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Original article
Retinal embolic events: frequency and impact following transcatheter aortic valve implantation (TAVI) for aortic stenosis
  1. William J Fusi-Rubiano1,
  2. Yit C Yang1,2,
  3. Andrew F Smallwood3,
  4. Randhir C Chavan4,
  5. Saib Khogali5,
  6. Nirodhini Narendran1,
  7. James M Cotton5
  1. 1 Department of Ophthalmology, New Cross Hospital, WV10 0QP, Wolverhampton, UK
  2. 2 School of Life and Health Sciences, Aston University, B4 7ET, Birmingham, UK
  3. 3 Department of Research and Development, New Cross Hospital, WV10 0QP, Wolverhampton, UK
  4. 4 Birmingham Midland Eye Centre, City Hospital, B18 7QH, Birmingham, UK
  5. 5 Department of Cardiology, Heart and Lung Centre, New Cross Hospital, WV10 0QP, Wolverhampton, UK
  1. Correspondence to Dr William J Fusi-Rubiano; william.fusi-rubiano{at}nhs.net

Abstract

Objectives Transcatheter aortic valve implantation (TAVI) is an established treatment for patients with severe symptomatic aortic stenosis. It has a cerebrovascular accident rate of about 5% but the effect on retinal embolic events has not been previously reported. This study investigated the occurrence of retinal emboli following TAVI.

Methods and analysis In this prospective observational study, 20 patients underwent full ophthalmic examination to assess retinal embolic events prior to TAVI and at 48 hours and 1 month post-TAVI.

Results At 48 hours post-TAVI, one patient had a new cotton wool spot in the right eye. At 1 month, another two patients had new retinal emboli events in at least one eye and a fourth patient developed retinal splinter haemorrhages in the right eye.

Conclusion Retinal embolic events and new retinal abnormalities following TAVI occurred in 15% and 20% of our cohort, respectively, without any associated retinal damage or significant visual problems. Retinal evaluation may be a useful surrogate test for cerebral embolisation in future studies assessing the utility of new valve prostheses and embolic protection devices

  • retina
  • imaging

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjophth-2016-000033

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    Footnotes

    • Contributors WF-R: involved in analysis of all data and manuscript preparation of the study. YCY: involved in design, submission, ocular assessment and manuscript preparation during the study. AFS: involved in participant recruitment, design, data collection, analysis and final manuscript review during the study. RCC: involved in design, planning, ocular assessment and final manuscript review during the study. SK: involved in study recruitment, cardiac assessment, conducting TAVI procedures and final manuscript review during the study. NN: involved in planning, ocular assessment and final manuscript review during the study. JMC: involved in design, submission, recruitment, cardiac assessment, lead for the study, conducting TAVI procedures and manuscript preparation during the study.

    • Competing interests SK is a proctor and trainer for both Boston scientific and Medtronic Ltd, and received travel support and speaker fees. JMC has received travel support from Medtronic Ltd and Speaker fees from Boston Scientific.

    • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

    • Ethics approval NRES Committee West Midlands - The Black Country.

    • Provenance and peer review Not commissioned; externally peer reviewed.