| Objective:A retrospective analysis of the clinical characteristics of patients with ocular ischemic syndrome(OIS)was conducted to investigate the factors influencing the best corrected visual acuity(BCVA)and intraocular pressure in patients with OIS,as well as the correlation between the duration of visual symptoms and the ocular clinical characteristics of patients.The changes of fundus,BCVA and intraocular pressure before and after carotid artery surgery were analyzed.Methods:41 patients(50 eyes)with OIS diagnosed in our hospital from June 2020 to October 2022 were analyzed retrospectively.Patients’ gender,age,BCVA,intraocular pressure,anterior segment and related imaging manifestations were observed and recorded.Statistical methods such as chi-square test and Mann-Whitney U test were used for analysis,and P<0.05 was statistically different.Result:1.General information41 patients(50 eyes)were included in this study,the average age was 65.61±6.39 years old,the ratio of male to female was 30:11,monocular in 32 cases,binocular in 9 cases.Visual acuity decreased in 46 eyes(92.0%),transient amaurosis in 4 eyes(8.0%),eye pain in 5 eyes(10.0%),and visual field defect in 2 eyes(4.0%).The average Log MAR visual acuity was 1.67 ±0.96.The mean intraocular pressure was 21.34 ±9.28 mm Hg.The duration of visual symptoms was less than 1 month in 30eyes(60.0%)and > 1 month in 20 eyes(40.0%).There were 19 cases(46.3%)with diabetes,11 cases(26.8%)with hypertension and 11 cases(26.8%)with cerebral infarction.2.Analysis of ocular features(1)Fundus manifestationRetinal hemorrhage in 27 eyes(54.0%),microaneurysm in 31 eyes(62.0%),cotton-wool spot in 13 eyes(26.0%).(2)The fluorescein fundus angiography(FFA)findings of OIS were divided into two groups: non-perfusion(NP)area(figure 1)and non-NP area(figure 2).FFA showed NP area in 22 eyes(48.9%)and no NP area in 23 eyes(51.1%).Chi-square test was used to analyze the correlation between the two angiographic features and duration of visual symptoms,neovascularization of the iris(NVI)and neovascular glaucoma(NVG).The results showed no correlation between the two angiographic features and the duration of visual symptoms,NVI and NVG(P>0.05).(3)Depending on the presence or absence of NVI,Patients with OIS were divided into two groups: NVI group and non-NVI group,36 eyes(72.0%)in NVI group and 14 eyes(28.0%)in non-NVI group.Mann-Whitney U test was used to compare the visual acuity and intraocular pressure between the two groups.The results showed that the visual acuity of the NVI group was worse than that of the non-NVI group,and there was a statistical difference(P < 0.05).There was no significant difference in IOP between the two groups(P>0.05).Chi-square test was used to analyze the association between the NVI and non-NVI groups and the duration of visual symptoms.The result showed that there was no correlation between NVI and the duration of visual symptoms(P>0.05).(4)According to the ultrasound biomicroscope findings,360°closure of the angle was defined as complete closure of the angle,less than 360° closure of the angle was defined as partial closure,and no closure of the angle was defined as open.The angles of OIS patients were divided into three groups: completely closed,partially closed and open.12 eyes(48.0%)in the group with completely closed angles,6 eyes(24.0%)in the group with partially closed angles,and 7 eyes(28.0%)in the group with open angles.The Kruskal-Wallis test was used to compare the visual acuity and intraocular pressure of the three groups.The results showed that there was a statistical difference in visual acuity(P<0.05)and a statistical difference in IOP(P< 0.05)between the three groups of patients.(5)In cases of combined NVI,IOP > 21 mm Hg was defined as NVG based on the first IOP examination result.Patients with OIS were divided into NVG group and non-NVG group,14 eyes(28.0%)in NVG group and 36 eyes(72.0%)in non-NVG group.The correlation between the two groups of patients and the duration of visual symptoms was analyzed using the chi-square test.The Mann-Whitney U test was used to analyze the difference in visual acuity between the two groups of patients.The results showed that there was no correlation between the presence of NVG and the duration of visual symptoms(P > 0.05),and there was no significant difference in visual acuity between the two groups(P>0.05).3.Comparison of visual acuity,intraocular pressure and fundus changes in patients before and after carotid artery surgeryIn our group,six cases were treated for carotid artery surgery,all with combined NVI and complete or partial closure of the angle.Among them,1 case underwent carotid endarterectomy,and 5 cases underwent carotid artery stenting.After carotid artery surgery,compared with the preoperative period,two cases of fundus cotton-wool spot disappeared,three cases of retinal hemorrhage were reduced,two cases of arm-retinal time were shortened,and three cases of vascular leakage were reduced.Paired sample t test and Wilcoxon symbolic rank test were used to compare the visual acuity and intraocular pressure of the patients before and 1 week after carotid artery operation.The results showed that there was a statistical difference(P<0.05)between preoperative and postoperative visual acuity in patients with NVI,and postoperative visual acuity was decreased.There was a statistically significant difference(P<0.05)in the preoperative and postoperative IOP in patients with closed angles and increased postoperative IOP.4.Analysis of carotid artery stenosis sites in OIS patientsAll cases in this group were first diagnosed in ophthalmology,and after suspected OIS,stenosis or occlusion of the extracranial segment of the internal carotid artery was detected by carotid artery ultrasound in 44 cases(88.0%),including 16eyes(36.4%)with 70-99% carotid stenosis and 28 eyes(63.6%)with carotid occlusion.Six patients(12.0%)had suspected OIS changes,and no stenosis or occlusion was found by carotid artery ultrasound.Severe stenosis or occlusion of the intracranial segment of the internal carotid artery was detected by head and neck computed tomographic angiography(CTA)or magnetic resonance angiography(MRA),which was diagnosed as OIS.Conclusion:1.There was no correlation between the two FFA features with and without NP area and the duration of visual symptoms,NVI and NVG.2.NVI is a sign of poor vision,there is no correlation between NVI and intraocular pressure,and there is no correlation between NVI and the duration of visual symptoms.3.The open status of the angle is associated with visual acuity,and complete closure of the angle may be a sign that the patient has poor vision.4.There is no correlation between the existence of NVG and the duration of visual symptoms in patients with OIS,and there is no correlation between visual acuity and the occurrence of NVG.5.Patients with NVI had decreased visual acuity 1 week after carotid artery surgery compared to preoperative.Patients with angle closure had increased IOP 1week after carotid artery surgery compared to preoperative.6.For the diagnosis of OIS,when there are ischemic changes in the fundus suspicious of OIS and no clear stenosis is seen on carotid artery ultrasound,the possibility of stenosis in the intracranial segment of the internal carotid artery needs to be considered and further CTA or MRA should be performed to avoid missing the diagnosis. |
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