多发性大动脉炎合并眼缺血综合征的诊治进展

Recent advances in the diagnosis and management of Takayasu arteritis complicated with ocular ischemic syndrome

多发性大动脉炎(TA)是一种少见的慢性非特异性血管炎,易造成眼部组织低灌注状态,从而出现以慢性缺血性视网膜病变为主的眼缺血综合征(OIS)。TA合并OIS以无痛性视力下降和一过性黑矇为主要表现,但由于该症状缺乏特异性,临床需借助荧光素眼底血管造影为主的多模式影像提高早期诊断率。早期诊断有助于及时逆转TA患者的眼底缺血状态,改善疾病的转归。针对TA合并OIS患者的治疗应基于多学科综合团队,联合全身及眼部治疗,根据疾病特点得出最优的个性化方案。眼科医师应提升对该病的认知,明确定期规范的眼科检查在本病随访过程中的重要性,以改善患者预后。

Takayasu arteritis(TA)is a rare,chronic non-specific vasculitis that can lead to ocular hypoperfusion.As a result,ocular ischemic syndrome(OIS),which prominently manifests as Takayasu retinopathy,may develop subsequently.Ocular manifestations mainly consist of progressive painless vision loss and amaurosis fugax in TA patients complicated with OIS.However,due to the lack of specific clinical characteristics,it is of great significance to improve the timely diagnosis aided by multimodal imaging,especially fundus fluorescein angiography.Early diagnosis of OIS is essential for reversal of ocular ischemia and better prognosis of TA patients.Management of OIS patients associated with Takayasu arteritis requires a combination of systemic and ophthalmic treatment.Therefore,the optimal individualized regiment should be determined by disease activity and progression,which are addressed by multi-disciplinary team assessment.Ophthalmologists should further understand the clinical features and the importance of regular ophthalmologic examinations during the disease course,thus to improve the overall survival and visual outcomes.