慢性眼部缺血综合征的临床特征分析

Clinical features of chronic ocular ischemic syndrome

目的:总结分析慢性眼部缺血综合征的发病特征、风险因素及预后,为该病的早期诊断预防治疗提供依据。方法:回顾分析12例临床确诊的慢性眼部缺血综合症患者的详尽临床资料,包括性别、年龄、病史眼部常规检查,彩色超声多普勒检查,头部MRI检查。对检查结果治疗及视功能恢复情况进行分析。结果:选取12例患者平均年龄69岁,男女比例2∶1,全身合并症包括高血压、心脑血管疾病、高血脂、高血糖、烟酒嗜好,视力下降时间1mo～3a,其中6例视力下降前6mo有黑矇病史,眼部检查视力:无光感～0.12,虹膜新生血管5例,高眼压4例,眼底表现:动脉细,部分动脉看不到血柱,静脉不同程度扩张,不迂曲,视网膜小片状出血和棉絮斑,视乳头旁新生血管和黄斑区不典型樱桃红。彩色超声多普勒检查见有颈动脉粥样斑块形成,管腔狭窄,眼动脉,视网膜中央动脉血流缓慢或看不到血流或血流加快;FFA检查8例表现有动脉前锋现象,臂-视网膜循环时间延长,视网膜循环时间长,头部MRI检查9例,其中7例发现腔隙性脑梗塞,脑白质缺血性改变,陈旧性脑软化灶。12例均接受扩张血管治疗及改善微循环治疗,疗效不明显。结论:眼部缺血综合征早期诊断需要依靠FFA和超声多普勒,晚期病例单纯扩血管及活血化瘀治疗效果不佳,需要联合心内科,神经内科进行病因治疗。

AIM： To analyze the characteristics, risk factors and prognosis of the chronic ocular ischemic syndrome, and to provide the basis on early diagnosis and prevention therapy of this disease. METHODS： Detailted clinical data of 12 patients with chronic ocular ischemic syndrome were analysed retrospectively, including gender, age, medical history, routine eye examination, color Doppler ultrasound and head MRI. The results of treatment and examination of visual function were analyzed. RESULTS：Totally 12 patients（ mean age 69 years, male/ female ratio of 2：1 ） systemic complications, including hypertension, cardiovascular disease, high cholesterol, high blood sugar, tobacco and alcohol addiction were analyzed. The time of Vision decreased （from no light perception to 0. 12） was from a month to three years, of which 6 cases decreased vision with black pot history in the first half year. Iris neovascularization in 5 cases, high intraocular pressure in 4 cases, fundus characteristic： some small arteries without blood, veins expansion with different degrees and without tortuous, retinal hemorrhage and small pieces cotton wool spots, depending on peripapillary neovascularization and altypical macular cherry red. Color Doppler examination showed the formation of carotid artery plaque, stenosis; ophthalmic artery, central retinal artery present slow blood flow, no blood or speeded up blood flow ; FFA of 8 cases presented arterial forward phenomenon, time extension in arm retinal circulation and long retinal circulation time. The head MRI examination in 9 cases, of which the lacunar infarcts, change of white matter ischemic and old cerebral malacia were found in 7 cases. 12 patients underwent dilation of blood vessels and the microcirculation therapy treatment withnot obvious efficacy. CONCLUSION.Early diagnosis of ocular ischemic syndrome should rely on the FFA and Doppler ultrasound; and advanced cases should be combined with the original treatment of heart, neurology, as the treatment of pure vasodilators and lived blood circulation have poor effect.