糖尿病合并高血压的眼和视网膜动脉血流动力学特点

目的揭示糖尿病伴高血压患者的眼和视网膜中央动脉血流动力学改变的特点。方法应用彩色多普勒血流成像技术，测量高血压、糖尿病、糖尿病高血压及正常对照者眼动脉和视网膜中央动脉的血流参数。结果高血压组的眼动脉血流速度和搏动指数，糖尿病组的眼动脉舒张末期血流速度、血管内径、和血管横断面积，糖尿病高血压组的眼动脉平均血流速度，均明显高于对照组；糖尿病高血压组的视网膜中央动脉舒张末期血流速度比高血压组显著下降，而视网膜中央动脉阻力指数明显增加；眼动脉血流速度及血流量比糖尿病组显著增加。结论糖尿病高血压患者的眼和视网膜中央动脉血流动力学改变，既呈现血流速度明显加快．又有血流灌注阻力增加的特征。糖尿病所致的视网膜循环阻力增加和高血压所致的视网膜血流灌注压下降，二者作用叠加模式使视网膜循环血量降低，早期就出现视网膜缺血性改变。糖尿病未发生视网膜病变前应用血管扩张药预防性治疗，比较治疗前后视网膜中央动脉的舒张末期血流速度和血管阻力指数来观察疗效。糖尿病伴高血压或动脉硬化者，可考虑用治疗前后视网膜中央动脉的收缩期峰值血流速度和血管搏动指数，和首次提出的视网膜中央动脉与眼动脉血流速度比值，作为疗效观察指标。     

国人青光眼视网膜中央动脉和眼动脉血流改变的Meta分析

目的:综合评价青光眼视网膜中央动脉(CRA)和眼动脉(OA)血流动力学改变的诊断意义和临床应用.方法:计算机网上检索中国期刊全文数据库1994/2006有关CRA和OA彩色超声多普勒血流动力学测定的青光眼病例-对照研究文献40篇,对CRA和OA血流参数进行同质性检验和合并效应量的检验.结果:合并分析后有统计学意义的同质性研究结果为青光眼对侧未损害眼的OA与CRA收缩期峰值血流速度比正常人分别降低0.55～0.68和0.41～0.51个标准差,舒张末期血流速度比正常人降低0.22～2.52和0.69～0.79个标准差,OA和CRA阻力指数分别高于正常人1.13～1.29和0.51～0.61个标准差.抗青光眼术后OA平均血流速度比正常低0.23～0.32个标准差,CRA阻力指数比正常高0.04～1.51个标准差.正常眼压性青光眼(NTG)的CRA的收缩期峰值和舒张末期血流速度比正常人分别低0.71～0.79和0.68～0.77个标准差,却比原发性开角型青光眼(POAG)患者高0.03～0.12和0.04～0.13个标准差.闭角型青光眼的CRA搏动指数比正常人和POAG患者分别降低0.04～0.11和0.33～0.40个标准差.高眼压组的OA舒张末期血流速度分别比低眼压组降低1.61～1.82,1.01～126,0.47～0.79个标准差,阻力指数分别比低眼压组增加0.57～0.73,0.82～1.06,0.03～0.34个标准差.合并分析后有统计学意义的结果是慢性闭角型青光眼(CCAG)的OA平均血流速度和CRA收缩期峰值血流速度比正常人分别降低0.06～2.25和0.34～3.81个标准差.结论:各型原发性青光眼缺血性改变最明显的是POAG,其次为NTG,CCAG.NTG的CRA收缩期峰值和舒张末期血流速度下降明显;CCAG的OA平均血流速度和CRA收缩期峰值血流速度下降明显;POAG的CRA阻力指数增加明显.抗青光眼术后彩色超声多普勒检测OA和CRA血流动力学参数,发现其缺血性改变程度,是重要的疗效评价方法和指标.     

糖尿病患者的眼动脉和视网膜中央动脉血流动力学改变

目的应用彩色多普勒显像(CDFI)检测探讨糖尿病患者的眼动脉和视网膜中央动脉血流动力学变化。方法应用CDFI检测30例糖尿病患者和50例正常对照组的眼动脉(OA)、视网膜中央动脉(CRA)的收缩期血流峰速(Vs)、舒张末期流速(Vd)平均流速(Vm)、血管阻力指数(R I)和搏动指数(PI)。结果与对照组比较,糖尿病组OA和CRA的的Vs、Vd降低、R I增加。结论糖尿病患者的OA和CRA血流速度降低,视网膜循环阻力升高,视网膜血液供应不良。     

年龄相关性黄斑变性患者视网膜中央动脉和睫状后动脉的血流动力学变化

目的:探讨视网膜中央动脉(CRA)和睫状后动脉(PCA)血流动力学的变化与年龄相关性黄斑变性的关系。方法:收集临床确诊的AMD患者47例(63眼),其中干性AMD41眼,湿性AMD22眼。另外选择正常人群30例(60眼)作为对照。用彩色多普勒超声检测(CRA)、(PCA)的血流动力学数据,并对其频谱血流资料进行分析。结果:收缩期峰值血流速度(PSV)均降低,除湿性AMD与正常组比较差异有显著性(P>0.05),其余各组间比较无显著性差异;舒张末期最低血流速度(EDV)下降,阻力指数(RI)和搏动指数(PI)升高,各组间比较均有显著性差异(P<0.05),随着AMD病情加重,各血流参数也相应变化,PCA较CRA更明显。结论:超声检测AMD患者的CRA和PCA血流,可直接反映脉络膜和视网膜血流动力学变化,当眼部发生缺血时导致CRA和PCA血流参数相应的改变;CDFI检查为AMD的发病机制研究、病情分析和预后评估可提供客观的检测手段。     

糖尿病球后动脉血流动力学的改变

应用彩色多普勒血流成像(CDFl)技术，检测57例糖尿病患者视网膜中央动咏(CRA)、眼动脉(OA)．表明了糖尿病组和对照组球后动脉血流频谱形态和血流动力学特点．提出了糖尿病眼血流动力学类型，认为OA缺血性改变是糖尿病性视功能损害的高危因素。发现血糖与平均血流速度(Vm)呈负相关(γ=-0.37、P<0.01，与RI、P1(γ-0.35、0.22、P<0．05)呈正相关．低速、低流量、高阻力型血流状态，是导致视网膜缺血性改变的重要血流动力学因素。 （中华眼底病杂志，1994，10：89-91）     

脑梗死患者眼动脉和视网膜中央动脉血流动力学的变化

目的:探讨眼动脉和视网膜中央动脉血流动力学的变化与发生脑梗死的关系。方法:用彩色多普勒超声检测脑梗死患者OA和CRA的血流动力学数据,并对其频谱血流资料进行分析。结果:舒张末期血流速度的缓慢、阻力指数及搏动指数的增加患侧较健侧明显(P<0.01或P<0.05);60岁以上较60岁以下明显。结论:超声检测CCA,OA与CRA血流,可间接反映脑血流动力学变化,当发生缺血性脑血管病或动脉硬化导致脑缺血时,OA与CRA也发生与脑动脉相应的缺血改变。     

正常眼压性青光眼患者眼部血流的波动性变化

目的：评价正常眼压性青光眼( NTG)患者眼部血流的波动性变化。
　　方法：前瞻性病例对照研究。彩色多普勒超声成像( CDI)用于测量正常眼压性青光眼患者的眼部血流参数-收缩期峰值流速(Vmax),舒张末期血流速度(Vd),最大速度的时间平均值(TAmax),搏动指数(PI),眼动脉(OA)阻力指数(RI)与收缩期/舒张期比值(S/D),视网膜中央动脉( CRA)和睫状后短动脉( SPCA),并对比正常人数值。比较两组采用非配对t检验,P≤0.05时有显著意义。
　　结果：当与正常人组P值分别为0.605,0.254,0.348对比时,正常眼压性青光眼组中眼动脉,视网膜中央动脉和睫状后短动脉的收缩期峰值流速降低。当与正常人组P值分别为0.000,0.014,0.138对比时,正常眼压性青光眼组中三项的舒张末期血流速度降低。当眼动脉P值分别为0.000,0.045,视网膜中央动脉P值为0.000和0.006,睫状后短动脉P值0.024和0.024时,搏动指数和阻力指数增加。当正常人组眼动脉,视网膜中央动脉和睫状后短动脉P值分别为0.047,0.041和0.189时,正常眼压性青光眼组收缩期/舒张期比值增加。
　　结论：研究得出彩色多普勒超声成像是测量青光眼血管组成部分的有效途径。比较正常眼压性青光眼组和正常人组时发现眼部血管血流速度下降,血管阻力指数增加。     

中青年缺血性脑血管病患者OA和CRA血流动力学的研究

目的:探讨中青年眼动脉(ophthalmic artery,OA)和视网膜中央动脉(central retinal artery,CRA)血流动力学的变化与发生缺血性脑血管病(ischemic cerebrovasctlar disease,ICD)的关系。方法:采用彩色多普勒超声仪检测缺血性脑血管病患者OA和CRA的血流动力学数据,对获得的资料进行回顾性分析。结果:ICD组舒张期血流速度降低及RI,PI值均升高明显(P<0.01)。收缩期血流速度降低不明显(P>0.05)。结论:利用超声检测OA和CRA,是早期间接发现脑动脉缺血改变的可靠方法。     

彩色多普勒超声在视网膜中央动脉阻塞的应用

目的应用彩色多普勒血流显像(colordopplerflowimagingCDFI)及脉冲多普勒(pulsewavedopplerPW)检测视网膜中央动脉阻塞病变(centralretinalarteryocclusionCRAO)球后各动脉血流参数,研究其血流动力学变化特征。方法应用CDFI及PW检测50例(50只眼)临床诊断为CRAO患者的眼动脉(ophthalmicarteryOA)、视网膜中央动脉(centralretinalarteryCRA)、睫状后短动脉(shortposteriorciliaryarterySPCA)的收缩期峰值血流速度(peaksystolicvelocityPSV)、舒张末期血流速度(enddiastolicvelocityEDV)、时间平均最大血流速度(timeaveragedmaximumvelocityTAMX)、搏动指数(pulsatilityindexPI)及阻力指数(resistanceindexRI)并与25例(50只眼)正常对照组及18例(23只眼)、缺血性视神经病变(ischemicopticneuropathyION)相应眼部球后各动脉血流参数进行统计学比较。结果与对照组比较CRAO组CRA的PSV、EDV及TAMX明显降低(P<0.01),PI、RI明显升高(P<0.01),SPCA的PSV、EDV、TAMX轻度降低但差异不显著(P>0.05),PI、RI变化无显著差异(P>0.05)。结论CDFI及PW可以根据CRAO血管血流动力学特征改变为临床诊断及鉴别诊断提供准确依据。     

增殖期糖尿病视网膜病变眼动脉的血流动力学特征

目的 探讨应用彩色多普勒血流成像(CDFI)技术检测增殖期糖尿病视网膜病变(PDR)的眼动脉(OA)血流动力学特征.方法 随机抽取PDR患者56例(56只眼)分为A组PDR合并视网膜脱离患者30例(30只眼),B组PDR不合并视网膜脱离患者26例(26只眼);C组为其他缺血性眼病患者14例(14只眼),其中包括视网膜中央动脉阻塞(CRAO)7例(7只眼)、前部缺血性视神经病变(AION)7例(7只眼);D组为正常对照组15例(30只眼).分别记录四组CDFI的OA血流参数.结果 PDR的A、B两组与其他缺血性眼病组舒张末期血流速度(EDV)之间,A、B两组与正常对照组EDV之间及阻力指数(RI)之间差异均有统计学意义(P<0.01);A、B两组与其他缺血性眼病组收缩期峰值血流速度(PSV)之间及砌之间,A、B两组与正常对照组PSV之间差异均无统计学意义(P>0.05).结论 PDR患者OA的外周循环阻力增加、远端组织血流灌注不足,当OA的PSV降低时可合并同侧颈内动脉狭窄及缺血性脑血管病.     

Variations in ocular hemodynamics in patients with early and late glaucoma

PURPOSE: To determine the retrobulbar hemodynamics in glaucoma patients with different degrees of optic nerve damage. METHODS: Color Doppler imaging was performed in 52 patients with controlled primary open angle glaucoma (POAG) and in 25 control subjects. Glaucomatous eyes were divided into early and late groups based on the perimetry findings. Peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index of the central retinal artery (CRA) and posterior ciliary arteries (PCA) were evaluated. RESULTS: Early glaucoma showed significantly decreased PSV in nasal PCA when compared with the normal. Late glaucoma showed significantly decreased PSV and EDV in the CRA and nasal PCA, and significantly decreased PSV in temporal PCA as compared with the control and early glaucoma. The resistive index of the CRA also increased significantly in late glaucoma. CONCLUSION: Eyes with advanced glaucomatous optic neuropathy were associated with more marked alterations in retrobulbar circulation than eyes with less nerve damage.     

Changes in orbital hemodynamics induced by nipradilol in healthy volunteers.

We evaluated changes in ocular hemodynamics induced by nipradilol, an NO donor, applied as an eye drop. Eight volunteers underwent color Doppler imaging for measurement of hemodynamic parameters in the central retinal artery (CRA) and ophthalmic artery (OA) after instillation of nipradilol. Intraocular pressure (IOP) and systemic blood pressure were also measured. Two months later, the same volunteers were examined after instillation of saline into the same eyes to obtain control data. The pulsatility index in the CRA was significantly lowered in the eyes treated with nipradilol compared with control eyes. Blood velocities in the CRA, hemodynamic parameters in the OA, IOP, blood pressure, and ocular perfusion pressure were unaffected by nipradilol. The current study suggests that nipradilol may dilate the CRA as a result of reduced vascular resistance in humans.     

Dorzolamide effect on ocular blood flow

PURPOSE: To evaluate the effect of dorzolamide on ocular blood flow in normal and glaucomatous eyes. METHODS: Twenty-six eyes with documented open-angle glaucoma of 26 patients and 13 normal control eyes of 8 age-matched subjects were included in this study. All eyes underwent color Doppler imaging for measuring peak-systolic velocity, end-diastolic velocity, and resistance index in the ophthalmic and central retinal arteries and the maximal and minimal velocities in the central retinal vein. Eyes were grouped in control and initial and advanced glaucoma categories. Measurements were made in all groups before and after application of topical dorzolamide. Intragroup comparisons between baseline and dorzolamide conditions were made using paired Student's t-test. Intergroup comparisons under baseline conditions between normal and glaucomatous eyes were made by using the one-way ANOVA test. Statistical significance was set at P < 0.05. RESULTS: The peak-systolic velocity of the central retinal artery in glaucomatous eyes and the end-diastolic velocity of the ophthalmic and central retinal arteries in all groups were significantly higher after application of dorzolamide. The minimal velocity of the central retinal vein showed significantly higher values after dorzolamide, whereas the maximal velocity remained unchanged. The peak-systolic velocity of the ophthalmic artery in all groups and the peak-systolic velocity of the central retinal artery in normal eyes also remained unchanged. The resistance index was significantly lower in the ophthalmic and central retinal arteries in all groups after dorzolamide. The intraocular pressure was significantly reduced in all groups after dorzolamide. Under baseline conditions normal control eyes and glaucomatous eyes showed differences in various measurements. Peak-systolic velocity was significantly lower in glaucomatous eyes than in normal control eyes with the exception of the ophthalmic artery in the initial glaucoma group. End-diastolic velocity was lower in glaucomatous eyes than in control eyes in both arteries. Maximal and minimal velocities of the central retinal vein were lower in glaucomatous eyes than in normal control eyes. Resistance index was higher in glaucomatous eyes than in normal control eyes in the ophthalmic artery but not in the central retinal artery. CONCLUSIONS: Most hemodynamic parameters of intraocular and periocular vessels improve after application of topical dorzolamide in both normal control and glaucomatous eyes. Dorzolamide should be regarded as a useful drug for treatment of glaucoma not only because it reduces intraocular pressure but also because it improves the ocular blood supply.     

青光眼术后彩色多谱勒眼底血流动力学检测分析

目的了解青光眼术后正常眼压和高眼压情况下眼底血流动力学变化,为临床治疗提供依据。方法应用彩色超声多谱勒检测高眼压组青光眼23只眼、眼压正常青光眼组25只眼和正常对照组23只眼,将每组数据间进行比较。结果与对照组比较,高眼压组视网膜中央动脉(CRA)舒张末期峰值速度(EDV)明显降低、阻力指数(RI)明显增高(P<0.01);眼压正常组青光眼的EDV明显下降,RI显著增高(P<0.05)。结论青光眼眼底血液循环障碍是造成视功能损害的原因之一,即使术后眼压正常情况下此危害也存在。     

Color Doppler imaging study of retrobulbar hemodynamics in chronic angle-closure glaucoma

PURPOSE: To evaluate the retrobulbar hemodynamics in patients with chronic angle-closure glaucoma (CACG) by using color Doppler imaging (CDI) and to correlate the degree of glaucomatous visual field loss with the hemodynamic parameters. DESIGN: Prospective case series. PARTICIPANTS AND CONTROLS: Twenty-six Chinese patients with CACG and 26 age-matched and gender-matched normal subjects were recruited. All CACG patients had history of chronic intraocular pressure (IOP) elevation and asymmetric visual field defects between their fellow eyes. After receiving laser peripheral iridotomy and/or filtration surgery, all of them had bilateral medication-free controlled IOP before enrolling into the study. METHODS: Each subject underwent CDI measurement in the central retinal artery (CRA) and the nasal and temporal short posterior ciliary arteries (PCA). Visual fields of the CACG patients were obtained with Humphrey 24-2 program. The visual field defects were scored with the Advanced Glaucoma Intervention Study (AGIS) system. For each CACG patient, the eye with lower AGIS score was defined as the better eye and the eye with higher score as the worse eye. MAIN OUTCOME MEASURES: Peak-systolic velocity (PSV), end-diastolic velocity (EDV) and resistance index (RI) were determined. RESULTS: The EDV in the CRA and the temporal PCA was decreased significantly (P = 0.041 and 0.023, respectively) in the worse eyes of CACG patients compared with those in the control eyes. The better eyes of CACG patients showed no significant change in hemodynamic parameters compared with the control eyes. While comparing the fellow eyes of CACG patients, the worse eyes had significantly lower EDV in the temporal PCA (P = 0.012) than the contralateral better eyes. In 11 CACG patients with a difference of at least 8 in AGIS visual field scores between their fellow eyes, the worse eyes had significantly lower EDV (P = 0.041) in the CRA and lower PSV (P = 0.018) and EDV (P = 0.018) in the temporal PCA compared with those in the contralateral eyes. In multivariate regression analysis, the AGIS scores were significantly correlated with the PSV in the CRA (P = 0.015) and with the EDV (P < 0.001) and RI (P = 0.027) in the temporal PCA in patients with CACG. CONCLUSIONS: Patients with well-controlled CACG may have decreased retrobulbar blood flow velocities and increased vascular resistance in the CRA and temporal PCA. The degree of retrobulbar hemodynamic impairment was well correlated with the degree of glaucomatous visual field loss.     

Short posterior ciliary artery, central retinal artery, and choroidal hemodynamics in brimonidine-treated primary open-angle glaucoma patients

PURPOSE: Malfunction in peripapillary hemodynamics has been suggested to play a major part in the pathogenesis of primary open-angle glaucoma (POAG). The aim of this study was to determine whether topically applied brimonidine can influence blood hemodynamic characteristics associated with the perioptic short posterior ciliary arteries (SPCAs), central retinal artery (CRA), and choroidal vascular system in POAG patients. DESIGN: Randomized clinical trial.In this prospective, institutional, double-masked, vehicle-controlled, randomized clinical trial, the intraocular pressure (IOP) and vascular dynamics of the SPCAs, CRA, and choroidal vascular system were analyzed in both eyes of 17 POAG patients, before and after treatment with 0.2% brimonidine for 4 weeks. RESULTS: Mean IOP reduction was significant (18.7%) following treatment with brimonidine. However, no clear changes were recorded with respect to blood perfusion parameters (peak systolic velocity, end-diastolic velocity, pulsatility, and resistance indices) associated with the SPCAs and CRA or the choroidal ocular pulse amplitude. CONCLUSIONS: Topical treatment of brimonidine to POAG patients causes a significant reduction of IOP, but blood hemodynamic properties associated with the SPCAs, CRA, and choroidal vascular systems appeared unaffected. Topically applied brimonidine, therefore, appears not to constrict or dilate peripapillary blood vessels.     

眼压对急性闭角型青光眼血流动力学的影响

目的 分析急性闭角型青光眼（AACG）患者在不同眼压状态下眼部血管的血流变化。方法 应用彩色多普勒超声诊断仪，分别检测正常人30例（30只眼），AACG患者42（42只眼）在高眼压状态下及小梁切除术后眼压正常时，眼动脉（OA）、视网膜中央动脉（CRA）、睫状后动脉（PCA）的血流速度、阻力指数。结果 （1）AACG患者在高眼压状态下，CRA和PCA的阻力指数与眼压（＞30mmHg）呈正相关（P＜0．01）。（2）在AACG患者CRA和PCA中，除了CRA的收缩期峰值血流速度在术后无明显变化外（P＝0．1406），其余各项血流动力学指标均发生显著性改善（P＜0．05）。（3）AACG中层得术后CRA和PCA的各项血流动力学指标仍不及正常人（P＜0．05）。结论 在AACG的发病过程中，高眼压可致眼血流动力学变化，说明青光眼性视神经损害并不是机械因素或血管因素单独起作用，而是二者联合起来共同作用的结果。     

青光眼小梁切除术前后眼部血流动力学变化的研究

目的:比较青光眼32眼小梁切除术前后的血流动力学变化。方法:利用彩色多普勒成像技术(CDI)分别检测正常对照组与青光眼组术前、术后2,12wk的眼部血流情况,包括眼动脉(OA)、睫状后短动脉(SPCA)和视网膜中央动脉(CRA)的收缩期峰值血流速度(PSV)、舒张末期血流速度(EDV)和阻力指数(RI)。结果:(1)青光眼组手术前后比较:青光眼组在小梁切除术后血流灌注明显好转,表现为PSV,EDV增高,RI下降;(2)青光眼术后组之间比较:PSV,EDV,RI有改变,但差异无统计学意义;(3)青光眼组术后与正常对照组比较:青光眼组在小梁切除术后眼压降至正常范围时OA,SPCA,CRA的PSV,EDV和RI仍不及正常人(P<0.05);(4)青光眼组术前与正常对照组比较:OA,SPCA,CRA均表现为PSV,EDV下降,RI增高(P<0.01)。结论:(1)青光眼患者与正常人相比较存在明显的血流灌注不足,小梁切除术可以有效的改善眼部血流灌注情况;(2)CDI可长期用于监测和评价青光眼小梁切除术的治疗效果。     

彩色多普勒超声对青光眼眼血流动力学变化的研究

目的：研究青光眼患者眼部血流动力学改变及手术前手的对比。方法：采用多普勒超声检查仪测定48例（78眼）原发性闭角型青光眼（primary close-angle alaucoma,PCAG),6例（12眼）原发性开角型青光眼（primary open-angle glaucoma,POAG),9例（18眼）单侧发病青光眼和26例（52眼）正常对照组的眼动脉（Ophthalmic artery,OA)、视网膜中央动脉（central retinal artery,CRA)的血流动力学参数,同时对11例（19眼）原发性青光眼进行手术前后血流参数的检测对比。结果：PCAG、POAG组、单侧发病青光眼的双眼均较正常对照组OA、CRA显示了明显的舒张末期血流速度（end diastolic velocity,EDV) 降低（P＜0．05）,阻力指数（resistive index,RI)增高（P＜0．05）,手术后OA、CRA的EDV较术前明显增加,RI下降（P＜0．01）。结论：局部血液循环障碍,导致视神经血供不足,对青光眼视神经损害有着重要的影响;手术可降低血管阻力,增加眼局部血液供应,改善并保护青光眼患者的视功能。