Retinal Precapillary Arteriolar Occlusion after Coronary Artery Bypass Grafting Surgery
DOI:
https://doi.org/10.1532/hsf.1347Abstract
Background: The aim of this study is to evaluate the microembolic changes related to occlusions of precapillary arterioles in the retina during coronary artery bypass grafting (CABG) surgery using fundus photography, and to examine systemic and operational factors related to occurrent lesions.Methods: Retinal microvascular damage was assessed by color fundus photography one day before CABG surgery, on postoperative day five, and again three months after surgery. In addition to patients’ demographics, diabetes mellitus, hypertension, chronic renal failure, and hypercholesterolemia (LDL level) were examined. Smoking history was recorded. Additionally, each patient’s carotid Doppler results were ranked by four degrees. Data related to the surgery were recorded.
Results: No retinal emboli were seen in any patient before surgery. In fundus photographs taken on the fifth day after surgery, retinal precapillary arteriolar occlusions were seen in 20 (28.57%) of the patients. Lesions were observed to have disappeared in the third month after surgery. There was no significant (P > .05) difference in age, sex, diabetes mellitus, HT ratio, tobacco consumption percentage, LDL values, and Doppler USG distribution between the two groups of patients with and without lesions. However, CABG surgery and cross-clamp removal time measured significantly
(P < .05) longer in the group with lesions than in the group without lesions.
Conclusion: Our results show that retinal microembolism can occur after CABG surgery in association with surgery time and cross-clamp time; however, this does not cause any clinical outcome.
References
Ascione R, Ghosh A, Reeves BC, et al. 2005. Retinal and cerebral microembolization during coronary artery bypass surgery: a randomized, controlled trial. Circulation 112:3833-8.
Barbut D, Hinton RB, Szatrowski TP, et al. 1994. Cerebral emboli detected during bypass surgery are associated with clamp removal. Stroke 25:2398-402.
Blauth CI. 1995. Macroemboli and microemboli during cardiopulmonary bypass. Ann Thorac Surg 59:1300-3.
Blauth C, Arnold J, Kohner EM, Taylor KM. 1986. Retinal microembolism during cardiopulmonary bypass demonstrated by fluorescein angiography. Lancet 2:837-9.
Buyukates M, Kargi S, Kandemir O, Aktunc E, Turan SA, Atalay A. 2007. The use of the retinal nerve fiber layer thickness measurement in determining the effects of cardiopulmonary bypass procedures on the optic nerve. Perfusion 22:401-6.
Clark RE, Brillman J, Davis DA, Lovell MR, Price TRP, Magovern GJ. 1995. Microemboli during coronary artery bypass grafting: genesis and effect on outcome. J Thorac Cardiovasc Surg 109:249-58.
Marren SE. 1994. Postpump retinopathy. Optom Vis Sci 71:462-5.
Moster ML. 1998. Visual loss after coronary artery bypass surgery. Surv Ophthalmol 42:453-7.
Padayachee TS, Parsons S, Theobold R, Linley J, Gosling RG, Deverall PB. 1987. The detection of microemboli in the middle cerebral artery during cardiopulmonary bypass: a transcranial Doppler ultrasound investigation using membrane and bubble oxygenators. Ann Thorac Surg 44:298-302.
Patton N, Aslam T, Macgillivray T, Pattie A, Deary IJ, Dhillon B. 2005. Retinal vascular image analysis as a potential screening tool for cerebrovascular disease: a rationale based on homology between cerebral and retinal microvasculatures. J Anat 206:319-48.
Pekel G, Kılıç I, Alihanoğlu Y, et al. 2014. Effects of coronary artery bypass grafting surgery on retinal vascular caliber, ocular pulse amplitude and retinal thickness measurements. Perfusion Aug 11 (epub ahead of print).
Shaw PJ, Bates D, Cartlidge NE, Heaviside D, Julian DG, Shaw DA. 1985. Early neurological complications of coronary artery bypass surgery. Br Med J (Clin Res Ed) 291:1384-7.
Stump DA, Moody DM, Brown WR, Kon ND, Rogers AT, Hammon JW. 1996. Emboli and brain function after cardiopulmonary bypass. Proc Am Acad Cardiovasc Perf 17:37-43.
Taylor RL, Borger MA, Weisel RD, Fedorko L, Feindel CM. 1999. Cerebral microemboli during cardiopulmonary bypass: increased emboli during perfusionist interventions. Ann Thorac Surg 68:89-93.
Williams IM. 1975. Retinal vascular occlusions in open heart surgery. Br J Ophthalmol 59:81-91.
