PDF(Pubmed)
Abstract：
UNASSIGNED: This review aims to understand the value of a carotid Doppler scan (CDS) when managing patients with clinical/suspected ocular ischaemic syndrome (OIS); correlations between internal carotid artery (ICA) stenosis reports; subsequent patterns of referral to vascular experts; and subsequent decisions concerning surgical versus medical management.
UNASSIGNED: A retrospective review of 402 CDS requests by a single eye center over 4 years (2016-2019) for patients with a clinical suspicion of OIS was conducted. Data analysis included 344 patients who had reported CDS of both ICAs. We also studied referral patterns by ophthalmologists to other specialties.
UNASSIGNED: CDS requests were related to the retina (53.2%), neuro/TIA problems (31.1%), glaucoma (10.5%) and other issues (5.2%). The majority of patients (209/344, 60.8%) had normal CDA results. Of the 688 ICAs reported, 469 (68.2%) were normal, 219 (31.8%) had atheroma present, and only 83 (12.1%) had significant stenosis. Of 83 ICAs with stenosis, 23 (27.7%) had ≥70% stenosis, 24 (28.9%) had 50-69% stenosis, and 25 (30.1%) had <50% stenosis. A total of 60/344 (17.4%) patients were referred to vascular/stroke teams: 15/60 (25%) referred had bilateral disease, and only 2/60 (3.3%) were offered carotid endarterectomy. All referred patients commenced statins and low-dose aspirin.
UNASSIGNED: Our cohort showed a low incidence of ICA stenosis according to CDS reports in patients with suspected OIS. There were very low rates of vascular and endarterectomy referral. Commencement of conservative treatment (mini aspirin+statin) by ophthalmologists could be beneficial even in the early stage of presenting clinical evidence of OIS.
Ocular ischemic syndrome (OIS) covers a wide spectrum of eye problems resulting from reduced blood flow to the eyes. OIS is commonly known to be a rapidly blinding disease due to late diagnosis. A high index of suspicion can lead to early investigation and perhaps prevent blindness with timely intervention. The fluorescein angiogram is a reliable eye test to confirm OIS disease affecting the retina. If reduced retina perfusion is confirmed, a carotid Doppler artery scan (CDS) is the next investigation to detect blood vessel lumen narrowing primarily affecting carotid arteries (neck arteries). The presence of carotid artery disease can indicate risk of stroke; hence, confirmed carotid artery disease merits a referral to vascular surgeons to consider carotid artery surgery aiming to unblock the artery and improve blood flow and hopefully reverse OIS. Our study aimed to investigate the prevalence of suspected OIS patients referred for carotid Doppler scans, correlations between carotid artery stenosis results and clinical OIS, and subsequent offers of carotid artery surgery versus conservative medical management. Our study showed that carotid artery disease severity defined by CDS has a poor correlation with clinical diagnosis of OIS. Conservative treatment is advised for all patients with carotid artery disease, whereas surgical options for carotid stenosis are rarely offered. Hence, this study questions the benefit of pursuing CDS tests in OIS patients, since the results do not change their management. Finally, we highlight the need for better guidance on carotid artery stenosis referral for carotid surgery.
UNASSIGNED: A retrospective review of 402 CDS requests by a single eye center over 4 years (2016-2019) for patients with a clinical suspicion of OIS was conducted. Data analysis included 344 patients who had reported CDS of both ICAs. We also studied referral patterns by ophthalmologists to other specialties.
UNASSIGNED: CDS requests were related to the retina (53.2%), neuro/TIA problems (31.1%), glaucoma (10.5%) and other issues (5.2%). The majority of patients (209/344, 60.8%) had normal CDA results. Of the 688 ICAs reported, 469 (68.2%) were normal, 219 (31.8%) had atheroma present, and only 83 (12.1%) had significant stenosis. Of 83 ICAs with stenosis, 23 (27.7%) had ≥70% stenosis, 24 (28.9%) had 50-69% stenosis, and 25 (30.1%) had <50% stenosis. A total of 60/344 (17.4%) patients were referred to vascular/stroke teams: 15/60 (25%) referred had bilateral disease, and only 2/60 (3.3%) were offered carotid endarterectomy. All referred patients commenced statins and low-dose aspirin.
UNASSIGNED: Our cohort showed a low incidence of ICA stenosis according to CDS reports in patients with suspected OIS. There were very low rates of vascular and endarterectomy referral. Commencement of conservative treatment (mini aspirin+statin) by ophthalmologists could be beneficial even in the early stage of presenting clinical evidence of OIS.
Ocular ischemic syndrome (OIS) covers a wide spectrum of eye problems resulting from reduced blood flow to the eyes. OIS is commonly known to be a rapidly blinding disease due to late diagnosis. A high index of suspicion can lead to early investigation and perhaps prevent blindness with timely intervention. The fluorescein angiogram is a reliable eye test to confirm OIS disease affecting the retina. If reduced retina perfusion is confirmed, a carotid Doppler artery scan (CDS) is the next investigation to detect blood vessel lumen narrowing primarily affecting carotid arteries (neck arteries). The presence of carotid artery disease can indicate risk of stroke; hence, confirmed carotid artery disease merits a referral to vascular surgeons to consider carotid artery surgery aiming to unblock the artery and improve blood flow and hopefully reverse OIS. Our study aimed to investigate the prevalence of suspected OIS patients referred for carotid Doppler scans, correlations between carotid artery stenosis results and clinical OIS, and subsequent offers of carotid artery surgery versus conservative medical management. Our study showed that carotid artery disease severity defined by CDS has a poor correlation with clinical diagnosis of OIS. Conservative treatment is advised for all patients with carotid artery disease, whereas surgical options for carotid stenosis are rarely offered. Hence, this study questions the benefit of pursuing CDS tests in OIS patients, since the results do not change their management. Finally, we highlight the need for better guidance on carotid artery stenosis referral for carotid surgery.
摘要：
■这篇综述旨在了解颈动脉多普勒扫描（CDS）在治疗临床/疑似眼缺血综合征（OIS）患者时的价值；颈内动脉（ICA）狭窄报告之间的相关性；随后转诊给血管专家的模式；以及随后有关手术与医疗管理的决策。
■对临床怀疑OIS的患者进行了为期4年（2016-2019年）的单个眼科中心的402项CDS请求的回顾性审查。数据分析包括344例报告了两种ICA的CDS的患者。我们还研究了眼科医生转诊到其他专业的模式。
■CDS请求与视网膜有关（53.2%），神经/TIA问题（31.1％），青光眼（10.5％）和其他问题（5.2％）。大多数患者（209/344，60.8%）的CDA结果正常。在报告的688个ICA中，469（68.2%）正常，219例（31.8％）存在动脉粥样硬化，只有83例(12.1%)有明显狭窄.在83个患有狭窄的ICA中，23例（27.7%）狭窄≥70%，24例（28.9%）有50-69%的狭窄，25例（30.1%）狭窄<50%。共有60/344（17.4%）患者转诊至血管/卒中团队：15/60（25%）患者转诊为双侧疾病，只有2/60（3.3％）进行了颈动脉内膜切除术。所有转诊患者均开始服用他汀类药物和低剂量阿司匹林。
■根据CDS报告，在疑似OIS患者中，我们的队列显示ICA狭窄发生率较低。血管和动脉内膜切除术的转诊率非常低。即使在提供OIS临床证据的早期阶段，眼科医生开始保守治疗（迷你阿司匹林他汀类药物）也可能是有益的。
眼部缺血综合征(OIS)涵盖了由于眼睛的血流量减少而导致的广泛的眼部问题。由于晚期诊断，OIS通常被认为是一种快速致盲的疾病。高度怀疑可以导致早期调查，并可能通过及时干预来预防失明。荧光血管造影是一种可靠的眼科检查，可确认影响视网膜的OIS疾病。如果证实视网膜灌注减少，颈动脉多普勒扫描(CDS)是检测主要影响颈动脉(颈动脉)的血管管腔狭窄的下一项研究.颈动脉疾病的存在可能表明中风的风险;因此，已确诊的颈动脉疾病值得转诊至血管外科医师考虑进行颈动脉手术,目的是疏通动脉,改善血流,并有望逆转OIS.我们的研究旨在调查颈动脉多普勒扫描的疑似OIS患者的患病率，颈动脉狭窄结果与临床OIS的相关性，以及随后提供的颈动脉手术与保守的医疗管理。我们的研究表明，CDS定义的颈动脉疾病严重程度与OIS的临床诊断相关性较差。建议对所有颈动脉疾病患者进行保守治疗，而颈动脉狭窄的手术选择很少提供。因此，这项研究质疑在OIS患者中进行CDS测试的好处，因为结果不会改变他们的管理。最后,我们强调需要更好地指导颈动脉狭窄转诊颈动脉手术.
■对临床怀疑OIS的患者进行了为期4年（2016-2019年）的单个眼科中心的402项CDS请求的回顾性审查。数据分析包括344例报告了两种ICA的CDS的患者。我们还研究了眼科医生转诊到其他专业的模式。
■CDS请求与视网膜有关（53.2%），神经/TIA问题（31.1％），青光眼（10.5％）和其他问题（5.2％）。大多数患者（209/344，60.8%）的CDA结果正常。在报告的688个ICA中，469（68.2%）正常，219例（31.8％）存在动脉粥样硬化，只有83例(12.1%)有明显狭窄.在83个患有狭窄的ICA中，23例（27.7%）狭窄≥70%，24例（28.9%）有50-69%的狭窄，25例（30.1%）狭窄<50%。共有60/344（17.4%）患者转诊至血管/卒中团队：15/60（25%）患者转诊为双侧疾病，只有2/60（3.3％）进行了颈动脉内膜切除术。所有转诊患者均开始服用他汀类药物和低剂量阿司匹林。
■根据CDS报告，在疑似OIS患者中，我们的队列显示ICA狭窄发生率较低。血管和动脉内膜切除术的转诊率非常低。即使在提供OIS临床证据的早期阶段，眼科医生开始保守治疗（迷你阿司匹林他汀类药物）也可能是有益的。
眼部缺血综合征(OIS)涵盖了由于眼睛的血流量减少而导致的广泛的眼部问题。由于晚期诊断，OIS通常被认为是一种快速致盲的疾病。高度怀疑可以导致早期调查，并可能通过及时干预来预防失明。荧光血管造影是一种可靠的眼科检查，可确认影响视网膜的OIS疾病。如果证实视网膜灌注减少，颈动脉多普勒扫描(CDS)是检测主要影响颈动脉(颈动脉)的血管管腔狭窄的下一项研究.颈动脉疾病的存在可能表明中风的风险;因此，已确诊的颈动脉疾病值得转诊至血管外科医师考虑进行颈动脉手术,目的是疏通动脉,改善血流,并有望逆转OIS.我们的研究旨在调查颈动脉多普勒扫描的疑似OIS患者的患病率，颈动脉狭窄结果与临床OIS的相关性，以及随后提供的颈动脉手术与保守的医疗管理。我们的研究表明，CDS定义的颈动脉疾病严重程度与OIS的临床诊断相关性较差。建议对所有颈动脉疾病患者进行保守治疗，而颈动脉狭窄的手术选择很少提供。因此，这项研究质疑在OIS患者中进行CDS测试的好处，因为结果不会改变他们的管理。最后,我们强调需要更好地指导颈动脉狭窄转诊颈动脉手术.
