颈内动脉狭窄及合并缺血性脑卒中患者视网膜微血管神经改变特征

目的　对比单侧颈内动脉狭窄（ICAS）患者双眼视网膜厚度及血流密度（VD）、视网膜神经纤维层（RNFL）厚度及神经节细胞复合体（GCC）厚度，探讨颈内动脉狭窄及合并缺血性脑卒中患者视网膜微血管神经的变化特点。方法　横断面研究。收集2019年12月至2021年12月在我院就诊的单侧ICAS≥70％（狭窄侧眼组）、对侧颈内动脉无狭窄或狭窄<50％（对侧眼组）的27例患者的临床资料。所有患者均行眼科常规及光学相干断层扫描血管成像（OCTA）检查。对比观察双眼视网膜厚度、VD、RNFL厚度及GCC厚度，并根据是否合并缺血性脑卒中进行亚组分析。结果　ICAS≥70％的患者狭窄侧眼组黄斑区浅层、深层视网膜及黄斑中心凹无灌注区面积周围300 μm环内的VD均较对侧眼组明显降低（均为P<0.05），狭窄侧眼组的视盘下颞区及颞下区VD均较对侧眼组明显降低（均为P<0.05）。合并缺血性脑卒中的ICAS患者狭窄侧眼组黄斑区视网膜浅层和深层VD、视盘下颞及颞下区VD、下半部GCC厚度均较对侧眼组显著降低（P<0.05）。不合并脑卒中的ICAS患者狭窄侧眼组与对侧眼组黄斑区及视盘的VD、RNFL厚度、GCC厚度差异均无统计学意义（均为P>0.05)。结论　重度及以上ICAS的患者已经出现视网膜微循环障碍，且在合并有缺血性脑卒中的患者中表现更明显，并出现神经节细胞的损伤，提示ICAS合并视网膜微血管和神经节细胞的损伤有可能是缺血性脑卒中发生的危险因素。

Features of retinal microvascular and neural changes in patients with internal carotid artery stenosis and ischemic stroke

Objective　To compare the thickness and vessel density (VD) of the retina, thickness of retinal nerve fiber layer (RNFL) and thickness of ganglion cell complex (GCC) in bilateral eyes of patients with unilateral internal carotid artery stenosis (ICAS), and analyze the retinal microvascular and neural changing characteristics of patients with ICAS and ischemic stroke.
Methods　A cross-sectional study was conducted. The data of 27 patients with unilateral ICAS≥70% (ipsilateral group) and no stenosis or stenosis < 50% in the contralateral internal carotid artery (contralateral group) who visited our hospital from December 2019 to December 2021 were collected. All patients underwent ophthalmic routine examination and optical coherence tomography angiography (OCTA). The thickness and VD of the retina, RNFL thickness and GCC thickness of bilateral eyes were compared, and subgroup analysis was performed based on the presence or absence of ischemic stroke.
Results　The VDs of superficial and deep retinal layers in the macular zone and a 300-μm width annulus surrounding foveal avascular zone of the ipsilateral group were significantly lower than those of the contralateral group (all P<0.05). Furthermore, the VDs in the inferior temporal zone and infratemporal zone of the optic disc in the ipsilateral group significantly decreased compared with the contralateral group (both P<0.05). In patients with ICAS and ischemic stroke, the VDs of superficial and deep retinal layers in the macular zone, inferior temporal zone and infratemporal zone of the optic disc, and inferior GCC thickness in the ipsilateral group significantly decreased (all P<0.05). In patients with ICAS and no ischemic stroke, there was no significant difference in the VDs of the macular zone and optic disc, thicknesses of RNFL and GCC of bilateral eyes (all P>0.05).
Conclusion　Patients with severe or above ICAS suffer from retinal microcirculatory disturbance. It is more obvious in patients with ICAS combined with ischemic stroke, who also suffer from ganglion cell injury. These findings suggest that the combination of ICAS and retinal microvascular and ganglion cell injury may be a risk factor for ischemic stroke.