Haase C G, Büchner T
Department of Neurology, University Hospital of Münster, Germany.
Eye (Lond). 1998;12 ( Pt 4):659-62. doi: 10.1038/eye.1998.164.
Retinal artery occlusion (RAO) is caused by arterio-arterial or cardiovascular emboli in about 50% of all cases, but the role of non-embolic causes remains unclear.
We studied 27 patients with amaurosis fugax (AFX), branch retinal artery occlusion (BRAO), central retinal artery occlusion (CRAO) and anterior ischaemic optic neuropathy (AION). Patients underwent an evaluation of cerebrovascular and cardiovascular risk factors, measurement of haemorheological parameters, and Doppler/duplex sonography including ultrasound detection of cerebral microembolic signals and echocardiography.
Forty-one per cent of the patients had internal carotid atherosclerosis but only one patient had microembolic signals, probably due to a cardiac thrombus. Vascular risk factors, especially hypertension, were present in 82% of the patients correlating with abnormal haemorheological parameters such as increased thrombocyte reactivity.
Our results indicate that altered haemorheological parameters, especially increased thrombocyte reactivity and vascular risk factors such as arterial hypertension, are non-embolic causes of vascular disease in a significant number of patients with RAO. This should guide diagnostic and therapeutic considerations concerning RAO in cases without proven embolic sources.
在所有视网膜动脉阻塞（RAO）病例中，约50%由动脉 - 动脉或心血管栓子引起，但非栓塞性病因的作用仍不明确。
我们研究了27例患有一过性黑矇（AFX）、视网膜分支动脉阻塞（BRAO）、视网膜中央动脉阻塞（CRAO）和前部缺血性视神经病变（AION）的患者。患者接受了脑血管和心血管危险因素评估、血液流变学参数测量以及多普勒/双功超声检查，包括脑微栓子信号的超声检测和超声心动图检查。
41%的患者存在颈内动脉粥样硬化，但只有1例患者有微栓子信号，可能是由于心脏血栓。82%的患者存在血管危险因素，尤其是高血压，这与血液流变学参数异常相关，如血小板反应性增加。
我们的结果表明，血液流变学参数改变，尤其是血小板反应性增加以及血管危险因素如动脉高血压，是大量RAO患者血管疾病的非栓塞性病因。这应指导在无明确栓子来源的RAO病例中的诊断和治疗考虑。
