颈动脉支架成形术治疗缺血性眼病的疗效观察  

Curative observation of carotid artery stent angioplasty for the treatment of ischemic ophthalmopathy

作　　者：冯雪艳[1] 牟明春[2] 陈海婷[1] 赵俊华[1] 范玉香[1] 

机构地区：[1]沧州市中心医院眼科,河北061000 [2]沧州市中心医院超声科

出　　处：《中国实用眼科杂志》2015年第7期824-827,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的 观察颈动脉支架成形术（CAS）治疗缺血性眼病的疗效及安全性.方法 前瞻性无对照研究.选择2009年5月至2013年2月就诊于沧州市中心医院眼科单眼一过性黑矇与眼缺血综合征患者48例（48只眼）,其中单眼一过性黑矇41例（41只眼）,眼缺血综合征7例（7只眼）.患眼侧颈动脉狭窄程度大于70％,且符合颈动脉支架成形术手术指征者.分别于术前、术后1周及术后3个月检测患眼眼底血管造影及球后血管血流动力学参数并对比分析,术后1年内定期随访,了解患眼复发及眼部恢复情况.结果 术后1周患眼眼动脉收缩期峰值流速（PSV） （29.23±4.46）cm/s、舒张末期流速（EDV） （10.19±1.35） cm/s及视网膜中央动脉PSV （12.23±0.56）、EDV （3.94±0.58） cm/s与术前比较增高,差异均有统计学意义（P＜0.05）;臂-视网膜循环时间（14.87±4.35）s较术前（17.21±3.68）s缩短,差异有统计学意义（P＜0.05）.术后1周与术后3个月在球后血管血流动力学参数及臂-视网膜循环时间上比较差异无统计学意义（P＞0.05）.术前12例患者存在眼动脉逆流现象,术后眼动脉逆流消失.单眼一过性黑嚎患者术后1年内5例复发.7例眼缺血综合征患者,其中3例虹膜红变,行视网膜光凝及CAS术后,虹膜新生血管消退,随访1年未复发;4例新生血管性青光眼,1例行睫状体冷冻,3例行视网膜光凝,CAS术后随访1年眼压控制正常,其中2例视力无变化,2例视力有提高.结论 CAS能有效改善眼部血液循环,对严重颈动脉狭窄引起的缺血性眼病的治疗效果明显,远期疗效有待进一步观察。Objective To observe the feasibility and safety of carotid artery stent angioplasty for treating the patients with ischemic ophthalmopathy.Methods Forty-eight patients （48 eyes） with amaurosis fugax （41 eyes） or ocular ischemic syndrome diseases（7 eyes） whose carotid artery stenosis were more than 70% and conformed to the carotid artery stent angioplasty surgical indications,were enrolled during May 2009 to February 2013.Fundus fluorescein angiography and hemodynamics data of retrobulbar vascellum were detected and analyzed preoperatively and 1 week and 3 months after operation.All patients were followed up regularly within one year to understand the relapse and recovery of eyes.Results PSV （29.234±4.46） and EDV （10.19±1.35） of ophthalmic artery and PSV （12.23±0.56） and EDV （3.94±0.58） of central retinal artery one week after operation were higher than that before operation.Arm-to-retinal circulation time （14.87±4.35） one week after operation was shorter than that before operation （17.21±3.68）.These differences were statistically significant.There were no statistical differences of hemodynamics data of retrobulbar vascellum and arm-to-retinal circulation time one week and three months after operation.Reversed ophthalmic artery flow could be found in 12 patients before operation and disappeared after operation.7 patients with ocular ischemic syndrome diseases,3 of whom had iris rubeosis underwent retinal photocoagulation and CAS.Iris neovascularization disappeared and did not relapse in one year.There were 4 patients with neovascular glaucoma,3 of whom underwent retinal photocoagulation while 1 of whom underwent ciliary cryotherapy.Intraocular pressures were normal in one year.The vision of 2 cases did not worsen and 2 cases improved.Conclusions CAS can improve eye blood circulation effectively,and treatment effect for severe carotid stenosis caused by ischemic eye disease is obvious.The long-term curative effect remains to be seen.

关 键 词：颈动脉支架成形术 缺血性眼病 血流动力学 

分 类 号：R653[医药卫生—外科学]