma: identification of a potential therapeutic window

BACKGROUND: Improved local treatment of uveal melanoma makes it possible for many patients to retain the affected eye, but a proportion will develop secondary complications such as neovascularisation of the iris (NVI) and require enucleation. Although vascular endothelial growth factor A (VEGF-A) is known to correlate with NVI and can cause NVI in experimental models, this pro-angiogenic cytokine is consistently reported to be absent in uveal melanoma. Novel anti-VEGF therapies are now in clinical trial, and the authors therefore wished to determine whether VEGF-A was indeed elevated in melanoma bearing eyes. METHODS: VEGF-A concentrations were measured in aqueous and vitreous from 19 and 30 enucleated eyes respectively. RESULTS: Elevated VEGF-A concentrations (up to 21.6 ng/ml) were found in melanoma bearing eyes compared with samples from patients undergoing routine cataract extraction (all had values below 0.96 ng/ml). Immunohistochemistry showed VEGF-A protein in the iris and/or ciliary body of 54% and basic fibroblast growth factor (bFGF) in 82% of the eyes examined. VEGF was found to a limited extent and at very low levels in only 9% of these tumours. Aqueous or vitreous VEGF levels showed no apparent correlation with retinal detachment, tumour size, vascularity, or immunohistochemistry. Though limited in number, the highest VEGF levels correlated with previous radiation therapy, and with the presence neovascularisation of the iris or optic nerve head. bFGF was not significantly elevated in ocular fluids: it is known to be a pro-angiogenic agent and was detected in the majority of primary uveal melanomas. CONCLUSION: Based on this study, though the source of VEGF within eyes harbouring uveal melanoma is not clear, these data suggest that anti-VEGF therapy might prove useful in the management of some patients with NVI secondary to uveal melanoma.     

Ocular ischemic syndrome in diabetic patients

PURPOSE: Diabetes mellitus aggravates carotid occlusive disease, that can manifest as ocular ischemic syndrome (OIS). Ocular manifestations and visual prognosis of OIS in diabetic patients were retrospectively analyzed. METHODS: Twenty-three consecutive diabetic patients with OIS were divided into two groups according to the presence of iris neovascularization, and the clinical features were reviewed. RESULTS: In the first group, 14 eyes of 12 diabetic patients (11 men and 1 woman) had no iris neovascularization. Two patients had bilateral OIS. The ages in this group ranged from 50-75 years. Four eyes with optic atrophy or ischemic optic neuropathy had severe visual loss. Six eyes with hypoperfusion retinopathy or retinal vein obstruction and 2 eyes with cataract had mild visual loss. Each eye with amaurosis fugax or retinal neovascularization had no visual deterioration. Asymmetrical retinopathy was observed in 2 patients. Carotid surgery stabilized and resolved amaurosis fugax and hypoperfusion retinopathy. In the second group, 11 eyes of 11 patients had iris neovascularization. The patients were all male and their ages ranged from 53-77 years. All eyes with iris neovascularization had severe visual deterioration. In 5 patients, asymmetrical ocular manifestation was observed. Carotid reconstruction surgery and ophthalmological treatment were not successful for recovering a satisfactory visual outcome in OIS. CONCLUSION: The features of OIS in diabetic patients mimic diabetic retinopathy and manifest with asymmetrical ocular findings. Iris neovascularization is an indicator of poor visual prognosis. It is essential to recognize the early stages of OIS associated with diabetes mellitus.     

A complicated case of ciliary body melanoma and glaucoma

This clinicopathological case report describes the bilateral ocular pathology in an eldery man suffering from primary open angle glaucoma, aphakia and a ciliary body melanoma which was treated by cryotherapy to preserve vision in the better eye. Liver metastases were detected 18 months after the tumour was recognised. At autopsy, melanoma metastases were found within a renal cell carcinoma which had also metastasised to the lungs. Other abnormalities included aphakic maculopathy, senile macular degeneration, asteroid hyalosis and patchy hyalinisation of the retinal vasculature, which in one eye was the source of preretinal neovascularisation derived from intramural neovascularisation.     

Reversible anterior segment ischaemia after carotid endarterectomy

Carotid artery disease has long been implicated in ocular ischaemic syndrome. The classical changes of ocular ischaemic syndrome have not been described to resolve with carotid endarterectomy. Herein, a case of documented carotid artery disease presenting with anterior segment ischaemia and retinal artery emboli is described. Prompt carotid endarterectomy resulted in resolution of most of the anterior segment ischaemic signs within a few days.     

虹膜荧光素血管造影在虹膜新生血管诊断中的应用

目的 探讨虹膜荧光素血管造影(IFA)在缺血性视网膜中央静脉阻塞(CRVO)虹膜新生血管(NVI)诊断中的价值.方法 经荧光素眼底血管造影(FFA)检查确诊的CRVO患者51例51只眼纳入研究.所有患者均行视力、裂隙灯显微镜检查、眼前节彩色照相、眼压及FFA+IFA检查.根据FFA检查结果分为非缺血性和缺血性CRVO,分别为20、31只眼.非缺血性CRVO20只眼中,男性11只眼,女性9只眼;年龄41～59岁.缺血性CRVO31只眼中,男性21只眼,女性10只眼;年龄28～62岁.采用德国海德堡眼底荧光血管造影仪进行FFA+IFA检查,将典型图像存入计算机图像处理系统进行分析.对比观察裂隙灯显微镜和IFA NVI的检出率.缺血性CRVO31只眼均行全视网膜激光光凝(PRP)治疗,其中,完成治疗27只眼,未坚持完成治疗4只眼.完成治疗后6个月,随访观察NVI消退情况.结果 非缺血性CRVO20只眼裂隙灯显微镜检查瞳孔缘及虹膜未见新生血管,占100.0%;IFA检查虹膜未见显影,呈色素遮蔽荧光,占100.0%.缺血性CRVO31只眼中,裂隙灯显微镜检查显示瞳孔缘及虹膜有细小新生血管13只眼,占41.9%;IFA检查显示NVI 23只眼,占74.2%.2种检查方法NVI检出率比较,差异有统计学意义(Z=-3.425,P=0.001).IFA检查NVI分别表现为小团状、细线状或不规则交叉网状强荧光染色及渗漏.完成PRP治疗的27只眼IFA检查结果显示,瞳孔缘及虹膜表面未见荧光染色及渗漏;未坚持完成PRP治疗4只眼,1～2个月后出现新生血管性青光眼(NVG).结论 IFA可以提示眼前节的缺血状态,具有较高的特异性,辅助CRVO缺血型早期诊断,预测是否发展NVG.

Abstract：

Objective To evaluate the application value of iris fluorescein angiography (IFA) in the diagnosis of ischemic center retinal vein occlusion (CRVO). Methods Fifty-one patients (51 eyes) with CRVO which had been diagnosed by fundus fluorescein angiography (FFA) were studied. All patients underwent the examination of visual acuity, slit lamp biomicroscope, anterior segment color photography,intraocular pressure, FFA and IFA. The patients were classified as non-ischemic CRVO (20 eyes) and ischemic CRVO (31 eyes). The 20 non-ischemic CRVO patients included 11 males and nine females, aged from 41 to 59 years. The 31 ischemic CRVO patients included 21 males and 10 females, aged from 28 to 62 years. FFA and IFA were performed for all the patients using Heidelberg retina angiograph, and the classic pictures were analyzed by the computer image processing system. The detection rate of iris neovascularization (NVI) by slit lamp biomicroscope and IFA was analyzed. All ischemic CRVO eyes underwent panretinal photocoagulation (PRP), and PRP was completed in 27 eyes and not completed in four eyes. Six months after PRP the regression of iris NVI was followed up. Results All non-ischemic CRVO eyes (100. 0% ) had no neovascularization on papillary margin and iris by slit lamp biomicroscopy, and had no fluorescence (pigment blocked fluorescence) on IFA. Thirteen eyes (41.9%) and 23 eyes (74.2%) of the 31 ischemic eyes had NVI by slit lamp biomicroscope and IFA, respectively. The NVI detection rate of those two methods was statistically different (Z= - 3. 425, P = 0. 001 ). NVI showed strong fluorescence and leakage with variable patterns (small blocks, thin lines and irregular cross-links) by IFA. There was no fluorescence staining and leakage on papillary margin and iris in 27 eyes who completed the PRP, but the neovascular glaucoma (NVG) occurred in one eyes who discontinued the PRP treatment after one to two months. Conclusions IFA has a high specificity in CRVO which hints the ischemic state of anterior segment. It is helpful to the early diagnosis of ischemic CRVO and the turnover of NVG.     

Follow-up results of surgical correction of ocular ischemic syndrome

The influence of surgeries in the carotid arteries produced on the visual functions and ocular blood circulation was studied in patients with ocular ischemic syndrome (OIS) during the remote postoperative period. A total of 180 patients with OIS (including 104 patients with an acute OIS clinical course and 76 patients with primary chronic clinical course) and with a pronounced stenosis of the carotid arteries were examined preoperatively and postoperatively within 1 or 2 years. A reliably improved visual acuity (preoperatively -0.37 +/- 0.05; and postoperatively -0.52 +/- 0.07; p < 0.01), positive dynamics in the electric sensitivity threshold and in a lability of the optic nerve were observed in patients with the acute OIS clinical course after reconstructive surgeries in the carotid arteries. An increase in contrast sensitivity of the visual analyzer was detected in 28.8% of patients with the acute clinical course and in 10.5% of patients with the chronic OIS clinical course. An improved blood circulation through the ocular artery was stated in patients of both groups. Reconstructive surgeries in the carotid arteries are most effective in correcting the acute OIS clinical variation.     

Comparison of healing patterns of different side-cut angulations after FS-LASIK

AIM: To investigate and evaluate healing patterns around flaps made with different side-cut angulations after femtosecond laser in situ keratomileusis(FS-LASIK).METHODS: Thirty-four patients(68 eyes) received a 90° side-cut(n=34) or a 120° side-cut flaps(n=34) made with a femtosecond laser. One day, 1 wk, 1 and 3 mo postoperatively, side-cut scar was evaluated under slit-lamp photography according to a new grading system(Grade 0=transparent scar, 1=faint healing opacity, and 2=evident healing opacity). In vivo corneal confocal microscopy and anterior segment optical coherence tomography(AS-OCT) were used to observe wound-healing patterns around flap margin in the two groups. Sirius Scheimpflug Analyzer was also used to analyze higher order aberrations 3 mo after surgery.RESULTS: There were no significant differences in flap wound-healing patterns at each follow up between the two groups(P>0.05). Three months after surgery, the flap edge scar classified as Grade 0 had excellent apposition and rapid nerve regeneration. At 3 mm and 5 mm pupil diameters, there were significant differences in trefoil aberrations between the two groups(P<0.05), but no statistically significant differences were found in total higher order aberrations(HOAs), spherical aberrations or coma in any of the pupil size conditions(P>0.05).CONCLUSION: Flap edge scars classified as Grade 0 have excellent apposition and rapid nerve regeneration, and 120° side-cut angle flaps induce less trefoil aberrations after FS-LASIK.     

糖尿病视网膜病变玻璃体切除术后新生血管性青光眼原因分析

目的:探讨增殖性糖尿病视网膜病变患者玻璃体切除术后发生新生血管性青光眼的原因。方法:对行玻璃体切除术后9例病例(11眼)发生新生血管性青光眼的原因进行回顾性分析。结果:11眼中行晶状体手术7眼,其中后囊破裂或不完整6眼,术前存在虹膜新生血管(NVI)2眼,术后视网膜脱离1眼,手术后至发生新生血管性青光眼(NVG)期间11眼均未行眼底荧光血管造影和视网膜光凝。结论:术中联合行晶状体手术、玻璃体腔填充物、光凝效果、术后发生视网膜脱离、术前存在NVI等对术后发生新生血管性青光眼均有影响。     

Intracameral anti-VEGF injection for advanced neovascular glaucoma after vitrectomy with silicone oil tamponade

AIM: To evaluate the effect of intracameral injection of conbercept for the treatment of advanced neovascular glaucoma(NVG) after vitrectomy with silicone oil tamponade.METHODS: Conbercept 0.5 mg/0.05 m L was injected into the anterior chamber of 5 eyes, which had developed advanced NVG after vitrectomy with silicone oil tamponade. Then, trabeculectomy with mitomycin C and pan-retinal photocoagulation(PRP) or extra-PRP were conducted within 2 d. The follow-up time was 6 mo. Best-corrected visual acuity(BCVA), intraocular pressure(IOP), neovascularization of iris(NVI) were recorded before and after treatment.RESULTS: Within 2 d after injection, IOP control, and NVI regression were optimal for trabeculectomy. Hyphema occurred in one eye in the process of injection. But none of them present hyphema after trabeculectomy. At the end of follow-up time, all eyes had improved BCVA, well-controlled IOP, and completely regressed NVI. CONCLUSION: Intracameral injection of conbercept is safe and effective in the treatment of patients with advanced NVG after vitrectomy with silicone oil tamponade. Within 2 d after injection is the optimal time window for trabeculectomy, which can maximally reduce the risk of perioperative hyphema.     

眼部缺血综合征的眼底荧光血管造影观察

目的:研究眼部缺血综合征(ocular ischemic syndrome,OIS)的眼底荧光血管造影的特征。方法:对41例眼部缺血综合征的患者行数字减影动脉造影(digtal subtraction angiography,DSA)、彩色多普勒血管检查(doppler)和眼底荧光血管造影检查(fundus flurescein angiography,FFA)。结果:FFA提示眼部缺血综合征患者臂-视网膜循环时间不同程度延长,视网膜静脉扩张,微血管瘤,血管壁着染以及黄斑水肿和视网膜毛细血管无灌注等改变。结论:眼部缺血综合征的FFA检查呈现特征性改变。为与其相关的全身性疾病的诊断和治疗提供佐证。     

Trabeculectomy for neovascular glaucoma in proliferative diabetic retinopathy,central retinal vein occlusion,and ocular ischemic syndrome: Surgical outcomes and prognostic factors for failure

Purpose:To evaluate the outcomes of trabeculectomy in the eyes with neovascular glaucoma (NVG), caused by proliferative diabetic retinopathy (PDR), central retinal vein occlusion (CRVO), and ocular ischemic syndrome (OIS).Methods:A retrospective review of NVG eyes that underwent trabeculectomy between 1991 and 2019. Complete success was defined as intraocular pressure (IOP) between 6 and 21 mmHg without antiglaucoma medications (AGM). The risk factors were analyzed by Cox''s proportional hazard model.Results:The study included 100 eyes of 100 subjects with a mean age of 58 ± 9.8 years and a median follow-up of 1.27 years (interquartile range: 0.63, 2.27). The cause of NVG was PDR in 59 eyes (59%), CRVO in 25 eyes (25%), and OIS in 16 eyes (16%). Trabeculectomy with mitomycin-C was performed in 88 eyes and trabeculectomy in 12 eyes. The cumulative complete success probability of trabeculectomy in PDR was 50% (95% confidence interval [CI]: 38, 65) at 1 year, 8% (1, 46) at 3–5 years. In OIS, it was 64% (43, 96) from 1 to 5 years. In CRVO, it was 75% (59, 94) at 1 year, 45% (23, 86) from 2 to 5 years. The PDR was associated with a higher risk of surgical failure compared to OIS (P = 0.04) and CRVO (P = 0.004). Other significant risk factors were increasing age (P = 0.02), persistent neovascularization of iris (NVI) (P = 0.03), higher number of anti-vascular endothelial growth factor (VEGF) injections prior to trabeculectomy (P = 0.02), and delay in performing trabeculectomy (P = 0.02).Conclusion:Compared to CRVO and OIS, the eyes with NVG secondary to PDR had poor success with trabeculectomy. Older age, persistent NVI, need for a higher number of anti-VEGF injections, and delayed surgery were associated with a higher risk for trabeculectomy failure.     

Blood flow in ocular vessels in 2 types of ocular ischemic syndrome

Ultrasonic triplex scanning of the orbit (gray scale two-dimensional ultrasonic examination, color Doppler mapping (CDM), and dopplerography) was carried out in 148 patients with ocular ischemic syndrome (OIS) aged 35-70 years, 104 of these with acute and 44 with primary chronic course. Signs of disordered bloodflow in the orbital and central retinal arteries were detected in patients with acute disease: 2-fold decreased maximum systolic bloodflow velocity, 5-fold decreased end diastolic bloodflow velocity, and 1.5 times increased resistance index in comparison with the norm. Chronic course of OIS was characterized by decreased maximum systolic velocity (by 1.5 times) and end diastolic bloodflow velocity (3-fold) in comparison with the norm in both arteries. Studies of ocular bloodflow by CDM timely detected angiological disorders in OIS and help define (in cooperation with angiosurgeon) the indications for angioreconstructive operations.     

Light-induced amaurosis fugax

PURPOSE: To describe an important symptom of bilateral amaurosis precipitated by exposure to bright light. METHODS: Case report. Clinical analysis of transient, painless, asymmetrical visual loss occurring in bright light in a 54-year-old man. RESULTS: Carotid ultrasound showed bilateral carotid disease. Carotid angiography demonstrated occlusion of the left internal carotid artery and severe stenosis of the right internal carotid artery and both external carotid arteries. Visual symptoms and an abnormal photostress test completely remitted after a right carotid endarterectomy. CONCLUSION: Light-induced amaurosis is an unfamiliar manifestation of ocular ischemic syndrome occurring with severe, often bilateral, carotid artery disease. Its recognition is important because the complaint is associated with severe carotid occlusive disease and recognition is necessary for timely surgical intervention because of the major risk for stroke.