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目的 采用光学相干断层扫描血管成像（optical coherence tomography angiography，OCTA）技术，探讨颈内动脉狭窄（internal carotid artery stenosis，ICAS）患者黄斑区微血管特征及其与血管狭窄的相关性。 方法 连续纳入2023年1月—2024年9月西安市第一医院（西北大学附属第一医院）神经内科和神经眼科收治的经血管评估确诊的ICAS患者，按狭窄侧别、程度分别进行分组，并纳入年龄、性别、既往史等相匹配的参与者为健康对照组。对研究对象进行黄斑区OCTA检查，并收集其小血管密度、血管密度、灌注面积、脉络膜层大中血管血管容积及血管指数等数据进行组间比较。 结果 本研究共纳入66例研究对象，其中单侧ICAS组20例、双侧ICAS组26例、健康对照组20例，男性54例（81.8%），平均年龄为（67.5±8.7）岁。3组间除既往卒中或TIA病史外，其他临床特征差异均无统计学意义。单侧ICAS组与健康对照组相比，双眼脉络膜毛细血管层灌注面积低于健康对照组，但单侧ICAS患者双眼间各指标差异均无统计学意义。双侧ICAS组与健康对照组相比，浅层血管复合体小血管密度、视网膜内层灌注面积、脉络膜毛细血管层灌注面积、视网膜内层血管密度、浅层血管复合体血管密度差异均有统计学意义（P0.05）。所有ICAS狭窄侧眼按狭窄程度分为中度及以下狭窄组（31只）、重度及以上狭窄组（41只），与健康对照组3组进行比较，发现浅层血管复合体小血管密度、脉络膜毛细血管层灌注面积、视网膜内层血管密度及浅层血管复合体血管密度差异均具有统计学意义（P0.05）。 结论 ICAS患者黄斑区微血管指标较健康对照组参与者降低，一侧ICAS病变可导致双眼黄斑区微循环受损，且受狭窄程度影响。 Abstract: Objective To explore the microvascular characteristics of the macular lutea in patients with internal carotid artery stenosis (ICAS) and their correlation with vascular stenosis using optical coherence tomography angiography (OCTA). Methods Patients diagnosed with ICAS through vascular assessment, who were admitted to the Department of Neurology and Neuro-Ophthalmology at The First Hospital of Xi’an (The First Affiliated Hospital of Northwest University) from January 2023 to September 2024, were consecutively included. Patients were grouped according to the lesion side and stenosis degree. Age, gender, and medical history-matched participants were included as a healthy control group. OCTA examinations were conducted in the macular lutea for the enrolled subjects, and the data of small vessel density, vessel density, perfusion area, volume of medium to large choroidal vessels, and vascular index were all collected for inter-group comparison. Results A total of 66 subjects were included in this study, including 20 cases in the unilateral ICAS group, 26 cases in the bilateral ICAS group, and 20 cases in the healthy control group. Among them, 54 (81.8%) were male, with an average age of (67.5 ± 8.7) years. There were no statistically significant differences in clinical characteristics among the three groups, except for the history of previous stroke or TIA. Compared with the healthy control group, the perfusion area of the choroidal capillary layer in both eyes of the unilateral ICAS group was lower than that of the healthy control group. However, there were no statistically significant differences in these indicators between both eyes of the unilateral ICAS patients. Compared with the healthy control group, there were statistically significant differences in the small vessel density of the superficial vascular complex, the perfusion area of the inner retinal layer, the perfusion area of the choroidal capillary layer, the vessel density of the inner retinal layer, and the vessel density of the superficial vascular complex in the bilateral ICAS group (P0.05). All eyes with ICAS were divided into moderate and below (31 cases) and severe and above (41 cases) stenosis groups. When comparing these two groups with the healthy control group, it was found that the differences in small vessel density of the superficial vascular complex, the perfusion area of the choroidal capillary layer, the vessel density of the inner retinal layer, and the vessel density of the superficial vascular complex were statistically significant (P0.05). Conclusions In ICAS patients, microvascular indicators in the macular lutea were reduced compared to those in the healthy control group. Unilateral ICAS lesions can lead to impaired macular microcirculation in both eyes, with the degree of impairment influenced by the severity of stenosis.

目的 探讨动脉内溶栓（intra-arterial thrombolysis，IAT）治疗视网膜中央动脉阻塞（central retinal artery occlusion，CRAO）患者的临床特征及功能性视觉恢复情况。 方法 纳入2018年1月—2023年8月西北大学附属第一医院神经内科和神经眼科连续收治的非动脉炎性CRAO患者，根据入院后是否进行IAT治疗分为IAT组和非IAT组。功能性视觉定义为 视力≥20/100。比较分析两组患者的临床特征和不同时间段（入院、出院时和出院1个月时）功能性视觉恢复情况。 结果 共纳入131例（131只眼）非动脉炎性CRAO患者，男性93例（71.0%），平均年龄为（61.6±12.6）岁， 其中IAT组57例（43.5%），非IAT组74例（56.5%）。与非IAT组患者相比，IAT组患者年龄更低[（58.4±12.5）岁 vs.（64.1±12.2）岁，P=0.011]、合并卒中病史者比例更低[10（17.5%）vs. 25（33.8%）， P=0.037]、发病至就诊时间更短[10.0（6.0～24.0）h vs. 55.0（20.2～162.0）h，P＜0.001]、醒后发病者比例更高[26（45.6%）vs. 15（20.3%），P=0.002]和患侧颈内动脉血管状态更佳（无狭窄∶轻度狭窄∶中-重度狭窄∶闭塞=41∶7∶7∶2 vs. 32∶11∶21∶10，P=0.006）。IAT组患者出院1个月时功能性视觉比例较非IAT组患者更高[25（43.9%）vs. 18（24.3%），P=0.018]，而入院和出院时差异无统计学意义 （P＞0.05）。多因素logistic回归分析显示，IAT组患者出院1个月时的功能性视觉较非IAT组患者显著改善（OR 3.24，95%CI 1.08～9.69，P=0.036）。IAT组患者术中发生眼动脉痉挛2例（3.5%）、穿刺部位皮肤出血2例（3.5%）和新发脑栓塞（均为无症状性栓塞）事件4例（7.0%）。 结论 是否进行IAT治疗的CRAO患者部分临床特征存在差异，IAT治疗可显著提高CRAO患者出院1个月时的功能性视觉，且手术安全性较好。提示临床医师需重视CRAO患者的IAT治疗，以期改善患者的视觉功能。 Abstract: Objective To investigate the clinical characteristics and functional visual recovery of patients with central retinal artery occlusion (CRAO) treated with intra-arterial thrombolysis (IAT). Methods The non-arteriotic CRAO patients admitted to the Department of Neurology and Neuro-ophthalmology of the First Affiliated Hospital of Northwest University from January 2018 to August 2023 were included. They were divided into IAT group and non-IAT group according to whether IAT was performed after admission. Functional vision is defined as visual acuity≥20/100. The clinical features and functional visual recovery at different time periods (admission, discharge and 1 month after discharge) were compared and analyzed between the two groups. Results A total of 131 patients (131 eyes) with non-arteriotic CRAO were included, including 93 males (71.0%) with a mean age of (61.6±12.6) years. There were 57 patients (43.5%) in IAT group and 74 patients (56.5%) in non-IAT group. Compared with patients in non-IAT group, patients in IAT group had younger age [(58.4±12.5) years vs. (64.1±12.2) years, P=0.011], lower proportion of stroke history [10 (17.5%) vs. 25 (33.8%), P=0.037], shorter time from onset to visit [10.0 (6.0-24.0) h vs. 55.0 (20.2-162.0) h, P0.05). Multivariate logistic regression analysis showed that the functional vision of CRAO patients in the IAT group at 1 month after discharge was significantly improved compared with those in the non-IAT group (OR 3.24, 95%CI 1.08-9.69, P=0.036). In the IAT group, ophthalmic artery spasm occurred in 2 cases (3.5%), skin bleeding at the puncture site in 2 cases (3.5%), and new cerebral embolism (all asymptomatic embolism) occurred in 4 cases (7.0%). Conclusions Some clinical features of CRAO patients who were treated with or without IAT were different. IAT can significantly improve the functional vision of CRAO patients at 1 month after discharge, and the surgical safety is good. This suggests that clinicians should pay more attention to IAT in CRAO patients in order to improve their visual function.