■嗜酸性粒细胞具有广泛的促凝血作用。在日常实践中,嗜酸性粒细胞相关的心血管毒性包括心内膜损伤,嗜酸性血管炎和动脉或静脉血栓形成。在这里,我们旨在报告无法解释的眼部血管表现和嗜酸性粒细胞增多患者的临床特征和治疗结果。
■我们进行了回顾,多中心,对嗜酸性粒细胞增多(≥0.5x109/L)并伴有眼部血管表现的患者的观察性研究和文献综述,这些患者与潜在的嗜酸性粒细胞疾病无关,但没有其他原因导致眼部表现.
■纳入57例患者(20例来自观察性研究,37例来自文献综述)。眼血管特征是34例(59%)患者嗜酸性粒细胞相关疾病的最初表现,包括29例视网膜中央动脉阻塞,视网膜六分支动脉阻塞,五个视网膜中央静脉阻塞,两个分支视网膜静脉阻塞,七种视网膜血管炎,两次视网膜血管痉挛,12Purtscher的视网膜病变,13个前部缺血性视神经病变和两个后部缺血性视神经病变。眼血管表现开始时的中位数[IQR]绝对嗜酸性粒细胞计数为3.5[1.7-7.8]x109/L。潜在的嗜酸性粒细胞相关疾病包括嗜酸性肉芽肿伴多血管炎(n=32),克隆性高嗜酸性粒细胞综合征(HES)(n=1),特发性HES(n=13),淋巴细胞性HES(n=2),药物不良反应(n=3),寄生虫病(n=2),结节性多动脉炎(n=1),IgG4相关疾病(n=1),嗜酸粒细胞性筋膜炎(n=1)和原发性硬化性胆管炎(n=1)。其他与嗜酸性粒细胞增多相关的眼外动脉或静脉血栓在4例(7%)和9例(16%)患者中报告,分别。视力预后较差:只有8例(10%)患者实现了眼科症状的完全恢复。在中位随访10.5[1-18]个月后,1例(3%)眼血管表现复发,3例患者(10%)有其他血管症状复发(2例患者有深静脉血栓形成,1例患者有肺栓塞).在复发的时候,所有病例的嗜酸性粒细胞绝对计数均高于0.5x109/L(n=4)。
■本研究通过增加眼血管表现,拓宽了与嗜酸性粒细胞增多相关的血管表现的范围。在有眼科血管表现和嗜酸性粒细胞增多的患者中,应积极治疗基础病理(和血液计数正常化)。
UNASSIGNED: Eosinophils have widespread procoagulant effects. In daily practice, eosinophil-related cardiovascular toxicity consists of endomyocardial damage, eosinophilic vasculitis and arterial or venous thrombosis. Here we aim to report on the clinical features and treatment outcomes of patients with unexplained ophthalmic vascular manifestations and
eosinophilia.
UNASSIGNED: We conducted a retrospective, multicenter, observational study and a literature
review of patients with
eosinophilia (≥0.5 x109/L) and concomitant ophthalmic vascular manifestations independent of the underlying eosinophilic disease but with no alternative cause for ophthalmic manifestations.
UNASSIGNED: Fifty-seven patients were included (20 from the observational study and 37 from the literature
review). Ophthalmic vascular features were the initial manifestation of eosinophil-related disease in 34 (59%) patients and consisted of 29 central retinal artery occlusions, six branch retinal artery occlusions, five central retinal vein occlusions, two branch retinal vein occlusions, seven retinal vasculitides, two retinal vasospasms, 12 Purtscher\'s retinopathies, 13 anterior ischemic optic neuropathies and two posterior ischemic optic neuropathies. The median [IQR] absolute eosinophil count at onset of ophthalmic vascular manifestations was 3.5 [1.7-7.8] x109/L. Underlying eosinophil-related diseases included eosinophilic granulomatosis with polyangiitis (n=32), clonal hypereosinophilic syndrome (HES) (n=1), idiopathic HES (n=13), lymphocytic HES (n=2), adverse drug reactions (n=3), parasitosis (n=2), polyarteritis nodosa (n=1), IgG4-related disease (n=1), eosinophilic fasciitis (n=1) and primary sclerosing cholangitis (n=1). Other extra-ophthalmologic arterial or venous thromboses related to
eosinophilia were reported in four (7%) and nine (16%) patients, respectively. Visual prognosis was poor: only eight (10%) patients achieved full recovery of ophthalmologic symptoms. After a median follow-up of 10.5 [1-18] months, one patient (3%) had a recurrence of an ophthalmic vascular manifestation, and three patients (10%) had a recurrence of other vascular symptoms (deep vein thrombosis in two and pulmonary embolism in one patient). At the time of recurrence, absolute eosinophil counts were above 0.5 x109/L in all cases (n=4).
UNASSIGNED: This study broadens the spectrum of vascular manifestations associated with hypereosinophilia by adding ophthalmic vascular manifestations. In patients with ophthalmological vascular manifestations and hypereosinophilia, aggressive treatment of the underlying pathology (and normalization of blood count) should be implemented.