Cibrão-Pedroso Ana, Rocha-Neves João, Vieira Rafael, Breda João Barbosa, Ferreira André
Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, Porto, 4200-319, Portugal.
Department of Biomedicine - Unit of Anatomy, Faculty of Medicine, University of Porto, Porto, Portugal.
Int J Retina Vitreous. 2025 Aug 4;11(1):91. doi: 10.1186/s40942-025-00713-1.
Carotid endarterectomy is a well-established procedure for enhancing cerebral perfusion in patients with internal carotid artery stenosis. As a multifactorial disease, carotid stenosis can have ocular implications, potentially affecting retinal and choroidal perfusion and contributing to visual dysfunction. This systematic review aims to evaluate changes in choroidal and retinal thickness after unilateral carotid endarterectomy, providing insight into the impact of the procedure on ocular perfusion.
A comprehensive search was performed across PubMed, Scopus, and Web of Science up to July 2024, without restrictions on language or publication date. The inclusion criteria included original studies assessing retinal or choroidal thickness via optical coherence tomography before and after carotid endarterectomy in adults. Additional manual searches of reference lists and citation tracking were employed to ensure completeness. Study quality was appraised via the NHLBI tool for observational studies.
Six prospective observational studies involving 269 patients were included. Findings on choroidal thickness changes after carotid endarterectomy are heterogeneous. While two studies reported significant postoperative Choroidal Thickness increases-one within a week and another at three months-other studies reported no significant changes. One study suggested that higher degrees of carotid stenosis may blunt early Choroidal Thickness response. Retinal measurements were less consistently assessed; among the three studies that evaluated retinal nerve fibre layer and ganglion cell complex thickness, no consistent postoperative changes were observed. Overall, variability in study designs, Optical Coherence Tomography protocols, and follow-up durations limits comparability, precluding meta-analysis.
This review highlights a potential association between carotid endarterectomy and improved ocular perfusion, as reflected by changes in choroidal thickness. However, inconsistencies across studies and limited data on retinal structural outcomes underscore the complexity of this relationship. These findings emphasize the need for larger, standardized studies to clarify the impact of carotid revascularization on the ocular microvasculature and guide future clinical practice.
颈动脉内膜切除术是一种成熟的用于改善颈内动脉狭窄患者脑灌注的手术。作为一种多因素疾病，颈动脉狭窄可能会影响眼部，潜在地影响视网膜和脉络膜灌注，并导致视觉功能障碍。本系统评价旨在评估单侧颈动脉内膜切除术后脉络膜和视网膜厚度的变化，以深入了解该手术对眼部灌注的影响。
截至2024年7月，在PubMed、Scopus和Web of Science上进行了全面检索，不受语言或出版日期限制。纳入标准包括评估成人颈动脉内膜切除术前和术后通过光学相干断层扫描测量视网膜或脉络膜厚度的原始研究。还进行了额外的参考文献列表手动检索和引文跟踪，以确保完整性。通过美国国立心肺血液研究所观察性研究工具评估研究质量。
纳入了6项涉及269例患者的前瞻性观察性研究。颈动脉内膜切除术后脉络膜厚度变化的研究结果存在异质性。两项研究报告术后脉络膜厚度显著增加，一项在一周内，另一项在三个月时，而其他研究报告无显著变化。一项研究表明，较高程度的颈动脉狭窄可能会减弱早期脉络膜厚度反应。视网膜测量评估的一致性较差；在评估视网膜神经纤维层和神经节细胞复合体厚度的三项研究中，未观察到一致的术后变化。总体而言，研究设计、光学相干断层扫描方案和随访时间的差异限制了可比性，无法进行荟萃分析。
本综述强调了颈动脉内膜切除术与眼部灌注改善之间的潜在关联，这可通过脉络膜厚度的变化反映出来。然而，研究之间的不一致以及视网膜结构结果的数据有限，凸显了这种关系的复杂性。这些发现强调需要进行更大规模、标准化的研究，以阐明颈动脉血运重建对眼部微血管系统的影响，并指导未来的临床实践。
