一过性黑矇患者颈动脉彩色超声多普勒图像特征分析

Clinical features and carotid artery color Doppler imaging in patients with transient amaurosis

目的探讨一过性黑矇患者的临床表现和颈动脉彩色超声多普勒（CDI）的影像特征。方法收集2010年4月至2012年12月在天津第三中心医院眼科就诊的一过性黑矇患者67例（98只眼），对患者进行病史询问，眼部视力、裂隙灯显微镜、眼压、眼底等检查，并进行颈部彩色超声多普勒检查，对检查结果进行分析总结。结果67例（98只眼）一过性黑嚎患者，主要伴发症状为眼前闪光12例（17．91％）、眼眶周围疼痛10例（14．93％）等。确定眼部缺血性疾病共16只眼（16．33％），其中包括静脉瘀滞性视网膜病变7只眼（7．14％）、视网膜中央或分支动脉阻塞3只眼（3．06％）、前部缺血性视神经病变1只眼（1．02％）、视盘新生血管1只眼（1．02％）、新生血管性青光眼4只眼（4．08％）。颈动脉彩色超声多普勒检查：双侧颈动脉硬化51例次（76．12％），颈动脉斑块26例次（38．81％），颈动脉狭窄24例次（35．82％），颈内动脉闭塞2例次（2．99％）。结论一过性黑矇是最常见的眼部缺血性表现，常由颈动脉狭窄引起，在眼部缺血性疾病出现之前就已出现。颈动脉彩色超声多普勒检查安全有效，对一过性黑矇患者及时做CDI检查并早期治疗颈动脉狭窄是预防眼缺血性疾病的可靠方法。

Objective To study the clinical manifestations and results of carotid artery color Doppler imaging （CDI） of patients with transient amaurosis. Methods Consecutive patients 67 cases （98 eyes） of amaurosis fugax were evaluated with medical history, visual acuity, slit lamp, intraocular pressure, and fundus examinations. CDI for carotid artery and central retinal artery were carried out. All the results were analyzed. Results The subjective manifestations of 67 patients with transient amaurosis included flash before the eye in 12 cases （17.91%）, periorbital pain in 10 cases （14.93%） et al. The ocular manifestations of 16 patients with ocular ischemic disease included venous stasis retinopathy 7 eyes （7.14%）, central or branch retinal artery occlusion in 3 eyes （3.06%）, anterior ischemic optic neuropathy in 1 eye （1.02%）, optic disc neovascularization in 1 eye （1.02%）, neovascular glaucoma in 4 eyes （4.08%）. Carotid artery CDI examination： carotid artery sclerosis in 51 cases （76.12%）, plaque in 26 cases （38.81%）, stenosis in 24 cases （35.82%）, occluded in 2 cases （2.99%）. Conclusions Transient amaurosis is the common manifestation of ocular ischernic appearance. It appears earlier than ocular ischemic disease. CDI is the best safe and reliable method for carotid artery examination. Carotid artery CDI examination and carotid artery stenosis treatment performed earlier are the effective measures for preventing ocular ischemic disease.