Analysis Of The Clinical Features Of Patients With Ocular Ischemic Syndrome

Objective: To investigate the clinical features of patients with ocular ischemicsyndrome (OIS), and analyze the correlation between OIS and carotid artery stenosisdegree as well as the various testing indicators, for improving the discovery and clinicaldiagnosis rate of the disease.Methods: The clinical data of patients who were diagnosed as OIS were collectedfrom Ophthalmology department of Dalian medical university first affiliated hospital.Retrospectively the clinical data of patients were analyzed, including the patient’sgender, age, history of systemic disease, best corrected visual acuity and anteriorsegment and fundus examination, fundus fluorescein angiography (FFA), transcranialDoppler sonography (TCD) of blood vessels of the eyes, carotid artery system withColor Doppler flow imaging (CDFI), computed tomography angiography (CTA) ofneck, carotid artery digital subtraction angiography (DSA) inspection result. Theclinical features of patients with OIS were statistically analyzed; the relation betweenthe carotid stenosis degree and the incidence of OIS was analyzed; the correlationbetween affected side internal carotid artery stenosis degree, intima-media thickness(IMT), plaque nature and TCD parameter were explored; and the peak systolic velocity(PSV), resistance index (RI) of the ophthalmic artery and central retinal artery in theaffected side were compared with the healthy side.Results: Out of total19patients (21eyes) with OIS,2cases had bilateral eyedisease,17cases were simple eye,12cases were male (13eyes),7cases were female (8eyes). The male to female ratio was about1.7:1. The average age was (62.5±7.8) years.The disease course was2days to10years. The main symptoms contain declinedeyesight in18eyes (85.7%), amaurosis fugax in11eyes (52.4%), the light resistance in6eyes (28.6%), ocular and orbital pain in5eyes (23.8%). The main ocular presentationswere as follows best corrected visual acuity was varies from no light perception to1.0;iris neovascularization and diagnosed neovascular glaucoma in2eyes (9.5%); fundus showed narrow retinal arteries and vein with irregular expansion but not tortuosity in21eyes (100%), pale optic disc in6eyes (28.6%), fleck-shaped hemorrhages in the middleand peripheral retina in4eyes (19%), retinal cotton-wool spots in4eyes (19%),papilledema in2eyes (9.5%), and macular cherry-red spot in1eye (4.8%). FFA andvisual field examination were as follows:21eyes (100%) showed extended arm-retinacirculation time and retinal artery-vein filling time, retinal vessel wall staining in18eyes (85.7%), retinal non-perfusion area in10eyes (47.6%), microaneurysm in6eyes(28.6%), advanced stage of optic disk and macular area fluorescence leakage in4eyes(19%); the visual field had different degree of narrowing in10eyes (47.6%). Imagingexamination results were as follows:19cases (100%) had varying degrees of internalcarotid artery stenosis or occlusion. Complete occlusion of the ipsilateral internalcarotid artery lumen in3cases (15.8%); the severe stenosis in9patients (47.4%); andmoderate stenosis in7patients (36.8%). The internal carotid artery CDFI examinationin affected side in17patients with unilateral disease showed7cases with arterialintima-media change and multiple plaque formation, lumen with different degree ofstenosis, the most serious stenosis was60%. The degree of internal carotid arterystenosis in affected side was significantly higher than the healthy side (t=8.498, P<0.05);there are no correlation between contralateral internal carotid artery stenosis degree,intima-media thickness, the nature of the plaque and TCD parameter of blood vessels ofthe eyes (P>0.05); in comparison of the affected side with the healthy side, the PSV ofophthalmic artery and central retinal artery was reduced, RI increased (P<0.05).Treatment: all patients accepted vasodilation and improving microcirculation treatments.3patients were examined by DSA, carotid endarterectomy was performed in1case,carotid artery stenting was performed in2cases. The postoperative intraocular pressurewere normal, and ocular symptoms improved, but there was no significant improvementin visual acuity;2patients with secondary neovascular glaucoma were treated withpanretinal photocoagulation,1patients was treated with ciliary cryotherapy, and afterthe treatment, the pain decreased, intraocular pressure controlled and the part of irisneovascularization disappeared. All patients’ vision had no obvious change before andafter the treatment.Conclusion:1. OIS mostly occurred in the elderly over the age of60, onset wasinsidious, clinical manifestations was complex, the main clinical features includeddeclined eyesight with no obvious causes, amaurosis fugax, iris neovascularization and hypoperfusion retinopathy.2. The PSV of ophthalmic artery and central retinal artery reduced, RI increased inthe patients of OIS, internal carotid artery stenosis degree and incidence of OIS washighly relevant; the combination use of TCD and CDFI can response vascular structuresand hemodynamic status more comprehensively, it can be used as an important tool fordiagnosis of OIS.3. OIS patients has poor prognosis, early diagnosis and effective recovery of theocular blood perfusion can maintain visual function and reduce the devastating ocularcomplications, the patients should be adopted multi-disciplinary comprehensivetreatment.