Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2020, Vol. 34 ›› Issue (4): 1-4.doi: 10.6040/j.issn.1673-3770.1.2020.047

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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

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

CLC Number: 

  • R771.3
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[1] 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.
[2] 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.
[3] ObjectiveObjectiveTo analyze the literature on ocular ischemic syndrome published between January 1, 2014 and December 31, 2019. MethodPapers on OIS that were published between January 1, 2014 and December 31, 2019, were screened and retrieved from the CNKI and WOS databases, and those that were relevant were searched and analyzed. ResultsIn this analysis, 35 Chinese papers on OIS were cited for 41 times with an h-index of 2, while 48 foreign papers were cited for 115 times with an h-index of 6. 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 20.8% 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.
[4] 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.
[5] 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.
[6] To evaluate the changes in the parameters of the macular and peripapillary vasculature in patients with neuromyelitis optica spectrum disorder(NMOSD). MethodsThis case-control study involved 40(76 eyes)aquaporin-4 antibody-positive NMOSD patients and 40(80 eyes)age- and gender-matched healthy controls(HCs). Of 76 eyes with NMOSD, 34 had a history of optic neuritis(ON); 40 had no history of ON. Macular superficial vessel density(MSVD), macular deep vessel density(MDVD), and radial peripapillary capillary(RPC)density were measured by OCT-A. The retinal nerve fiber layer(RNFL)and ganglion cell complex(GCC)thicknesses were measured by OCT. Comparisons of the retinal structural and microvascular parameters of the cohorts were performed using generalized estimating equation(GEE)models. The relationship between retinal vessel density and retinal thickness was also analyzed. ResultsRPC density and MSVD were significantly lower in eyes with NMOSD+ON than in those with NMOSD-ON and HC(P<0.05). The GCC and RNFL thicknesses were also significantly thinner in eyes with NMOSD+ON than in those with NMOSD-ON and HC(P<0.001 for both). MDVD was lower in eyes with NMOSD-ON than in those with HC(P<0.05); however, other vessel densities were not significantly different(P>0.05). In eyes with NMOSD, MSVD, whole image vessel density(WIVD)of RPC, and peripapillary vessel density(PPVD)were correlated with GCC and RNFL thicknesses(P<0.001). However, MDVD and inside disc vessel density(IDVD)were not correlated with GCC and RNFL thicknesses(P>0.05). ConclusionRetinal microvascular changes were present in eyes with NMOSD+ON. However, these changes, except those in MDVD, were not significant in eyes with NMOSD-ON. Thinner GCC and RNFL were associated with lower MSVD and RPC density.. Measurement of the parameters of the macular retinal and peripapillary vasculature in neuromyelitis optica spectrum disorder patientsXU Jing, QU Yuanzhen, LIANG Xiaofang, YANG Liu, TANG Yang Department of Ophthalmology,Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, ChinaAbstract: Objective〓 [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(4): 69-74.
[7] LI Rui, LI Yong, XIE Hongtao, YUE ZhangXian, LIU Zhaochen, YUAN huimin. Effects of intraocular lens implantation and postoperative intraocular pressure fluctuations on the fundus macular and optic disc vascular density [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(1): 89-92.
[8] YANG Xiufen, LI Hongyang, ZHAO Lu,WEI Ying, HU Xiangdong, CHEN Jun, WANG Yanling. Clinical and imaging characteristics in patients with ocular ischemic syndrome [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(4): 119-123.
[9] LIANG Qianqian, YANG Tinghua, ZHAO Bojun. Application of optical coherence tomography angiography in retinal vein occlusion [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(2): 139-142.
[10] YAN Xin, WANG Cui, ZHAO Bojun. Clinical manifestations of polypoidal choroidal vasculopathy. [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2017, 31(4): 98-102.
[11] LI Yuguang, LIU Fengying, LIU Qian. Severe nasal bleeding caused by traumatic injury of the internal carotid artery: with a report of 12 cases. [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2016, 30(5): 88-91.
[12] ZHU Zicheng, WANG Xiaozhong, KE Genjie, WEN Yuechun, SUN Siqin. Analysis of simultaneous indocyanine green angiography and fundus fluorescein angiography in high myopia [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2015, 29(5): 65-68.
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[14] WANG Jing-jie1,WEI Rui-li2,JIN Ling1. Application of B ultrasound in diagnosis of choriodal hemangioma [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2010, 24(6): 70-.
[15] PAN Xue-mei,WANG Xing-rong,YUAN Ming-jun . Fundus angiography with fluorescein and optical coherence tomography in Stargardt′s disease [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(2): 162-164 .
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