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目的探讨眼部缺血综合征(ocularischemicsyndrome,OIS)的临床表现及分期。设计回顾性病例系列研究。研究对象OIS患者13例16眼。方法患者行常规眼部检查、眼底荧光素血管造影(fundusfluorescentangiography,FFA)、眼动脉、颈动脉系统超声多普勒(dopplerultrasonography,DU)检查。主要指标视力,颈动脉狭窄程度,眼前节、眼底的临床体征及FFA结果。结果13例16眼均表现不同程度的视力下降。4眼有眼前段缺血表现。眼底检查显示16眼(100%)的视网膜动脉狭窄、平直,静脉纡曲扩张;视网膜小片状出血14眼(88%);棉絮斑3眼(19%);黄斑水肿12眼(80%);晚期视乳头新生血管形成3眼(19%)。FFA显示脉络膜血管充盈迟缓9眼(56%);视网膜血管循环时均延长16眼(100%);视网膜周边毛细血管无灌注11眼(73%)。DU均显示颈动脉狭窄或血流迟缓,管腔狭窄超过直径60%者4例(25%)。眼动脉血流流速减低11眼(69%)。根据FFA和颈动脉DU结果将该病分为早期与晚期。结论OIS是严重脑血管病与缺血性心脏病可以看到的眼部表现。FFA及眼动脉、颈动脉超声多普勒检查是诊断该病的重要手段。
Objective To investigate the clinical manifestations and staging of ocular ischemic syndrome (OIS). Design retrospective case series. Thirteen patients (16 eyes) were enrolled in this study. Methods The patients underwent routine eye examination, fundus fluorescecent angiography (FFA), ophthalmic artery and carotid system doppler ultrasonography (DU). The main indicators of visual acuity, carotid stenosis, anterior segment, fundus clinical signs and FFA results. Results 13 cases of 16 eyes showed varying degrees of vision loss. 4 eyes had anterior segment ischemia performance. Fundus examination showed retinal artery stenosis, flattened and venous dilatation in 16 eyes (100%), retinal flare bleeding in 14 eyes (88%), spotted cotton in 3 eyes (19%), macular edema in 12 eyes (80% ); Late optic papilla neovascularization in 3 eyes (19%). FFA showed slow choroidal vascular filling in 9 eyes (56%), prolonged retinal vascular circulation in 16 eyes (100%), peripheral retinal capillaries in 11 eyes (73%) without perfusion. DU showed carotid artery stenosis or slow blood flow, stenosis more than 60% of diameter in 4 cases (25%). Ophthalmic artery blood flow decreased by 11 eyes (69%). According to FFA and carotid artery DU results the disease is divided into early and late. Conclusion OIS is an ocular manifestation of severe cerebrovascular disease and ischemic heart disease. FFA and ophthalmic artery, carotid artery Doppler ultrasound is an important means of diagnosis of the disease.