摘要目的 观察颈动脉狭窄伴眼部缺血性表现的临床特征及治疗效果.方法 回顾分析经颈动脉彩色超声多普勒(CDFI)及数字减影血管造影(DSA)检查确诊并接受单纯药物、颈动脉支架置人或颈动脉内膜切除术治疗的210例颈动脉狭窄患者中有眼部缺血性表现的81例患者的临床资料.其中,仅有眼部缺血临床症状者49例,占60.49%;确诊为眼部缺血性疾病者32例,占39.51%.后者24例行视网膜激光光凝、降眼压药物、睫状体冷冻等治疗.回顾分析时,对比分析CDFI和DSA检测发现的颈动脉狭窄程度与眼部缺血性表现的相关性,并依据CDFI血流成像系统评价3种治疗方法的临床效果.结果 有眼部缺血性表现的81例患者中,一过性黑矇38例,占46.91%;眼前闪光30例,占37.03%;眼部红肿且伴眼眶周围疼痛者28例,占34.57%;复视11例,占13.58%;视力下降9例,占11.11%.确诊有眼部缺血性疾病的32例患者中,缺血性视神经病变9例,占28.13%;眼部缺血综合征和视网膜中央或分支动脉阻塞各6例,各占18.75%;视网膜出血5例,占15.62%;眼外肌麻痹4例,占12.50%;新生血管性青光眼2例,占6.25%.颈动脉狭窄程度与眼部缺血性疾病发病率之间呈高度正相关(R=0.837,P<0.05).颈动脉支架置入术与颈动脉内膜切除术治疗的有效率均显著高于单纯药物治疗(t=2.73,3.14;P<0.01).结论 颈动脉狭窄伴眼部缺血表现者,可出现一过性黑矇、眼前闪光、眼部红肿及眼眶周围疼痛、复视、视力下降等眼部缺血性临床症状以及缺血性视神经病变、眼部缺血综合征、视网膜中央或分支动脉阻塞、新生血管性青光眼等眼部缺血性疾病.颈动脉支架置入术和颈动脉内膜切除术的疗效显著高于单纯药物治疗.

abstractsObjective To observe the clinical characteristics and therapeutic effects of carotid artery stenosis-related ocular ischemic appearance (OIA) . Methods The clinical data of 210 patients of carotid artery stenosis (81 of them with OIA) were retrospectively reviewed. They were diagnosed by color doppler image(CDI)or digital subtraction angiography (DSA), and had undergone medicine, carotid artery stenting (CAS)and carotid endarterectomy (CEA). Of 81 patients with OIA, 49 patients (60. 49%) with OIA only, 32 patients(39. 51%)with ocular ischemic disease (OID). 24/32 OID patients received ophthalmic treatment such as retinal laser photocoagulation and anti-glaucoma therapy (drugs and cyclocryotherapy). Results The ocular manifestations of 81 OIA patients included transient amaurosis in 38 cases (47. 14%), flash before the eye in 30 cases (36. 67%), periorbital swelling and pain in 28 cases (34. 57%), diplopia in 11 cases (13.58%) and vision loss in 9 cases (11. 11%). The ocular manifestations of 32 OID patients included ischemic optic neuropathy in 9 cases (28. 13%), ocular ischemic syndrome in 6 cases (18. 75%), central or branch retinal artery occlusion in 6 cases (18. 75%), retinal hemorrhage in 5 patients (15. 62%),extraocular muscle paralysis in 4 patients (12. 50%) and neovascular glaucoma in 2 patients (6. 25%). The higher the degree of carotid stenosis, the higher incidence of ocular ischemic disease, there was highly positive correlation between each other (R = 0. 837, P<0. 05). The total effective rate of carotid artery stenting and carotid endarterectomy was significantly higher than drug treatment alone (t = 2. 73, 3.14; P<0.01). Conclusion The ocular manifestations of carotid stenosis-related ocular ischemic appearance can be transient amaurosis, eyes flashing, eye redness, periorbital pain, diplopia and decreased visual acuity. The ocular manifestations of carotid stenosis-related ocular ischemic disease can be ischemic optic neuropathy, ocular ischemic symptoms, central or branch retinal artery occlusion and neovascular Carotid artery stenting and carotid endarterectomy are more effective than drug treatment alone for those patients.