眼缺血综合征的研究进展

doi:10.3877/cma.j.issn.2095-2007.2023.03.011

眼缺血综合征是因颈内动脉狭窄或闭塞引起慢性缺血性和致盲性眼病。眼缺血综合征的眼前节临床表现主要有眼肌麻痹、上睑下垂、结膜水肿、角膜溃疡、角膜水肿、新生血管性青光眼、虹膜炎及不对称性白内障等；眼后节临床表现主要有视网膜动脉变细、视网膜静脉扩张而不迂曲、中周部视网膜出血、视网膜棉絮斑、微动脉瘤、新生血管形成、玻璃体积血及黄斑樱桃红斑点等。眼缺血综合征的临床表现复杂多样不典型，且早期症状不明显。因此，临床上眼缺血综合征的漏诊和误诊率较高。本文中笔者对该病流行病学、临床表现、诊断与鉴别诊断、辅助检查、治疗及预后的最新研究进展进行综述。

关键词: 眼缺血综合征, 颈内动脉狭窄, 新生血管性青光眼

Ocular ischemic syndrome is a chronic ischemic and blinding eye disease caused by stenosis or occlusion of the internal carotid artery. The clinical manifestations of anterior segment of ocular ischemic syndrome mainly included ophthalmoplegia, ptosis, conjunctival edema, corneal ulcer, corneal edema, neovascular glaucoma, iritis and asymmetric cataract; the posterior segment signs exhibited narrowed retinal arterioles, dilated retinal veins without tortuosity, peripheral retinal hemorrhages, cotton-wool spots, microaneurysms, retinal neovascularization, vitreous hemorrhage and cherry-red spot at the macula lutea, etc. Ocular ischemic syndrome was easily undiagnosed or misdiagnosed due to the asymptomatic onset and complicated ocular manifestations; in additon, the symptoms at the early stage of this diseaseare not obvious. The progress of the epidemiology, clinical manifestations, diagnosis and differential diagnosis, auxiliary examination, treatment and prognosis of this disease were reviewed in this paper.

Key words: Ocular ischemic syndrome, Stenosis of the carotid artery, Neovascular glaucoma

表1 颈内动脉狭窄患者眼缺血综合征与未出现眼缺血综合征者的临床特点占比(%)

临床表现	眼缺血综合征	未发生眼缺血综合征
视力下降	90.00	26.67
眼部疼痛	36.67	6.67
视野缺损	40.00	0
角膜水肿	20.00	6.67
巩膜充血	26.67	0
前部葡萄膜炎	26.67	0
新生血管	73.33	3.33
新生血管性青光眼	33.33	0
葡萄膜炎	6.67	0
视网膜动脉细	63.33	10.00
视网膜动脉扩张	63.33	13.33
视网膜出血	50.00	20.00
微动脉瘤	70.00	16.67

表1 颈内动脉狭窄患者眼缺血综合征与未出现眼缺血综合征者的临床特点占比(%)

临床表现	眼缺血综合征	未发生眼缺血综合征
视力下降	90.00	26.67
眼部疼痛	36.67	6.67
视野缺损	40.00	0
角膜水肿	20.00	6.67
巩膜充血	26.67	0
前部葡萄膜炎	26.67	0
新生血管	73.33	3.33
新生血管性青光眼	33.33	0
葡萄膜炎	6.67	0
视网膜动脉细	63.33	10.00
视网膜动脉扩张	63.33	13.33
视网膜出血	50.00	20.00
微动脉瘤	70.00	16.67

图1 眼缺血综合征患者眼底照相和荧光素眼底血管造影成像　图A示患者眼底照相可见其视网膜动脉变细，静脉扩张，黄斑呈樱桃红斑点；图B示荧光素眼底血管造影成像，可见视网膜动脉内界限分明的荧光素前缘，臂－视网膜循环时间延长

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