山东大学耳鼻喉眼学报 ›› 2020, Vol. 34 ›› Issue (4): 1-4.doi: 10.6040/j.issn.1673-3770.1.2020.047

• 眼缺血综合征多学科精准诊疗 述评 •    下一篇

正确判读眼缺血综合征预警信号,提高诊断水平

黄映湘,王艳玲   

  1. 黄映湘, 王艳玲首都医科大学附属北京友谊医院 眼科, 北京 100050
  • 收稿日期:2020-05-22 出版日期:2020-07-20 发布日期:2020-08-28
  • 基金资助:
    国家自然科学基金资助(81870686);首都卫生发展科研专项资助(首发2018-1-2021)

Correct interpretation of the predictors of ocular ischemic syndrome to improve diagnostic performance HUANG Yingxiang, WANG Yanling Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China Abstract:

Ocular ischemic syndrome(OIS)is a severe ophthalmic disease caused by ocular hypoperfusion, which occurs due to stenosis or occlusion of the common or internal carotid arteries. The clinical presentations and signs of OIS are complex, incidental, and different. OIS is easily misdiagnosed or remains undiagnosed because of its asymptomatic onset and complicated ocular manifestations. Therefore, it is crucial to trace the etiology of OIS. Presently, different imaging modalities can evaluate the carotid artery blood supply, collateral circulation, and brain perfusion. Thus, appropriate modalities must be selected for OIS diagnosis based on their advantages and disadvantages. Furthermore, the auxiliary examination results should be accurately and promptly considered and interpreted when establishing a diagnosis of OIS. Thus, the management of OIS requires cooperation with ophthalmologists, cardiologists, and neurologists.   

  1. Key words: Ocular ischemic syndrome;
    Carotid artery stenosis;
    Carotid artery occlusion;
    angiography眼缺血综合征(ocular ischemic syndrome, OIS)是由颈动脉狭窄或闭塞引起的一系列眼前部或眼后部缺血性疾病, 临床中以表现为低灌注性视网膜病变最常见。本病常与缺血性脑病伴随出现, 目前已发展成为一类涉及眼科、神经科和血管外科的交叉学科疾病[1]。文献报道[2], OIS患者的5年死亡率高达40%, 大多数死因以继发性心脑血管疾病为主。广大眼科医师近年来已经对OIS进行了高度关注, 对OIS的认知逐步提高。由于OIS的表现多样且隐匿的临床特点, 我们需要正确判读OIS预警信号, 加强多学科合作, 提高诊治水平, 才能更准确地发现问题解决问题。
  • Received:2020-05-22 Online:2020-07-20 Published:2020-08-28

摘要: 眼缺血综合征(OIS)是由颈动脉狭窄或闭塞引起的一系列眼前部及/或眼后部缺血性疾病,早期临床表现隐匿,详细地问诊有助于疾病的早期诊断;因眼部供血血管堵塞位置和程度不同,患者的体征也千差万别,追根溯源十分重要;不同血管成像模式的检查方法可用来评估颈动脉供血、侧支循环和脑灌注,需要了解不同技术的特性,有针对性地选择检查手段,正确判读OIS预警信号,多学科合作精准诊断,挽救OIS患者视力。

关键词: 眼缺血综合征, 颈动脉狭窄, 颈动脉闭塞, 血管成像

Abstract: Ocular ischemic syndrome(OIS)is a severe ophthalmic disease caused by ocular hypoperfusion, which occurs due to stenosis or occlusion of the common or internal carotid arteries. The clinical presentations and signs of OIS are complex, incidental, and different. OIS is easily misdiagnosed or remains undiagnosed because of its asymptomatic onset and complicated ocular manifestations. Therefore, it is crucial to trace the etiology of OIS. Presently, different imaging modalities can evaluate the carotid artery blood supply, collateral circulation, and brain perfusion. Thus, appropriate modalities must be selected for OIS diagnosis based on their advantages and disadvantages. Furthermore, the auxiliary examination results should be accurately and promptly considered and interpreted when establishing a diagnosis of OIS. Thus, the management of OIS requires cooperation with ophthalmologists, cardiologists, and neurologists.

Key words: Ocular ischemic syndrome, Carotid artery stenosis, Carotid artery occlusion, angiography

中图分类号: 

  • R771.3
[1] 王艳玲. 建立多学科综合诊疗模式,提高眼缺血综合征诊治水平[J].中华眼底病杂志,2013,29(3):233-236. doi:10.3760/cma.j.issn.1005-1015.2013.03.001. WANG Yanling.Establishment of multidisciplinary diagnosis and treatment patterns for ocular ischemic syndrome[J]. Chinese Journal of Ocular Fundus Diseases, 2013,29(3):233-236. doi:10.3760/cma.j.issn.1005-1015.2013.03.001.
[2] Sivalingam A, Brown GC, Magargal LE, et al. The ocular ischemic syndrome. II. Mortality and systemic morbidity[J]. Int Ophthalmol, 1989, 13(3): 187-191. doi:10.1007/BF02028208.[PubMed]
[3] 杨秀芬, 李红阳, 赵露, 等. 眼缺血综合征的临床及影像学特点分析[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 119-123. doi:10.6040/j.issn.1673-3770.0.2018.526. YANG Xiufen, LI Hongyang, ZHAO Lu, et al. Clinical and imaging characteristics in patients with ocular ischemic syndrome[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(4): 119-123. doi:10.6040/j.issn.1673-3770.0.2018.526.
[4] Malhotra R, Gregory-Evans K. Management of ocular ischaemic syndrome[J]. Br J Ophthalmol, 2000, 84(12): 1428-1431. doi:10.1136/bjo.84.12.1428.
[5] Countee RW, Gnanadev A, Chavis P. Dilated episcleral arteries-a significant physical finding in assessment of patients with cerebrovascular insuYciency[J]. Stroke,1978,9(1):42-45. doi: 10.1161/01.str.9.1.42.
[6] 关明琦,张家红,邵兵. 颈动脉狭窄与眼缺血综合征[J]. 中国实用眼科杂志,2013,31(4):480-481. doi:10.3760/cma.j.issn.1006-4443.2013.03.028. GUAN Mingqi,ZHANG Jiahong,SHAO Bing.Carotid stenosis and eye ischemia syndrome[J]. Chinese Journal of Practical Ophthalmology, 2013, 31(4):480-481. doi:10.3760/cma.j.issn.1006-4443.2013.03.028.
[7] Guo T, Zhang HR. Clinical features and carotid artery color Doppler imaging in patients with ocular ischemic syndrome[J]. Zhonghua Yan Ke Za Zhi, 2011, 47(3): 228-234.
[8] Biousse V, Nahab F, Newman NJ. Management of acute retinal ischemia: follow the guidelines![J]. Ophthalmology, 2018, 125(10): 1597-1607. doi:10.1016/j.ophtha.2018.03.054.
[9] Romero JR, Pikula A, Nguyen TN, et al. Cerebral collateral circulation in carotid artery disease[J]. Curr Cardiol Rev, 2009, 5(4): 279-288. doi:10.2174/157340309789317887.
[10] Sharma VK, Wong KS, Alexandrov AV. Transcranial Doppler[M] //Frontiers of Neurology and Neuroscience. S. Karger AG, 2016: 124-140.
[11] 陈龙华. TCD、CTA、DSA检查颈内动脉狭窄的临床价值分析[J].医学影像学杂志,2016,26(8):1529-1531. CHEN Longhua.Analysis of clincal value of TCD, CTA and DSA in the examination of carotid artery stenosis[J]. Journal of Medical Imaging, 2016,26(8):1529-1531.
[12] 管林军, 熊华花, 黄珊珊, 等. 彩色多普勒超声与DSCTA评价颈动脉狭窄的对比研究[J]. 临床超声医学杂志, 2018, 20(7): 453-456. doi:10.3969/j.issn.1008-6978.2018.07.007. GUAN Linjun, XIONG Huahua, HUANG Shanshan, et al. Comparative study of color Doppler ultrasound and dual source CTA in assessment of carotid artery Stenosis[J]. Journal of Ultrasound in Clinical Medicine, 2018, 20(7): 453-456. doi:10.3969/j.issn.1008-6978.2018.07.007.
[13] 刘胜玉. DSA、彩色多普勒超声、CTA诊断颈动脉狭窄的应用价值[J]. 中国疗养医学, 2019, 28(4): 407-409. doi:10.13517/j.cnki.ccm.2019.04.026.
[14] Cheng Y, Qu JF, Chen Y, et al. Anterior segment neovascularization in diabetic retinopathy: a masquerade[J]. PLoS One, 2015, 10(6): e0123627. doi:10.1371/journal.pone.0123627.
[15] 张子靖,马翔.颈动脉系统影像学检查在眼缺血综合征中的临床应用[J].眼科学报,2018,33(2):113-117. doi:10.3978/j.issn.1000-4432.2018.05.02. ZHANG Zijing, MA Xiang. Clinical application of carotid artery system imaging examination in ocular ischemic syndrome[J]. Eye Science, 2018, 33(2):113-117. doi:10.3978/j.issn.1000-4432.2018.05.02.
[16] Du L, Liu HY, WANG XK, et al. Distinguishable distribution of cerebral artery stenoses: ultrasonographic evidence from a north-east Chinese cohort[J]. Ann Clin Lab Res, 2016, 4:2. doi:10.21767/2386-5180.100089.
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