Neuro-Ophthalmology Service (EJR, ALG, JFR), Harvard Medical School, Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; Vitreoretinal Surgery Service (EJR), Harvard Medical School, Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; Neuro-Ophthalmology (ALG), Kaiser Permanente, Oakland, Northern California; Department of Otolaryngology (NK), Massachusetts Eye and Ear, Boston, Massachusetts; The Warren Alpert Medical School (NK), Brown University, Providence, Rhode Island; Neurointerventional Service (TML-M), Massachusetts General Hospital, Boston, Massachusetts; and Department of Radiology (MEC), Harvard Medical School Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts.
J Neuroophthalmol. 2021 Mar 1;41(1):24-28. doi: 10.1097/WNO.0000000000000883.
Embolic events leading to retinal ischemia or cerebral ischemia share common risk factors; however, it has been well documented that the rate of concurrent cerebral infarction is higher in patients with a history of transient ischemic attack (TIA) than in those with monocular vision loss (MVL) due to retinal ischemia. Despite the fact that emboli to the ophthalmic artery (OA) and middle cerebral artery share the internal carotid artery (ICA) as a common origin or transit for emboli, the asymmetry in their final destination has not been fully explained. We hypothesize that the anatomic location of the OA takeoff from the ICA may contribute to the differential flow of small emboli to the retinal circulation vs the cerebral circulation.
We report a retrospective, comparative, case-control study on 28 patients with retinal ischemia and 26 patients with TIA or cerebral infarction caused by embolic events. All subjects underwent either computed tomography angiography or MRA. The location of the ipsilateral OA origin off the ICA was then graded in a blinded fashion and compared between cohorts. Vascular risk factors were collected for all patients, including age, sex, hypertension, hyperlipidemia, arrhythmia, diabetes, coronary artery disease, and smoking.
We find that in patients with retinal ischemia of embolic etiology, the ipsilateral OA takeoff from the ICA is more proximal than in patients with cerebral infarcts or TIA (P = 0.0002). We found no statistically significant differences in demographic, vascular, or systemic risk factors.
We find that the mean anatomical location of the OA takeoff from the ICA is significantly more proximal in patients with MVL due to retinal ischemia compared with patients with TIA or cerebral ischemia. This finding contributes significantly to our understanding of a long observed but poorly understood phenomenon that patients with MVL are less likely to have concurrent cerebral ischemia than are patients with TIA.
导致视网膜缺血或脑缺血的栓塞事件具有共同的危险因素；然而，有充分的文献记载，有短暂性脑缺血发作（TIA）病史的患者并发脑梗死的发生率高于因视网膜缺血导致单眼视力丧失（MVL）的患者。尽管眼动脉（OA）和大脑中动脉栓塞的起源或通过颈内动脉（ICA）相同，但它们最终目的地的不对称性尚未得到充分解释。我们假设 OA 从 ICA 发出的解剖位置可能导致小栓子向视网膜循环和脑循环的不同流动。
我们报告了一项回顾性、对照、病例对照研究，共纳入 28 例视网膜缺血患者和 26 例由栓塞事件引起的 TIA 或脑梗死患者。所有患者均行计算机断层血管造影或磁共振血管造影检查。然后盲法对同侧 OA 起源于 ICA 的位置进行分级，并比较两组之间的位置。收集所有患者的血管危险因素，包括年龄、性别、高血压、高血脂、心律失常、糖尿病、冠心病和吸烟。
我们发现，栓塞性视网膜缺血患者的同侧 OA 起源于 ICA 的位置比脑梗死或 TIA 患者更靠近近端（P = 0.0002）。我们没有发现两组之间在人口统计学、血管或系统性危险因素方面有统计学差异。
我们发现，与 TIA 或脑梗死患者相比，因视网膜缺血导致 MVL 的患者 OA 从 ICA 发出的解剖位置明显更靠近近端。这一发现极大地促进了我们对一种长期观察到但理解不足的现象的理解，即 MVL 患者并发脑缺血的可能性低于 TIA 患者。
