眼缺血综合征的临床特点和颈动脉彩色超声多普勒图像特征  

Clinical features and carotid artery color Doppler imaging in patients with ocular ischemic syndrome

作　　者：郭彤[1] 张惠蓉[1] 

机构地区：[1]北京大学第三医院眼科,教育部视觉损伤与修复重点实验室,100191

出　　处：《中华眼科杂志》2011年第3期228-234,共7页Chinese Journal of Ophthalmology

摘　　要：目的 探讨眼缺血综合征的临床特点和颈动脉彩色超声多普勒（CDI）图像特征.方法 回顾性病例系列研究.收集17例（20只眼）确诊为眼缺血综合征患者的临床资料进行回顾性分析,包括患者的病史、视力、眼前节裂隙灯显微镜、直间接检眼镜、荧光素眼底血管造影、颈动脉CDI、脑血管造影及核磁共振检查资料.结果 17例（20只眼）眼缺血综合征患者中,男性13例,女性4例;双眼罹患者3例,其中右眼13只,左眼7只;患者年龄46～83岁,中位数70岁.（1）临床症状：主诉视力下降12例（70.6%）,反复一过性黑矇3例（17.6%）,眼前黑影2例（11.8%）.出现症状到就诊时间为2 d至6年,中位数3个月.（2）视力：最佳矫正视力＜0.05者3只眼（15.0%）,0.05至＜0.3者7只眼（35.0%）,0.3至＜0.7者7只眼（35.0%）,≥0.7者3只眼（15.0%）.（3）眼底表现：有棉絮斑3只眼（15.0%）,视网膜出血5只眼（25.0%）,视网膜动静脉普遍变细、血管呈串珠状、中周部微血管瘤6只眼（30.0%）,视乳头和视网膜新生血管5只眼（25.0%）,虹膜新生血管2只眼（10.0%）,新生血管性青光眼1只眼（5.0%）,视神经萎缩1只眼（5.0%）.（4）荧光素眼底血管造影：臂至视网膜循环时间延长至14.5～39.9 s,中位数20.9 s;动静脉血管壁着染;视网膜中周部可见微血管瘤形成的点状强荧光;部分患者可有动静脉短路和无灌注区形成.（5）颈内动脉CDI检测：同侧颈内动脉管腔完全闭塞者5例（19只眼,26.4%）,管腔狭窄范围80.0%～95.0%者7例（36.8%）,52.0%～80.0%者7例（36.8%）.其余14例对侧未发病眼同侧颈内动脉CDI检查,显示5例管腔狭窄,狭窄范围分别占管腔的80.0%、70.0%、60.0%、50.0%及40.0%,但眼底无异常.收缩期峰值流速（PSV）：17例（20只眼）同侧颈内动脉检查,8例管腔完全闭塞和严重狭窄者测不到血流;其余12只眼中有11只眼同侧PSV异常,其中PSV增高者9例,流速92Objective To report the clinical manifestations and results of carotid artery color Doppler imaging （CDI） of ocular ischemic syndrome （OIS）. Methods It was a retrospective case series study. Consecutive patients suspected with OIS were retrospectively studied from 1995 to 2009. We evaluated all patients with medical history, visual acuity, slit lamp, direct and indirect funduscopy, Fundus fluorescence angiography. CDI for internal carotid artery （ICA）, Diagnostic Cerebral Angiography and magnetic resonance imaging were also performed. Results 17 patients （20 eyes） with OIS were studied,13 males and 4 females. The age range of patients was 46 to 83 years old （median 70）. 13 right eyes and 7 left eyes （3 bilateral） were involved. （1） Symptoms： 70.6% （12/17） of the patients complained of visual decrease. 17.6% （3/17） had history of repeated amaurosis fugax （transient monocular visual loss）; 11.8%（2/17） patients presented with floaters. The course before the first presentation was 2 days to 6 years （median 3 months）. （2） Visual Acuity（VA）： among the 20 involved eyes, the best corrected VA 〈0.05 in 3 eyes （15.0%）; 0.05 to 〈0.3 in 7 eyes （35.0%）; 0.3 to 〈0.7 in 7 eyes （35.0%）; ≥0.7 in 3 eyes （15.0%）. （3） Fundus manifestations： 15.0% （3/20） eyes had cotton-wool spots; 25.0% （5/20） had retinal hemorrhages; retinal arterioles and vein became narrow; venous beading could be seen in severe cases. 30.0% （6/20） had microaneurysms in mid-peripheral area. The pressure of central retinal artery decreased; 25.0% （5/20） had optic disc or retinal neovascularization; 10.0% （2/20） had iris neovascularization. 5.0% （1/20） had neovascular glaucoma; 5.0% （1/20） had optic atrophy. （4） Fundus fluorescence angiography： arm-retinal circulation time prolonged to 14. 5 to 39. 9 seconds, （median 20.9 seconds）. The retinal and choroidal circulation time was also prolonged. The wall of artery and venous could be stainin

关 键 词：眼 缺血 视网膜疾病 颈动脉狭窄 颈内动脉 超声检查 多普勒 彩色 

分 类 号：R771[医药卫生—眼科]