山东大学耳鼻喉眼学报 ›› 2019, Vol. 33 ›› Issue (4): 119-123.doi: 10.6040/j.issn.1673-3770.0.2018.526

• 论著 • 上一篇    下一篇

眼缺血综合征的临床及影像学特点分析

杨秀芬1,李红阳1,赵露1,魏莹2,胡向东2,陈珺2,王艳玲1   

  1. 1.首都医科大学附属北京友谊医院眼科, 北京100050;
    2.首都医科大附属北京友谊医院超声科, 北京100050
  • 出版日期:2019-07-20 发布日期:2019-07-22
  • 基金资助:
    博士启动基金项目(2016DOC03)

Clinical and imaging characteristics in patients with ocular ischemic syndrome

YANG Xiufen1, LI Hongyang1, ZHAO Lu1,WEI Ying2, HU Xiangdong2, CHEN Jun2, WANG Yanling1   

  1. Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
  • Online:2019-07-20 Published:2019-07-22

摘要: 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。

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

中图分类号: 

  • R774.5
[1] Kearns TP, Hollenhorst RW. Venous-stasis retinopathy of occlusive disease of the carotid artery[J]. Proc Staff Meet Mayo Clin, 1963, 38: 304-312.
[2] Hayreh SS. Ocular vascular occlusive disorders: natural history of visual outcome[J]. Prog Retin Eye Res,2014,41:1-25. doi: 10.1016/j.preteyeres.2014.04.001.
[3] Mendrinos E, MacHinis TG, Pournaras CJ. Ocular ischemic syndrome[J]. Survey of Ophthalmology, 2010, 55(1): 2-34. doi:10.1016/j.survophthal.2009.02.024.
[4] Hazin R, Daoud YJ, Khan F. Ocular ischemic syndrome: recent trends in medical management[J]. Curr Opin Ophthalmol, 2009, 20(6): 430-433. doi:10.1097/ICU.0b013e3283313d38.
[5] Winterkorn JM, Teman AJ. Recurrent attacks of amaurosis fugax treated with calcium channel blocker[J]. Ann Neurol, 1991, 30(3): 423-425. doi:10.1002/ana.410300317.
[6] Hung JH, Chang YS. Ocular ischemic syndrome[J]. CMAJ,2017,189(23):E804. doi: 10.1503/cmaj.160459.
[7] Mukherji S, Kurli M, Sandramouli S. Indications and outcome of carotid Doppler ultrasound: an ophthalmic perspective[J]. Eur J Ophthalmol, 2004, 14(3): 240-244.
[8] 王艳玲, 赵露, 黄映湘, 等. 眼缺血综合征的临床观察[J]. 中华眼科杂志, 2009, 45(12): 1080-1083. doi:10.3760/cma.j.issn.0412-4081.2009.12.006. WANG Yanling, ZHAO Lu, HUANG Yingxiang, et al. Clinical characteristics of ocular ischemic syndrome[J]. Chinese Journal of Ophthalmology, 2009, 45(12): 1080-1083. doi:10.3760/cma.j.issn.0412-4081.2009.12.006.
[9] Klijn CJ, Kappelle LJ, van Schooneveld MJ, et al. Venous stasis retinopathy in symptomatic carotid artery occlusion: prevalence, cause, and outcome[J]. Stroke, 2002, 33(3): 695-701.
[1] 严槟,尹小芳,叶祖科,卢彦,洪剑威. 玻璃体腔注射雷珠单抗联合GLP治疗BRVO-ME的临床观察[J]. 山东大学耳鼻喉眼学报, 2017, 31(1): 110-113.
[2] 王旭川,盛艳娟,王玉. 非外伤性玻璃体积血的病因及手术疗效分析[J]. 山东大学耳鼻喉眼学报, 2017, 31(1): 107-109.
[3] 严晓腾,冯军,康欣乐. 玻璃体腔注射康柏西普治疗视网膜静脉阻塞继发黄斑水肿的临床观察[J]. 山东大学耳鼻喉眼学报, 2016, 30(4): 105-108.
[4] 赵露,谢国丽,王艳玲. 玻璃体腔注射雷珠单抗对湿性年龄相关性黄斑变性患者眼血流动力学的影响[J]. 山东大学耳鼻喉眼学报, 2016, 30(4): 101-104.
[5] 严晓腾, 冯军, 康欣乐. 曲安奈德玻璃体腔注射联合格栅样光凝治疗囊样黄斑水肿[J]. 山东大学耳鼻喉眼学报, 2015, 29(1): 60-63.
[6] 李昊,周芳. 特发性黄斑裂孔的形态与预后分析[J]. 山东大学耳鼻喉眼学报, 2014, 28(2): 81-83.
[7] 刘敏1,郭建莲1,张华2. 玻璃体手术治疗特发性黄斑前膜的临床观察[J]. 山东大学耳鼻喉眼学报, 2013, 27(5): 65-67.
[8] 邵雁1,徐新荣2. 中药治疗年龄相关性黄斑变性研究进展[J]. 山东大学耳鼻喉眼学报, 2013, 27(5): 91-94.
[9] 樊旭,关娟,赵慧英,王倩,盛豫. 先天性黄斑缺损1例[J]. 山东大学耳鼻喉眼学报, 2012, 26(3): 93-94.
[10] 赵强 综述,魏伟 审校 . 眼底自发荧光与多焦视网膜电图在干性老年黄斑变性诊断中的应用[J]. 山东大学耳鼻喉眼学报, 2011, 25(6): 80-82.
[11] 蔡克波. 内界膜剥除治疗高度近视黄斑劈裂的疗效分析[J]. 山东大学耳鼻喉眼学报, 2011, 25(5): 108-110.
[12] 杨丽敏. 曲安奈德离子导入治疗视网膜黄斑水肿的临床观察[J]. 山东大学耳鼻喉眼学报, 2009, 23(5): 71-72.
[13] 吴昌龙 综述,王 玉 审校 .

糖尿病黄斑水肿的治疗

[J]. 山东大学耳鼻喉眼学报, 2008, 22(4): 369-372 .
[14] 卢爱东,刘晓玲,高 洁,陈 芳,梁仲琪 . 曲安奈德联合微脉冲激光治疗糖尿病性黄斑水肿[J]. 山东大学耳鼻喉眼学报, 2008, 22(4): 366-368 .
[15] 潘雪梅,王兴荣,袁明俊 . Stargardt病的荧光素眼底血管造影和光相干断层扫描特征[J]. 山东大学耳鼻喉眼学报, 2008, 22(2): 162-164 .
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 杨长亮,黄治物,姚行齐,诸勇,孙艺 . 正常气骨导听性脑干反应及其应用[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 9 -13 .
[2] 曹忠良 . 颌面复合伤155例临床分析[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 89 -89 .
[3] 毕景云 . 鼻中隔矫正术后血肿的处理[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 90 -91 .
[4] 刘大昱,潘新良,雷大鹏,许风雷,张立强,栾信庸 . 梨状窝内侧壁癌的手术治疗[J]. 山东大学耳鼻喉眼学报, 2007, 21(1): 8 -11 .
[5] 刘 艳,刘新义,王金平,李大健 . 后鼓室解剖结构测量观察及临床意义[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 218 -221 .
[6] 赵 敏,王守森,甄泽年,陈贤明,王茂鑫 . 鼻内镜联合显微镜行蝶窦及经蝶鞍区微创手术[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 244 -245 .
[7] 伦 杰,吕心红 . 鼻部脂溢性角化病1例[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 252 -252 .
[8] 王红霞,王鹏程 . NSE、S100及GFAP在视网膜母细胞瘤中的表达及意义[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 263 -264 .
[9] 黄 方,黄海琼,黄建强,何荷蕃 . 支气管内镜视频监视系统在小儿气管-支气管异物诊治中的应用[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 276 -277 .
[10] 于志良,王卫卫,王明华 . 耳鼻喉综合动力系统切除会厌囊肿23例[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 278 -279 .