Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2020, Vol. 34 ›› Issue (4): 23-27.doi: 10.6040/j.issn.1673-3770.1.2020.059

Previous Articles     Next Articles

Recent ocular ischemic syndrome advancesWANG Luping Overview HUANG Yingxiang, WANG Yanling Guidance Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, ChinaAbstract:

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.   

  1. Key words:Ocular ischemic syndrome;
    Fluorescein angiography;
    Optical coherence tomography angiography;
    Cell therapy眼缺血综合征(ocular ischemic syndrome, OIS)是由同侧颈总动脉或颈内动脉狭窄或阻塞导致眼动脉(视网膜中央动脉及睫状前/后动脉)低灌注, 而产生一系列脑部和眼部症状的慢性进行性眼病。1963年Hedges[1]首次报道颈内动脉闭塞患者不仅存在对侧肢体运动及感觉障碍, 并且合并一系列眼部症状, 如一过性黑矇、视物模糊等。除此之外, Hedges观察到此类患者视网膜存在静脉扩张和周边点片状出血, 由此提出颈动脉供血不足引起视网膜缺血缺氧的理论基础。OIS起病隐匿, 眼部表现复杂多样, 且容易被其他眼血管疾病掩盖, 如糖尿病性视网膜病变和视网膜静脉阻塞等, 因此临床上容易漏诊或误诊, 导致患者不可逆的视力丧失, 5年死亡率高达40%, 患者大多死于心肌梗死和脑梗死等心脑血管事件[2-3]。因此, OIS需要眼科、神经科和心脏病科等多学科综合诊疗, 通过大规模临床研究, 建立OIS医学数据库, 进一步规范多学科诊疗流程, 对于降低患者的患盲率和死亡率是至关重要的。
  • Received:2020-06-21 Online:2020-07-20 Published:2020-08-28

Abstract: 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.

Key words: Ocular ischemic syndrome, Fluorescein angiography, Optical coherence tomography angiography, Cell therapy

CLC Number: 

  • R771.3
[1] Hedges TR Jr. Ophthalmoscopic findings in internal carotid artery occlusion[J]. Am J Ophthalmol, 1963, 55: 1007-1012.
[2] LuoJY, Yan ZC, Jia Y, et al. Clinical analysis of 42 cases of ocular ischemic syndrome[J]. J Ophthalmol, 2018, 2018: 2606147. doi:10.1155/2018/2606147.
[3] Karacostas D, Terzidou C, Voutas S, et al. Isolated ocular ischemic syndrome with no cerebral involvement in common carotid artery occlusion[J]. Eur J Ophthalmol, 2001, 11(1): 97-101. doi:10.1177/1120672101011-00121.
[4] Hung JH, Chang YS. Ocular ischemic syndrome[J]. Can Med Assoc J, 2017, 189(23): E804. doi:10.1503/cmaj.160459.
[5] Brown GC, Magargal LE. The ocular ischemic syndrome. Clinical, fluorescein angiographic and carotid angiographic features[J]. IntOphthalmol, 1988, 11(4): 239-251. doi:10.1007/BF00131023.
[6] Benjankar M, Sitaula S, Karki P. Ocular ischemic syndrome; A case report[J]. Nepal J Ophthalmol, 2019, 11(21): 86-90. doi:10.3126/nepjoph.v11i1.25434.
[7] Kearns TP, Siekert RG, Sundt TM. The ocular aspects of carotid artery bypass surgery[J]. Trans Am OphthalmolSoc, 1978, 76: 247-265.
[8] Anguita R, Nazar C, Kobus R, et al. Bilateral ocular ischemic syndrome as a manifestation of Takayasu arteritis in children[J]. Can J Ophthalmol, 2019, 54(3): e105-e108. doi:10.1016/j.jcjo.2018.08.018.
[9] Terelak-Borys B, Skonieczna K, Grabska-Liberek I. Ocular ischemic syndrome—a systematic review[J]. Med SciMonit, 2012, 18(8): RA138-RA144. doi:10.12659/msm.883260.
[10] Mizener JB, Podhajsky P, Hayreh SS. Ocular ischemic syndrome[J]. Ophthalmology, 1997, 104(5): 859-864. doi:10.1016/s0161-6420(97)30221-8.
[11] 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. doi:10.1161/hs0302.104619.
[12] Sivalingam A, Brown GC, Magargal LE. The ocular ischemic syndrome. III. Visual prognosis and the effect of treatment[J]. Int Ophthalmol, 1991, 15(1): 15-20. doi:10.1007/BF00150974.
[13] López Sánchez E, Francés Muñoz E, Mondéjar García JJ, et al. Anterior pole ischemia and carotid stenosis[J]. Arch Soc Esp Oftalmol, 2000, 75(6):421-424.
[14] Michelson PE, Knox DL, Green WR. Ischemic ocular inflammation. A clinicopathologic case report[J]. Arch Ophthalmol, 1971, 86(3): 274-280. doi:10.1001/archopht.1971.01000010276007.
[15] Kim YH, Sung MS, Park SW. Clinical features of ocular ischemic syndrome and risk factors for neovascularGlaucoma[J]. Korean J Ophthalmol, 2017, 31(4): 343-350. doi:10.3341/kjo.2016.0067.
[16] Mendrinos E, MacHinis TG, Pournaras CJ. Ocular ischemic syndrome[J]. SurvOphthalmol, 2010, 55(1): 2-34. doi:10.1016/j.survophthal.2009.02.024.
[17] Sharma S. Ophthaproblem. Ocular ischemic syndrome[J]. Can Fam Physician, 1999, 45: 901, 909.
[18] Battista M, Borrelli E, Sacconi R, et al. Optical coherence tomography angiography in diabetes: a review[J]. Eur J Ophthalmol, 2020, 30(3): 411-416. doi:10.1177/1120672119899901.
[19] Pellegrini M, Vagge A, Ferro Desideri LF, et al. Optical coherence tomography angiography in neurodegenerative disorders[J]. J Clin Med, 2020, 9(6): E1706. doi:10.3390/jcm9061706.
[20] Rao HL, Pradhan ZS, Suh MH, et al. Optical coherence tomography angiography in Glaucoma[J]. J Glaucoma, 2020, 29(4): 312-321. doi:10.1097/ijg.000000000-0001463.
[21] Balaratnasingam C, Inoue M, Ahn S, et al. Visual acuity is correlated with the area of the fovealavascular zone in diabetic retinopathy and retinal vein occlusion[J]. Ophthalmology, 2016, 123(11): 2352-2367. doi:10.1016/j.ophtha.2016.07.008.
[22] Yang S, Liu XQ, Li H, et al. Optical coherence tomography angiography characteristics of acute retinal arterial occlusion[J]. BMC Ophthalmol, 2019, 19(1): 147. doi:10.1186/s12886-019-1152-8.
[23] Campbell JP, Zhang M, Hwang TS, et al. Detailed vascular anatomy of the human Retina by projection-resolved optical coherence tomography angiography[J]. Sci Rep, 2017, 7: 42201. doi:10.1038/srep42201.
[24] Saito K, Akiyama H, Mukai R. Alteration of optical coherence tomography angiography in a patient with ocular ischemic syndrome[J]. Retin Cases Brief Rep, 2019. doi:10.1097/ICB.0000000000000857.
[25] Choi EY, Lee SC, Kim M. Optical coherence tomography angiography before and after bevacizumabinjection in ocular ischemic syndrome[J]. Retina(Philadelphia, Pa), 2018, 38(3): e23-e25. doi:10.1097/IAE.0000000000001981.
[26] Kawaguchi S, Okuno S, Sakaki T, et al. Effect of carotid endarterectomy on chronic ocular ischemic syndrome due to internal carotid artery Stenosis[J]. Neurosurgery, 2001, 48(2): 328-332; discussion 322-3. doi:10.1097/00006123-200102000-00016.
[27] Nederkoorn PJ, van der Graaf Y,Hunink MG. Duplex ultrasound and magnetic resonance angiography compared with digital subtraction angiography in carotid artery Stenosis: a systematic review[J]. Stroke, 2003, 34(5): 1324-1332. doi:10.1161/01.STR.0000068367.08991.A2.
[28] Koelemay MJ, Nederkoorn PJ, Reitsma JB, et al. Systematic review of computed tomographic angiography for assessment of carotid artery disease[J]. Stroke, 2004, 35(10): 2306-2312. doi:10.1161/01.STR.0000141426.63959.cc.
[29] Marx JL, Hreib K, Choi IS, etal. Percutaneous carotid artery angioplasty and stenting for ocular ischemic syndrome[J]. Ophthalmology, 2004, 111(12): 2284-2291. doi:10.1016/j.ophtha.2004.05.029.
[30] Abraham S, Feucht N, Lohmann CP, et al. Ocular ischemic syndrome[J]. Ophthalmologe, 2015, 112(8): 679-681. doi:10.1007/s00347-014-3178-x.
[31] Franco-Cardenas V, Shah SU, Apap D, et al. Assessment of ischemic index in retinal vascular diseases using ultra-wide-field fluorescein angiography: single versus summarized image[J]. SeminOphthalmol, 2017, 32(3): 353-357. doi:10.3109/08820538.2015.1095304.
[32] Arai N, Sasahara A, Hagiwara S, et al. Immediate improvement of ischemic oculopathy after stenting for internal carotid artery stenosis[J].Brain Nerve, 2014, 66(12):1503-1508. doi: 10.11477/mf.1416200065.
[33] Amselem L, Montero J, Diaz-Llopis M, et al. Intravitreal bevacizumab(Avastin)injection in ocular ischemic syndrome[J]. Am J Ophthalmol, 2007, 144(1):122-124. doi:10.1016/j.ajo.2007.02.037.
[34] Schmidt-Erfurth U, Garcia-Arumi J, Bandello F, et al. Guidelines for the Management of Diabetic Macular Edema by the European Society of Retina Specialists(EURETINA)[J]. Ophthalmologica, 2017, 237(4):185-222. doi:10.1159/000458539.
[35] Mansour SE, Browning DJ, Wong K, Flynn HW Jr, Bhavsar AR. The Evolving Treatment of Diabetic Retinopathy[J].Clin Ophthalmol, 2020,14:653-678. Published 2020 Mar 4. doi:10.2147/OPTH.S236637.
[36] Amoroso F, Pedinielli A, Astroz P, et al. Comparison of pain experience and time required for pre-planned navigated peripheral laser versus conventional multispot laser in the treatment of diabetic retinopathy[J]. Acta Diabetol, 2020, 57(5):535-541. doi:10.1007/s00592-019-01455-x.
[37] Bertelli PM, Pedrini E, Guduric-Fuchs J, et al. Vascular regeneration for ischemic retinopathies: hope from cell therapies[J]. Curr Eye Res, 2020, 45(3): 372-384. doi:10.1080/02713683.2019.1681004.
[38] Park SS, Moisseiev E, Bauer G, et al. Advances in bone marrow stem cell therapy for retinal dysfunction[J]. Prog Retin Eye Res, 2017, 56:148-165. doi:10.1016/j.preteyeres.2016.10.002.
[39] Fiori A, Terlizzi V, Kremer H, et al. Mesenchymal stromal/stem cells as potential therapy in diabetic retinopathy[J]. Immunobiology, 2018, 223(12): 729-743. doi:10.1016/j.imbio.2018.01.001.
[40] Park SS. Cell Therapy Applications for Retinal Vascular Diseases: Diabetic Retinopathy and Retinal Vein Occlusion[J]. Invest Ophthalmol Vis Sci, 2016, 57(5):ORSFj1-ORSFj10. doi:10.1167/iovs.15-17594.
[1] 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.
[2] 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.
[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] 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.
[7] 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.
[8] 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.
[9] 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-.
[10] 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 .
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1]

DONG Wei-hong,BI Hong-sheng,WANG Xing-rong,MA Xian-zhen,DU Xiu-juan,YU Chao

. Vitreo-retinal surgery for severe ocular trauma in 52 cases[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(4): 362 -365 .
[2] WANG Xiang-ru,JIANG Hua,ZHANG Xia,WANG Xiao-li . Relationships among different refractive components following penetrating keratoplasty[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(4): 373 -375 .
[3] XU Yao-dong, LIU Xiang, OU Yong-kang, ZHENG Yi-qing,CHEN Sui-jun,JI Shu-fang, GUO Xiao-juan . Surgical management for stenosis or atresia after operations for congenital external atresia in 10 cases[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(5): 427 -428 .
[4] JIANG Peng-fei,LIU Feng-chun,L Yong-bin . Imaging sectional anatomy of the optic canal[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(5): 464 -466 .
[5] TIAN Shengxia,WANG Xiaohong,CHEN Xin,CAO Liantao, XUE Kun . Local application of glucocorticoids for chronic sinusitis andnasal polyps after endoscopic surgery[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2006, 20(1): 51 -52 .
[6] . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2006, 20(2): 102 -104 .
[7] YIN Ji-qing . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2006, 20(5): 477 -477 .
[8] XING Jin-yan,ZONG Shu,TAO Ai-lin,ZHANG Jian-guo . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2006, 20(5): 451 -455 .
[9] XIE Zhi-gang,ZHANG Xi-ying . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2006, 20(3): 242 -243 .
[10] LI Liang,LIN Peng . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2007, 21(2): 185 -187 .