Hayreh Sohan Singh, Zimmerman M Bridget
Department of Ophthalmology and Visual Sciences, College of Medicine, University of Iowa, Iowa City, Iowa.
Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa.
Ophthalmol Retina. 2017 Jan-Feb;1(1):12-18. doi: 10.1016/j.oret.2016.08.003.
To compare prevalence of carotid artery disease and its various types of lesions in different types of ocular arterial occlusive disorders.
Cohort study.
614 consecutive patients (728 eyes) with ocular arterial occlusive disorders.
At first visit, all patients had a detailed ophthalmic and medical history, comprehensive ophthalmic evaluation, and carotid artery evaluation (by Doppler/angiography) on the side of ocular arterial occlusion, and echocardiography. The same ophthalmic evaluation was performed at each follow-up visit. Ocular arterial occlusive disorders were divided into central (CRAO) and branch (BRAO) retinal artery occlusion, ocular ischemic syndrome (OIS), non-arteritic anterior ischemic optic neuropathy (NA-AION) and amaurosis fugax (AF).
Carotid artery and echocardiographic abnormalities, and incidence of transient ischemic attack (TIA)/stroke and myocardial ischemia.
The study consists of a cohort of 266 eyes with NA-AION, 203 with CRAO, 127 with BRAO, 80 with OIS and 52 with AF. Carotid artery stenosis on the involved side was worse in AF and OIS compared to BRAO, CRAO, and NA-AION (p<0.0001). Presence of carotid artery plaques on the involved side was significantly higher in OIS, AF, and CRAO compared to NA-AION (p=0.002, p=0.003, and p=0.0003, respectively). Echocardiography revealed an embolic source in 61% of CRAO and 53% of BRAO compared to only 3% of NA-AION patients (p<0.0001). TIA/stroke before or after onset of ocular condition occurred in 17% of OIS, 11% of AF, 7% of CRAO, 6% of NA-AION, and 3% of BRAO patients. Kaplan-Meier estimate of the incidence of TIA /stroke within 3 months after onset was 6% (95% CI: 2%, 17%) for OIS, 3% (95% CI: 0.4%, 19%) for AF, and 1% (95% CI: 0.3%, 4.1%) for CRAO. Report of myocardial ischemia before or after onset of ocular condition was 52% in AF, 22% in OIS, 22% in BRAO, 21% in CRAO, and 6% in NA-AION patients.
The incidence of carotid artery stenosis and plaques, cardiac embolic source, TIA/stroke and myocardial ischemia differ among various ocular arterial occlusive disorders. The role of embolism and hemodynamic disturbances caused by carotid artery disease in these disorders is discussed.
比较不同类型眼部动脉闭塞性疾病中颈动脉疾病及其各种病变类型的患病率。
队列研究。
614例连续的眼部动脉闭塞性疾病患者（728只眼）。
初诊时，所有患者均有详细的眼科和病史、全面的眼科评估以及患侧眼部动脉闭塞侧的颈动脉评估（通过多普勒/血管造影）和超声心动图检查。每次随访时均进行相同的眼科评估。眼部动脉闭塞性疾病分为中央视网膜动脉阻塞（CRAO）和分支视网膜动脉阻塞（BRAO）、眼部缺血综合征（OIS）、非动脉炎性前部缺血性视神经病变（NA-AION）和一过性黑矇（AF）。
颈动脉和超声心动图异常，以及短暂性脑缺血发作（TIA）/中风和心肌缺血的发生率。
该研究包括266只眼的NA-AION患者、203只眼的CRAO患者、127只眼的BRAO患者、80只眼的OIS患者和52只眼的AF患者。与BRAO、CRAO和NA-AION相比，AF和OIS患侧的颈动脉狭窄更严重（p<0.0001）。与NA-AION相比，OIS、AF和CRAO患侧颈动脉斑块的存在显著更高（分别为p=0.002、p=0.003和p=0.0003）。超声心动图显示，61%的CRAO患者和53%的BRAO患者有栓子来源，而NA-AION患者中只有3%（p<0.0001）。眼部疾病发作前或发作后发生TIA/中风的患者，OIS患者中占17%，AF患者中占11%，CRAO患者中占7%，NA-AION患者中占6%，BRAO患者中占3%。Kaplan-Meier估计眼部疾病发作后3个月内TIA/中风的发生率，OIS为6%（95%CI：2%，17%），AF为3%（95%CI：0.4%，19%），CRAO为1%（95%CI：0.3%，4.1%）。眼部疾病发作前或发作后心肌缺血的报告，AF患者中为52%，OIS患者中为22%，BRAO患者中为22%，CRAO患者中为21%，NA-AION患者中为6%。
不同类型的眼部动脉闭塞性疾病中，颈动脉狭窄和斑块、心脏栓子来源、TIA/中风和心肌缺血的发生率有所不同。讨论了颈动脉疾病引起的栓塞和血流动力学紊乱在这些疾病中的作用。
