颅内静脉窦狭窄患者眼部表现及支架术后眼底改变的相关研究

Ocular Manifestations of Patients with Cerebral Venous Sinus Stenosis and Fundus Changes after Venous Sinus Stenting

目的了解颅内静脉窦狭窄(cerebral venous sinus stenosis,CVSS)患者眼部特征,分析静脉窦支架置入术后眼底改变情况,探讨与视盘水肿程度相关的可能因素。方法回顾性纳入2014年1月-2018年8月在首都医科大学附属北京天坛医院神经介入中心确诊,并行静脉窦支架置入术的CVSS患者,收集患者一般资料、病程、视力、眼底检查、视野情况、颅内压、DSA检查、静脉窦内压测定及患者术后的眼部变化等临床资料。总结CVSS患者的眼部特征和静脉窦支架置入术后的眼底改变情况,应用Kendall’s tau-b相关分析探讨与视盘水肿程度相关的可能因素。结果共纳入125例CVSS患者,存在视功能损害者101例(80.8%),包括视物模糊、视力下降、视物变形、阵发性黑蒙、视野缺损、复视等,其中65例(52.0%)眼部症状为首发症状,35例(28.0%)仅表现出眼部症状。视盘水肿115例,共223只眼。视盘水肿等级中位值3(2~4)级(Fri sén分级)。部分患者可见视盘周围出血、渗出、棉绒斑,视网膜皱褶及静脉迂曲扩张,视盘色淡或苍白等。视盘水肿等级与颅内压正相关(Kendall’s tau-b=0.271,P=0.029),与病程负相关(Kendall’s tau-b=-0.261,P=0.002)。其中79例经内科治疗无效患者接受了静脉窦支架置入术,术后患者视盘水肿均有减轻,术后1个月视盘水肿等级降为2(1~3)级;术后6个月时视盘水肿完全消退比例达94.4%(135/143)。结论对双眼视盘水肿患者要除外CVSS可能性;眼底检查是CVSS诊疗评估及判断颅内压情况的一项重要无创检查,同时也是CVSS患者治疗后随访观察的必要检查。视盘水肿程度与颅内压正相关,与病程负相关;静脉窦狭窄合并视盘水肿经内科治疗无效患者可考虑行静脉窦支架置入术治疗,促进视盘水肿消退,减少视神经不可逆性损害。

Objective To understand ocular manifestations of patients with cerebral venous sinus stenosis(CVSS),analyze fundus changes after venous sinus stenting and explore possible related factors of papilledema degree.Methods Data of patients with CVSS in Neurointervention Center,Beijng Tian Tan Hospital from January 2014 to August 2018 were retrospectively analyzed.The ocular characteristics of CVSS patients and ophthalmological changes after CVSS stenting were analyzed and summarized.Results Of 125 patients,101(80.8%)had visual impairment,including blurred vision or decreased vision,metamorphosis,transient amaurosis,visual field defect,diplopia.65(52.0%)patients had ocular discomfort as the first symptom and 35(28.0%)patients had only ocular symptom.Of 115 patients(223 eyes)with initial papilledema,the median pepilledema grade was 3(2-4)(Frisén grades). Some patients showed hemorrhage, exudation, cotton-wool spot, retinal tissue foldsurrounding the disc, dilated and tortuous retinal veins, papilla pale. There was a positive relevancebetween papilledema grade and intracranial pressure (Kendall’s tau-b=0.271, P =0.029), and anegative relevance between papilledema grade and duration of the disease (Kendall’s tau-b=-0.261,P =0.002). 79 patients underwent venous sinus stenting, papilledema of all patients with stentingalleviated soon after operation. At 1 month after stenting, the grade of papilledema was reducedto grade 2 (1-3). At 6 months after stenting, 94.4% eyes (135/143) with initial papilledema had noedema in the disc.Conclusions Patients with binocular papilledema should consider CVSS. The fundus examinationis necessary for diagnosis and follow up of CVSS and assessing intracranial pressure. Papilledemadegree had a positive relevance with intracranial pressure, and a negative relevance with duration ofthe disease. Patients with CVSS and papilledema who are refractory for medical treatment shouldconsider venous sinus stenting as possible as earlier to reduce papilledema and irreversible damageof optic nerve.