Zarkali Angeliki, Cheng Suk Fun, Dados Agnes, Simister Robert, Chandratheva Arvind
Cerebrovasc Dis. 2018;45(5-6):228-235. doi: 10.1159/000489567. Epub 2018 May 17.
Ischaemic visual loss is often considered a lower risk factor than other transient ischaemic attacks (TIA). We aimed to determine the recurrence risk, prevalence and management of vascular risk factors in these patients.
The study took place in the University College Hospital London daily TIA clinic, main referral centre for North-Central London and Moorfields Eye Hospital. Consecutive records for patients with transient (< 24 h) or permanent (> 24 h) ischaemic visual loss were reviewed during the period January 2014-October 2016. Patients diagnosed with temporal arteritis were excluded.
Of 400 patients, 224 (56%) were male with mean age 64.5 years (SD 15.1); 263 patients (65.8%) presented with transient and 137 patients (34.2%) with permanent ischaemic visual loss; 51.3% had hypertension (HTN), 35.3% hypercholesterolaemia, 14.5% diabetes, 11.8% ischaemic ocular events, 10.0% ischaemic heart disease, 7.3% atrial fibrillation (AF), 6.3% TIA, 5.3% stroke, and 12.3% were smokers. Median vascular risk factors were 2 (range 1-6), but 122 (30.5%) had ≥3. Those with diabetes (p < 0.001), HTN (p = 0.008), previous myocardial infarction (p = 0.005), or ≥3 vascular risk factors (p = 0.012) were more likely to present with permanent visual loss, while patients with history of transient events, TIA (p = 0.002), or ocular (p = 0.002) presented with transient visual loss. Ninety-day recurrence was 10.5%; this was higher in patients with ≥3 risk factors (hazard ratio 1.42, 95% CI 0.95-2.11, p = 0.111). Patients with past TIA were more likely to be on secondary prevention than those with ocular ischaemia; 60.0 vs. 34.1% received antiplatelets and 76.0 vs. 43.9% statins. At presentation, only 55.2% (16 patients) with known AF were anticoagulated, despite all of them having CHADSVASC ≥1.
Approximately one-third of patients with ocular ischaemia had ≥3 vascular risk factors with recurrences higher in these patients. Yet only half of those with previous ischaemic ocular events were on antiplatelets or statins. These patients should be investigated and treated as aggressively as other forms of TIA or stroke.
缺血性视力丧失通常被认为是比其他短暂性脑缺血发作（TIA）风险更低的因素。我们旨在确定这些患者血管危险因素的复发风险、患病率及管理情况。
该研究在伦敦大学学院医院每日TIA门诊、伦敦中北部主要转诊中心以及摩尔菲尔德眼科医院进行。回顾了2014年1月至2016年10月期间短暂性（<24小时）或永久性（>24小时）缺血性视力丧失患者的连续记录。排除诊断为颞动脉炎的患者。
400例患者中，224例（56%）为男性，平均年龄64.5岁（标准差15.1）；263例患者（65.8%）表现为短暂性缺血性视力丧失，137例患者（34.2%）表现为永久性缺血性视力丧失；51.3%患有高血压（HTN），35.3%患有高胆固醇血症，14.5%患有糖尿病，11.8%有缺血性眼部事件，10.0%有缺血性心脏病，7.3%有房颤（AF），6.3%有TIA，5.3%有中风，12.3%为吸烟者。血管危险因素的中位数为2（范围1 - 6），但122例（30.5%）有≥3个危险因素。患有糖尿病（p<0.001）、HTN（p = 0.008）、既往心肌梗死（p = 0.005）或≥3个血管危险因素（p = 0.012）的患者更可能表现为永久性视力丧失，而有短暂性事件、TIA病史（p = 0.002）或眼部病史（p = 0.002）的患者表现为短暂性视力丧失。90天复发率为10.5%；在有≥3个危险因素的患者中更高（风险比1.42，95%可信区间0.95 - 2.11，p = 0.111）。既往有TIA的患者比有眼部缺血的患者更可能接受二级预防；接受抗血小板药物治疗的比例分别为60.0%和34.1%，接受他汀类药物治疗的比例分别为76.0%和43.9%。就诊时，尽管所有已知AF的患者CHADSVASC≥1，但只有55.2%（16例）接受了抗凝治疗。
约三分之一的眼部缺血患者有≥3个血管危险因素，这些患者的复发率更高。然而，既往有缺血性眼部事件的患者中只有一半接受了抗血小板药物或他汀类药物治疗。这些患者应像其他形式的TIA或中风患者一样积极进行检查和治疗。
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