Amaurosis fugax in young adults.

EDITOR,-We read with interest the article by O'Sullivan et al.' The nine presented patients went through extensive investigations, including echocardiograms in all cases. Yet, no evidence of an embolic or atheromatous aetiology was found. Unfortunately, the authors failed to mention whether the echocardiography was transthoracic or transoesophageal. We had experience with a 29-year-old woman, with recurrent retinal artery branch occlusion in both eyes. A thorough investigation, including transthoracic echocardiography, failed to reveal any pathology. Transoesophageal echocardiography, however, disclosed mitral valve prolapse with a thickened mitral valve and numerous vegetations, which were probably the origin for the embolic retinal events. It has been found that transoesophageal echocardiography leads to a significant improvement in the identification of potential cardiac sources for arterial embolism associated with cerebral ischaemic events when compared with results using transthoracic echocardiography.2 Transoesophageal echocardiography has also been shown to be better in detecting mitral valve prolapse and other cardiac abnormalities in young patients.3 Greven et al' and Wiznia et al' have reported that transoesophageal echocardiography was more helpful than transthoracic echocardiography in disclosing the pathology that led to retinal vascular occlusion. It seems to us that in cases of 'amaurosis fugax in young adults', when no pathological findings can be found, transoesophageal echocardiography is warranted. ALON D SADEH ANAT LOEWENSTEIN MICHAELA GOLDSTEIN MOSHE LAZAR Department ofOphthalmology, Ichilov Hospital, Tel-Aviv 64239, Israel