关键词: 眼缺血综合征, 颈动脉狭窄, 颈动脉彩色超声多普勒, 经颅多普勒超声

Abstract: 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.

Key words: Ocular ischemic syndrome, Carotid stenosis, Color Doppler imaging, Transcranial Doppler ultrasonography