Objective To observe the clinical characteristics and therapeutic effects of carotid artery stenosisrelated ocular ischemic appearance(OIA).Methods The clinical data of 210 patients of carotid artery stenosis (81 of them with OIA) were retrospectively reviewed. They were diagnosed by color doppler image（CDI）or digital subtraction angiography (DSA),and had undergone medicine,carotid artery stenting (CAS)and carotid endarterectomy (CEA). Of 81 patients with OIA,49 patients (60.49%) with OIA only, 32 patients（39.51%）with ocular ischemic disease (OID).24/32 OID patients received ophthalmic treatment such as retinal laser photocoagulation and anti glaucoma therapy (drugs and cyclocryotherapy). Results The ocular manifestations of 81 OIA patients included transient amaurosis in 38 cases (47.14%),flash before the eye in 30 cases (36.67%), periorbital swelling and pain in 28 cases (34.57%), diplopia in 11 cases (13.58%) and vision loss in 9 cases (11.11%). The ocular manifestations of 32 OID patients included ischemic optic neuropathy in 9 cases (28.13%), ocular ischemic syndrome in 6 cases (18.75%), central or branch retinal artery occlusion in 6 cases (18.75%), retinal hemorrhage in 5 patients (15.62%)，extraocular muscle paralysis in 4 patients (12.50%) and neovascular glaucoma in 2 patients (6.25%). The higher the degree of carotid stenosis,the higher incidence of ocular ischemic disease,there was highly positive correlation between each other (R=0.837, P＜0.05).The total effective rate of carotid artery stenting and carotid endarterectomy was significantly higher than drug treatment alone (t=2.73, 3.14; P＜0.01). Conclusion The ocular manifestations of carotid stenosis related ocular ischemic appearance can be transient amaurosis, eyes flashing,eye redness,periorbital pain, diplopia and decreased visual acuity.The ocular manifestations of carotid stenosisrelated ocular ischemic disease can be ischemic optic neuropathy, ocular ischemic symptoms, central or branch retinal artery occlusion and neovascular Carotid artery stenting and carotid endarterectomy are more effective than drug treatment alone for those patients.
ObjectiveTo observe ocular ischemic appearance (OIA) associated with carotid artery stenosis and its effects on the hemodynamics of central retinal artery (CRA) and ophthalmic artery (OA). MethodsA total of 30 normal persons and 60 patients with carotid artery stenosis diagnosed by color Doppler flow imaging (CDFI) and digital subtraction angiography (DSA) were enrolled in this prospective study.Sixty patients were randomly divided into 2 groups:30 patients with the carotid artery stenosis degree < 60% and 30 cases with the carotid artery stenosis degree≥60%. Thirty normal persons were enrolled in the normal control group. All patients underwent a comprehensive eye examination to determine if OIA exists. The Doppler spectral patterns of CRA and OA were observed by CDFI. The peak systolic velocity (PSV), end diastolic velocity (EDV), blood vessel diameter (BVD) and resistance index (RI) of CRA and OA were measured. ResultsIn the group of the carotid artery stenosis degree≥60%, 24/30 patients (80.0%) had the ophthalmic symptoms and 9/30 patients (30.0%) had ophthalmic signs. In the group of the carotid artery stenosis degree < 60%, 9/30 patients (30.0%) had the ophthalmic symptoms and 3/30 patients (10.0%) had ophthalmic signs. For patients with≥60% stenosis, CDFI revealed a bread-like waveform of CRA, and single peak of OA instead of the typical 3-peak/2-notch waveform. For patients with < 60% stenosis, CDFI revealed a normal pattern of CRA and OA (3-peak/2-notch). The PSV(t=5.255, P=0.007) and EDV(t=4.949, P=0.005) of CRA in the stenosis≥60% group were statistically decreased compared to the normal control group, but the BVD(t=0.457, P > 0.05)and RI(t=0.213, P > 0.05)were normal. The PSV, EDV, BVD and RI of CRA in the stenosis < 60% group were normal(P > 0.05). The PSV(t=4.457, P=0.010)and EDV(t=4.588, P=0.009)of CRA in the stenosis≥60% group were statistically decreased compared to the stenosis < 60% group, but the BVD and RI were the same between these 2 groups. ConclusionPatients with carotid stenosis≥60% had a higher OIA incidence, reduced PSV, EDV of their CRA, while had no significant changes of OA hemodynamics.