Chen San-Ni, Hwang Jiunn-Feng, Huang Jeff, Wu Shey-Lin
Department of Ophthalmology, Changhua Christian Medical Foundation Changhua Christian Hospital, Changhua, Taiwan.
School of Medicine, Chung Shan Medical University, Changhua, Taiwan.
BMJ Open Ophthalmol. 2020 Jul 27;5(1):e000467. doi: 10.1136/bmjophth-2020-000467. eCollection 2020.
To introduce a special subgroup, retinal artery occlusion (RAO) with multiple emboli, which is highly associated with ipsilateral carotid artery occlusion disease (CAOD).
This is a cohort study. Cases of RAO with multiple retinal emboli were consecutively enrolled. All patients underwent at least one of the carotid/cerebral evaluations: carotid arteriography, orbital/carotid colour Doppler ultrasonography and CT angiography to demonstrate haemodynamic changes and to discuss possible mechanisms and pathways of the emboli.
Among 208 RAO eyes, 12 eyes (5.7%) in 11 patients had multiple emboli were recruited in this study. Eleven eyes (91.6%) had ipsilateral carotid plaques and atherosclerosis with high-grade stenosis; among them, five were total carotid occlusion. Haemodynamic changes were found in nine patients with RAO (81.8%) with carotid stenosis 60% or greater. Most compensatory intracranial circulations were re-established via the circle of Willi with antegrade ophthalmic flows, but the direction of ophthalmic flow reversed in three eyes indicating the recruitment of external collaterals. Two cases underwent carotid stent successfully.
RAOs with multiple emboli are rare but highly associated with severe CAOD with haemodynamic flow changes, warning critical condition in carotid/cerebral circulations. Either direct embolism from the carotid or cardiac lesions or indirect embolism via the collateral pathways is the mechanism of pathogenesis. Immediate action should start to manage these patients to prevent further deterioration.
介绍一个特殊亚组，即伴有多发栓子的视网膜动脉阻塞（RAO），其与同侧颈动脉阻塞性疾病（CAOD）高度相关。
这是一项队列研究。连续纳入伴有多个视网膜栓子的RAO病例。所有患者至少接受一项颈动脉/脑部评估：颈动脉造影、眼眶/颈动脉彩色多普勒超声检查和CT血管造影，以显示血流动力学变化，并探讨栓子可能的机制和途径。
在208只RAO眼中，本研究纳入了11例患者的12只眼（5.7%）有多个栓子。11只眼（91.6%）有同侧颈动脉斑块和动脉粥样硬化伴高度狭窄；其中5例为颈动脉完全闭塞。在9例（81.8%）颈动脉狭窄60%或更高的RAO患者中发现了血流动力学变化。大多数代偿性颅内循环通过Willis环重新建立，眼动脉血流为顺行，但3只眼中眼动脉血流方向逆转，表明有外侧支循环参与。2例成功进行了颈动脉支架置入术。
伴有多个栓子的RAO很少见，但与伴有血流动力学变化的严重CAOD高度相关，提示颈动脉/脑循环处于危急状态。栓子形成的机制要么是来自颈动脉或心脏病变的直接栓塞，要么是通过侧支途径的间接栓塞。应立即采取行动治疗这些患者，以防止病情进一步恶化。
