The eye as a window to CVD: case series and literature review of retinal ischaemic perivascular lesion (RIPL).

Retinal ischaemic perivascular lesions (RIPL) are characterised on spectral domain optical coherence tomography (SD-OCT) as focal thinning of the inner nuclear layer (INL) associated with outer nuclear layer (ONL) upward expansion. We present a small case series of 11 patients and reviewed all relevant original research on RIPL and its association with cardiovascular diseases (CVD). All 11 patients had RIPL incidentally identified on SD-OCT by two consultant ophthalmologists during a routine medical retina clinic. We obtained a thorough medical history to identify risk factors and CVD. The most common risk factor was type 2 diabetes mellitus (90.9%), followed by hypertension (81.9%). A diagnosis of arrhythmia was determined in 36.4% patients, coronary artery disease in 27.3%, cerebrovascular events in 36.4%, peripheral vascular disease in 27.3% and carotid artery stenosis in 8.3%. A literature search was conducted using PubMed, Google Scholar and Scopus, using all relevant key words. Seven pieces of original research were described in the literature. Six of these described a RIPL prevalence ranging from 34.62% to 91%. One paper described a case series with an incidence of 72.7% new diagnosis of CVD in their cohort who were identified to have RIPLs. The ophthalmologists' role in detecting RIPLs could be used to assess cardiovascular risk status, supporting a multi-disciplinary approach in managing CVD.