Costa V P, Kuzniec S, Molnar L J, Cerri G G, Puech-Leão P, Carvalho C A
Department of Ophthalmology, University of São Paulo, Brazil.
Ophthalmology. 1997 Dec;104(12):1994-2002. doi: 10.1016/s0161-6420(97)30066-9.
The purpose of the study was to evaluate the ophthalmologic findings and to analyze the retrobulbar hemodynamics of patients with severe (greater than 70% stenosis) occlusive carotid artery disease (OCAD) by means of color Doppler imaging (CDI).
A case-controlled study.
Fifty-six consecutive patients with severe OCAD and an age- and sex-matched control group consisting of 56 healthy patients without OCAD were studied.
All 112 patients underwent a complete ophthalmologic examination. Color Doppler imaging of both orbits was performed by one masked investigator.
Peak systolic velocity, end diastolic velocity, and the resistive index of the ophthalmic, central retinal, and temporal short posterior ciliary arteries were measured. The authors compared the hemodynamic parameters measured in patients with severe OCAD with those obtained in the control group. The hemodynamic parameters of patients with asymmetric OCAD (stenosis > 70% in one internal carotid artery and stenosis < 50% in the contralateral artery) were also compared. In an attempt to determine risk factors associated with the ocular ischemic syndrome (OIS), the authors compared patients with severe OCAD and OIS with patients with severe OCAD without OIS.
Peak systolic and end diastolic velocities in the ophthalmic, central retinal, and temporal short posterior ciliary arteries were significantly lower in patients with severe OCAD (P < 0.01). The mean resistive indices in the central retinal and temporal short posterior ciliary arteries were higher in the group with severe OCAD (P < 0.01). Similar results were obtained in the analysis of 25 patients with asymmetric carotid stenosis. Younger age (P = 0.012), severe bilateral OCAD (P = 0.01), high-grade carotid stenosis (P = 0.013), and reversed ophthalmic artery flow (P = 0.038) were significant risk factors for OIS.
Patients with severe OCAD show hemodynamic changes that suggest reduced retrobulbar blood flow. Patients with severe bilateral OCAD, high-grade carotid stenosis, and reversed ophthalmic artery flow may have a greater risk of developing OIS.
本研究旨在通过彩色多普勒成像（CDI）评估重度（狭窄程度大于70%）颈内动脉闭塞性疾病（OCAD）患者的眼科检查结果，并分析其球后血流动力学情况。
病例对照研究。
连续纳入56例重度OCAD患者，并设立一个由56例无OCAD的健康患者组成的年龄和性别匹配的对照组。
112例患者均接受了全面的眼科检查。由一名不知情的研究人员对双侧眼眶进行彩色多普勒成像检查。
测量眼动脉、视网膜中央动脉和颞侧睫状后短动脉的收缩期峰值流速、舒张末期流速和阻力指数。作者将重度OCAD患者测量的血流动力学参数与对照组获得的参数进行比较。还比较了不对称OCAD（一侧颈内动脉狭窄>70%，对侧动脉狭窄<50%）患者的血流动力学参数。为了确定与眼部缺血综合征（OIS）相关的危险因素，作者将重度OCAD合并OIS的患者与重度OCAD但无OIS的患者进行了比较。
重度OCAD患者的眼动脉、视网膜中央动脉和颞侧睫状后短动脉的收缩期峰值流速和舒张末期流速显著降低（P<0.01）。重度OCAD组视网膜中央动脉和颞侧睫状后短动脉的平均阻力指数较高（P<0.01）。在对25例不对称颈动脉狭窄患者的分析中也得到了类似结果。年龄较小（P=0.012）、重度双侧OCAD（P=0.01）、高度颈动脉狭窄（P=0.013）和眼动脉血流逆转（P=0.038）是OIS的显著危险因素。
重度OCAD患者表现出血流动力学变化，提示球后血流减少。重度双侧OCAD、高度颈动脉狭窄和眼动脉血流逆转的患者发生OIS的风险可能更高。
