Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2019, Vol. 33 ›› Issue (4): 119-123.doi: 10.6040/j.issn.1673-3770.0.2018.526

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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

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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

CLC Number: 

  • R774.5
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[1] LI ManOverview,FENG Xue, WANG YanlingGuidance. Association between ocular ischemic syndrome and ischemic stroke [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(5): 88-92.
[2] 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.. 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: [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(4): 1-4.
[3] Carotid artery stenosis is a common clinical disorder. Its main clinical symptoms are transient ischemic attacks and cerebral infarction, ocular ischemic syndrome(OIS)is rare. Its diagnostic imaging modalities include doppler ultrasound imaging, CTA, and MRA. Medical therapy, including risk factor management of atherosclerosis, is necessary for all patients with carotid artery stenosis. Carotid revascularization techniques, including carotid endarterectomy or carotid artery stenting, should be performed for asymptomatic patients with severe carotid artery stenosis and symptomatic patients with moderate carotid stenosis. Patients with carotid artery stenosis need early interventions to prevent stroke, improve ocular artery perfusion, and, ultimately, prevent further vision loss.. Advances in the diagnosis and treatment of carotid artery stenosisXU Zeqin Overview GUO Lianrui Guidance Department of Vascular Surgery, Xuan Wu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing 100053, ChinaAbstract: [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(4): 11-15.
[4] Ocular ischemic syndrome(OIS)is usually undiagnosed or misdiagnosed due to its asymptomatic onset, complicated ocular manifestations, and the lack of awareness, and patients with OIS have a higher mortality. Improving the understanding, diagnosis, and treatment of OIS through multidisciplinary collaboration is key to investigating and preventing systemic vascular events as well as decreasing blindness and mortality. This review summarizes the recent advances in the epidemiology, clinical diagnosis, and management of OIS.. Recent ocular ischemic syndrome advancesWANG Luping Overview HUANG Yingxiang, WANG Yanling Guidance Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, ChinaAbstract: [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(4): 23-27.
[5] ObjectiveObjectiveTo analyze the literature on ocular ischemic syndrome published between January , and December , . MethodPapers on OIS that were published between January , and December , , were screened and retrieved from the CNKI and WOS databases, and those that were relevant were searched and analyzed. ResultsIn this analysis, Chinese papers on OIS were cited for times with an h-index of , while foreign papers were cited for times with an h-index of . Of the organizations that published the highest number of papers and had the highest h-indexes, the Capital Medical University and the Polish Medical University of Pomerania were the leading institutions. The Chinese Journal of Ophthalmology was the leading domestic journal, and the Journal of Ophthalmology and Plos One were the leading foreign journals. China published the highest number of papers abroad, China and South Korea had the highest h-indexes. China′s National Natural Science Foundation provided the most support to the field of OIS, accounting for .% of the total domestic literature. The most frequently cited article in the WOS database was by Hayreh, SS, which was on the prevalence and pathogenesis of ocular vascular occlusive disease and melanosis, it was also part of the top ten studies that focused on the utility of OCT in providing insights into OIS and the mechanisms of ischemia and hypoxia. ConclusionThe utility of OCT in providing insights into OIS and the mechanisms of hypoxia and ischemia represents a modern focus of researchers.. Analysis of the literature on ocular ischemic syndrome at home and abroadMENG Bo, HUANG Yingxiang, WANG Kang, ZHAO Lu, WANG Yanling Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, ChinaAbstract: [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(4): 35-40.
[6] ObjectiveTo discuss the early diagnosis and multidisciplinary diagnosis and treatment of neovascular glaucoma in ocular ischemic syndrome. MethodsThe medical records of a 54-year-old male patient with cerebral infarction who presented with right-eye vision loss that had persisted for a week were reviewed. After slit-lamp examination and fluorescence angiography, he was diagnosed with ocular ischemic syndrome(OIS)complicated by neovascular glaucoma in the right eye and treated with intravitreal injection of anti-VEGF drugs and panretinal photocoagulation. ResultsAfter three months of treatment, the right-eye iris neovascularization subsided, and the intraocular pressure was controlled within normal limits. ConclusionOcular ischemia is often missed or misdiagnosed by ophthalmologists, neurologists, cardiologists, and vascular surgeons due to its insidious onset and complex clinical manifestations. Therefore, the establishment of multidisciplinary diagnosis and treatment can improve the prognosis of OIS patients.. Neovascular glaucoma in ocular ischemic syndrome: a case report and literature reviewQIN Shuqi1, WANG Luping1, JIANG Bin2, WANG Yanling1 1. Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing 10050, China; 2. Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing 10050, ChinaAbstract: [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(4): 53-55.
[7] Spectral-domain optical coherence tomography(SD-OCT)was used to measure and observe the characteristics of the subfoveal choroidal thickness(SFCT)in patients with ocular ischemic syndrome(OIS)as well as explore the indicators for early evaluation of OIS. MethodsThis was a retrospective case-control study. Forty-eight patients(48 eyes)were included between January 2017 and January 2020. The patients were divided into two groups: the OIS and the control groups, with each consisting of 24 patients(24 eyes). Their basic information, including age, gender, body mass index(BMI), and the history of diabetes, hypertension, and hyperlipidemia, was collected. SFCT was measured using SD-OCT in EDI mode. The basic data and SFCTs of the two groups were compared. ResultsThere were no significant differences between the ages, gender, BMIs, and the prevalence of diabetes, hypertension, and hyperlipidemia of the two groups(all P>0.05). The mean SFCT of the OIS group was 204.83±27.34 μm, and that of the control group was 226.58±33.49 μm. The differences between the two groups were statistically significant(t=2.464, P=0.018). ConclusionsSFCT was thinner in patients with OIS. SFCT can be used as an indicator for early assessment of OIS.. Analysis of choroidal thickness in patients with ocular ischemic syndromeFU Qiang, WANG Hongxing Department of Ophthalmology, Beijing Chuiyangliu Hospital, Beijing 100022, ChinaAbstract: Objective〓 [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(4): 60-63.
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