眼缺血综合征的临床及影像学特点分析

目的 探讨眼缺血综合征的临床表现以及影像学检查特征。 方法 收集2015年2月至2017年12月确诊为眼缺血综合征患者的临床资料进行回顾性分析。 结果 20例(24眼)眼缺血综合征患者年龄59~88岁,平均71.68岁。其中男16例(19眼),女4例(5眼);右眼13只,左眼11只,其中双眼者4例。患者主诉为不同程度视力下降者13眼(54.17%),眼部疼痛或者眼眶疼痛者6眼(25%)。其中有13眼(58.33%)有一过性黑曚病史。最佳矫正视力结果显示,<0.05者4眼(16.67%),0.05以上至<0.3者9眼(37.5%),0.3以上至<0.7者8眼(33.33%),≥0.7者3眼(12.5%)。眼底检查显示,20例患者(24眼)均可见位于赤道部及周边视网膜的点状及小片状出血,视网膜动脉变细,静脉不同程度扩张,但迂曲不明显。荧光素眼底血管造影检查显示,造影早期视网膜动-静脉循环时间为20.3~90.2 s,其中1眼(4.17%)造影结束静脉未完全充盈;9眼(37.5%)显示出动脉“前锋”现象,18眼(75%)可见视网膜微血管瘤,2眼(8.33%)发现视网膜动静脉交通支,视网膜新生血管1眼(4.17%);视网膜无灌注区出现者10眼(41.67%)。18眼(75%)在造影晚期出现视网膜动脉及静脉壁着染。本组患者13例行双侧颈动脉彩色超声多普勒检查、7例患者行双侧经颅多普勒超声检查。颈动脉彩色超声多普勒检查显示,同侧颈内动脉起始部和(或)颈总动脉分叉处的管腔内膜和(或)中膜增厚,最厚约1.3 mm。3例患者同侧颈内动脉管腔完全闭塞和严重狭窄,测不到血流;其余同侧颈动脉彩色超声多普勒检查显示收缩期峰值流速(PSV)异常,PSV为73~484 cm/s,中位数295 cm/s。经颅多普勒超声检查的7例患者均发现不同程度的脑动脉硬化及颈动脉狭窄。 结论 眼缺血综合征多见于老年人,男性多见,其临床表现复杂多变,眼底造影检查及颈动脉部位的多普勒超声是诊断眼缺血综合征的可靠方法。

Clinical and imaging characteristics in patients with ocular ischemic syndrome

Objective To describe the clinical and imaging features of ocular ischemic syndrome in a patient visiting the ophthalmology department. Methods This study was a retrospective case series. Consecutive patients suspected of having ocular ischemic syndrome from 2015 to 2017 were retrospectively studied. Results The study included 20 patients(24 eyes)with ocular ischemic syndrome; of these, 16 were men and 4 were women. The patients were 59 to 88 years old(mean age: 71.68 years). The ocular ischemic syndrome involved 13 right eyes and 11 left eyes; in 4 patients, the involvement was bilateral. The symptoms reported by the patients were decreased vision in 13 eyes(54.17%)and ocular or periocular pain in 6 eyes(25%). A history of transient monocular vision loss was noted in 13 eyes(58.33%). The best-corrected visual acuity(BCVA)was <0.05 in 4 eyes(16.67%), 0.05 to <0.3 in 9 eyes(37.5%), 0.3 to <0.7 in 8 eyes(33.33%), and >0.7 in 3 eyes(12.5%). Retinal examination typically revealed midperipheral retinal hemorrhages, arteriolar narrowing, and venous dilation. Fundus fluorescein angiography showed that the retinal arteriovenous passage time was prolonged(20.3 to 90.2 s). At the end of the angiography, incomplete filling of the veins was seen in 1 eye(4.17%)and the “front” phenomenon of arteries in 9 eyes(37.5%). Hyperfluorescent dots indicating microaneurysms could be seen in 18 eyes(75%). Arteriovenous shunts were found in 2 eyes and retinal neovascularization in 1 eye(4.17%). Non-perfused areas were observed in 10 eyes(41.67%). The arterial and venous walls could be stained in 18 eyes(75%). Color Doppler imaging was performed on 13 patients and transcranial Doppler imaging on 7 patients. The color Doppler imaging showed that the intima and/or media at the origin and/or bifurcation of the internal carotid artery(ICA)were thickened, the thickest of which was about 1.3 mm. ICA was totally occluded or severely narrow in 3 cases, and no blood flow was found. The other cases showed abnormal peaks of systolic velocity, ranging from 73 to 484 cm/s(median: 295 cm/s). Transcranial Doppler ultrasonography detected different degrees of stenosis or occlusion of cerebral vessels and ICA. Conclusions Ocular ischemic syndrome is usually found in the older population and more commonly in men.The clinical manifestations are complex and variable. Fundus fluorescein angiography and Doppler ultrasonography of the carotid artery are reliable methods to diagnose ocular ischemic syndrome.