视神经切开术治疗视网膜中央静脉阻塞的初步报告

目的 探讨视神经切开术治疗缺血性视网膜中央静脉阻塞的效果及其并发症。方法 选择缺血性视网膜中央静脉阻塞患者8例,病程3～8个月,平均3．6个月。患者均经系统药物治疗3个月效果不佳,其中3例有高血压病史,3例患有严重的黄斑囊样水肿。术前患者均行眼底照相、荧光素眼底血管造影(FFA)及相干光断层扫描(OCT)检查。手术常规做睫状体平坦部巩膜三切口,应用显微玻璃体视网膜切开刀,以鼻侧视乳头边缘为中心,垂直刺人达最宽处为止,刺入深度约2．2mm,宽度约1．2mm。术后1～3个月分别行眼底照像、FFA及OCT检查。结果术后随访3～5个月。术后1个月内,所有患者视网膜或黄斑水肿均减轻或消退。术后3个月,患者行眼底照像、FFA及OCT检查结果均显示视网膜出血吸收,视乳头黄斑水肿消退;6例视力较术前提高(62．5％)。术后3～4周,2例发生玻璃体出血,其中l例继发新生血管性青光眼;2例术中穿刺时出血。结论 视神经切开术有助于视网膜内出血、渗出及黄斑水肿的消退,部分患者视力可得到改善。     

放射状视神经切开术治疗视网膜中央静脉阻塞的效果观察

目的观察放射状视神经切开术(RON)治疗视网膜中央静脉阻塞(CRVO))的效果。方法CRVO患者7例(7眼),均进行眼科常规检查、眼底荧光血管造影(FFA)和光学相干断层扫描(OCT)检查后确诊。行标准三通道闭合式玻璃体切除手术后,使用改良的MVR刀在视盘鼻侧缘做放射状视神经切开术。结果术中和术后无严重并发症。6例术后视网膜出血、静脉迂曲扩张和黄斑水肿等视网膜淤滞状态逐渐消退,视力均有不同程度的提高。1例年轻患者术后发生玻璃体积血。结论RON手术可以改善CRVO的视网膜淤滞状态和提高视力,但需要进一步观察手术的远期效果。     

放射状视神经切开术治疗缺血型视网膜中央静脉阻塞合并黄斑水肿的疗效观察

目的 观察放射状视神经切开术(RON)治疗缺血型视网膜中央静脉阻塞(CRVO)合并黄斑水肿的效果。 方法 回顾分析6例缺血型CRVO合并黄斑水肿患者行玻璃体切割联合RON治疗的临床资料，对比观察患者手术前后视力、荧光素眼底血管造影(FFA)、光相干断层扫描(OCT)检查结果,重点观察黄斑厚度、视网膜静脉充盈、视网膜出血和视盘水肿的改善情况。 结果 6例患者手术后视力均有不同程度提高，视网膜出血明显减少，5例患者黄斑水肿不同程度改善，4例患者视网膜静脉扩张改善，2例合并视盘水肿的患者手术后视盘水肿消失。 结论 RON能够改善缺血型CRVO合并的黄斑水肿，但不能排除治疗效果和玻璃体切割手术有关。(中华眼底病杂志,2005,21:3-5)     

放射状视神经切开术治疗缺血型视网膜中央静脉阻塞伴黄斑水肿的疗效评估

目的评估放射状视神经切开术（RON）治疗缺血型视网膜中央静脉阻塞（CRVO）伴黄斑水肿的效果。方法回顾性分析2005～2007年行RON治疗的18例缺血型CRVO伴明显黄斑水肿患者的临床资料,其中15例术前确诊为缺血型CRVO,3例玻璃体积血手术后确诊为缺血型CRVO。手术前后均进行视力、荧光素眼底血管造影（FFA）、光相干断层扫描（OCT）检查。术后随访1周,1、3、6个月,比较患者手术前后的检查结果。所有患者在应用药物或手术前均签署知情同意书。结果除3例病程太长或黄斑变性视力未恢复,其余15例视力在短期内均有不同程度的提高,视力恢复〈3个月组好于〉3个月组（p=0．025）。眼底照相、OCT及FFA检查结果显示黄斑水肿均在1个月内明显消退,眼底出血3个月内吸收。1例术中穿刺视盘时出现鼻侧视网膜下局限性出血。结论RON能够改善缺血型CRVO合并的黄斑水肿。早期手术干预视力预后较好。术中联合应用的黄斑内界膜剥离术所起的作用尚需进一步评估。     

动静脉鞘膜切开治疗视网膜分支静脉阻塞

目的观察动静脉鞘膜切开术治疗视网膜分支静脉阻塞的临床效果.方法对3例(3只眼)视力低于0.1的视网膜分支静脉阻塞患者进行平坦部玻璃体切割术和动静脉鞘膜切开术.结果 3只眼术后玻璃体清亮,视力均有不同程度的提高,视网膜内出血和黄斑水肿明显减轻,无手术并发症发生.结论动静脉鞘膜切开术是治疗视力较差的视网膜分支静脉阻塞的有效方法.     

放射状视神经切开术治疗视网膜中央静脉 阻塞的初步观察

目的观察放射状视神经切开术（RON）治疗视网膜中央静脉阻塞（CRVO）的临床效果。方法回顾分析 5例经平坦部玻璃体途径行RON治疗的CRVO患者的临床资料。其中，2例患者手术前确诊为CRVO，手术前后分别进行视力、眼底照相、荧光素眼底血管造影（FFA）、彩色超声多谱勒（CDI）血流扫描、电脑视野及光相干断层扫描（OCT）等检查；3例患者因玻璃体积血接受手术治疗，手术中确诊为CRVO所致。5例均有明显黄斑水肿。对比观察患者手术前后视力、眼底检查及手术后眼底照相和OCT检查结果。手术后随访12个月。结果除1例患者视力下降外，其余4例患者视力均有不同程度提高。 眼底照相和（或）FFA、OCT检查显示手术后1个月时黄斑水肿均明显消退，手术后2个月时眼底出血基本吸收， 1例行视野检查者显示手术后视野改善。1例手术后出现玻璃体积血，2例手术中穿刺视盘时出血。结论RON可有助于CRVO患者改善患眼黄斑水肿，减少眼底出血，防止新生血管形成，并能一定程度地提高视力，对治疗CRVO具有一定可行性及临床价值。但尚需要较大规模、多中心的随机临床对照观察来进一步研究证实。(中华眼底病杂志,2005,21:6-9)     

激光格栅样光凝治疗视网膜中央静脉阻塞致黄斑囊样水肿的分析

目的:分析格栅样光凝治疗视网膜中央静脉阻塞致黄斑囊样水肿的效果。方法:经眼底荧光造影(fundus fluorescein angiography,FFA)和光学相关断层扫描(optic coherence tomagraphy,OCT)检查确诊为视网膜中央静脉阻塞伴黄斑囊样水肿的患者137例137眼,进行格栅样光凝。术后1wk;1,3mo复查视力、FFA及OCT。结果:术后1mo检查结果:视力提高者为119眼(86.9%),不变者18眼(13.1%);术后3mo检查结果:视力提高者为124眼(90.5%),不变者13眼(9.5%)。治疗后1mo及3mo视力与治疗前比较均有显著性差异。结论:格栅样光凝治疗中央静脉阻塞致黄斑囊样水肿效果肯定,但必须要有足够量的有效的光凝斑,并要根据眼底状况决定格栅样光凝的方式。     

去炎松玻璃体内注射治疗视网膜中央静脉阻塞引起的黄斑水肿37例

目的:评估去炎松玻璃体内注射治疗视网膜中央静脉阻塞造成的黄斑水肿效果。方法:中央视网膜静脉阻塞(CRVO)并发黄斑水肿患者37例(37眼)接受玻璃体腔注射去炎松(40g/L,0.1mL,1～3次)治疗。非缺血性CRVO33眼,缺血性CRVO4眼,注射1次20眼,注射2次15眼,注射3次2眼,平均随访时间9(3～27)mo。患者从症状出现至一次注射药物平均时隔时间为2.7(0.3～9)mo。注射前后均进行最佳矫正视力、眼压、裂隙灯显微镜、荧光素眼底血管造影(FFA)和中央黄斑厚度光相干断层扫描(OCT)检查。结果:治疗前平均视力为0.08(0.01～0.4)。注射后1～3mo,最佳矫正视力提高25眼,无变化3眼,视力下降9眼,在视力提高患眼中,视力提高3行以上12眼,视力提高2行10眼,提高1行3眼。此后,部分视力下降和视力未提高患者,进行2次或3次注射,最终随诊时视力提高24眼,视力无变化3眼,视力下降10眼,在视力提高的患眼中,视力提高3行以上8眼,视力提高2行10眼,提高1行6眼,整个治疗前后平均视力增加2～3行。治疗后1～3mo时,间接眼底镜检查黄斑水肿完全消退16眼,水肿明显减轻19眼,水肿加重2眼。最终随诊时,间接眼底镜检查黄斑水肿完全消退19眼,减轻17眼,加重1眼。15眼在注射药物后1wk～6mo期间先后出现不同程度的高眼压达35.4(25.1～40.1)mmHg(1mmHg=0.133kPa),13眼进行降眼压治疗,其中4眼接受抗青光眼手术。在32只晶状体眼中,出现了晶状体后囊膜下混浊的并发性白内障9眼,进行白内障摘除4眼。OCT检查发现玻璃体腔注射药物治疗后黄斑厚度减少,中央黄斑平均厚度减少至注射前厚度的46%。4眼没有视力的提高。结论:玻璃体腔内注射去炎松是一种治疗视网膜中央静脉阻塞引起黄斑水肿的有效方法。对于缺血性中央视网膜静脉阻塞患者视力不会提高。     

放射状视神经切开术治疗视网膜中央静脉阻塞

目的观察放射状视神经切开术（RON）治疗视网膜中央静脉阻塞（CRVO）的临床疗效。方法回顾分析12例CRVO患者RON治疗的临床资料。所有患者均进行常规视力和眼底检查、眼底照相和荧光素眼底血管造影（FFA）、光相干断层扫描（OCT）检查。12只患眼视力均在0.1以下，伴有严重出血、视网膜水肿。手术时用显微玻璃体视网膜刀（MVR）或CRVO切开刀（CRVO knife）刺入视盘鼻侧，切口深达筛板及筛板后且于筛板区鼻侧切开。手术后随访观察2~15个月，平均随访时间为6.5个月。对比观察手术眼视力、视野及眼底改变情况。结果12只患眼的RON手术均获成功。9只眼视力有不同程度提高，占75%，6只眼手术后视力大于或等于0.1，占50%。眼底检查、眼底照相和FFA、OCT检查显示视网膜水肿、出血逐渐消失，静脉怒张、纡曲明显好转；视网膜浆液性脱离减轻或消失；黄斑囊样水肿消退，3只眼黄斑中心凹恢复。3只眼手术中视神经出血，晚期4只眼视神经切开部位萎缩。结论视盘鼻侧边缘的RON安全可行，可以改善CRVO患眼的视力，缓解视网膜出血和水肿。(中华眼底病杂志,2005,21:10-12)     

氩绿激光治疗视网膜分支静脉阻塞的临床疗效

目的:探讨氩绿激光治疗视网膜分支静脉阻塞的临床疗效。方法:经眼底荧光血管造影(FFA)确诊为视网膜分支静脉阻塞(BRVO)患者60例60眼。患者随机分两组:A组(治疗组)使用氩绿视网膜光凝治疗30例;B例(对照组)口服活血化瘀药物(复方血栓通胶囊)治疗30例;两组患者随访时间为治疗后1,3,6,12mo,随访内容为视力、FFA检查及眼底情况,对治疗6mo后视力恢复结果和黄斑水肿消退情况进行对比。结果:A组:显效8例,有效20例,无效2例。B组:显效2例,有效14例,无效14例。A组合并黄斑囊样水肿者14例,给予氩绿视网膜光凝治疗后黄斑水肿消退12例,未消退2例;B组合并黄斑囊样水肿者13例,药物治疗后黄斑水肿消退3例,未消退10例,经卡方检验,差异有统计学意义(P<0.05)。结论:氩绿激光对视网膜分支静脉阻塞的激光治疗有显著疗效,激光治疗组治疗后6mo病情稳定,效果好。     

Radial optic neurotomy for central retinal vein occlusion: a retrospective pilot study of 11 consecutive cases

PURPOSE: Retinal vascular occlusive disease is the second leading cause of permanent retinal blindness. The etiology of central retinal vein occlusion (CRVO) is not well understood. The anatomy of the optic disk including the cribriform plate and scleral ring may contribute to the development of retinal vaso-oclussive diseases. Neurovascular compression within the confined space at this location may play a pathoetiologic role in CRVO. The authors performed radial optic neurotomy in patients with CRVO to relax this space and relieve pressure on the central retinal vein. METHODS: Radial optic neurotomy (RON) was performed on 11 consecutive patients with severe, hemorrhagic CRVO with visual acuities of 20/400 or less. A microvitreoretinal blade was used to relax the scleral ring, cribriform plate, and adjacent sclera of the optic disk. Reperfusion of the retina was achieved via decompressing the central retinal vein. RESULTS: Radial optic neurotomy was performed successfully in all 11 patients. There were no complications noted with this procedure. All patients had clinical improvement as determined by fundus examination, photography, and fluorescein angiography. Postoperative visual acuities were equal or improved in 82% of patients. Eight of the patients (73%) had rapid improvement of visual acuity with an average gain of five lines of vision. CONCLUSIONS: Surgical decompression of CRVO via RON is a technically feasible and initially safe procedure that is associated with rapid reperfusion of the retina. Resolution of the intraretinal hemorrhage, edema, and ischemia may improve the visual prognosis in patients with this common retinal disorder.     

Radial Optic Neurotomy in Central Retinal Vein Occlusion: Preliminary Results

Background: To investigate the efficacy of radial optic neurotomy (RON) on visual prognosis and clinical findings in central retinal vein occlusion (CRVO). Methods: Prospective, non-randomised, self-controlled comparative trial. Six patients with ischemic CRVO who had visual acuity (VA) less than or equal to 0.1 and duration of CRVO at least 1 month, and 6 patients with non-ischemic CRVO who maintained their VA less than or equal to 0.1 during the minimal follow-up of 3 months underwent pars plana vitrectomy and RON. LogMAR VA measurement and fluorescein angiography were performed before and after surgery. Automated perimetry was obtained from 4 patients at the last visit. Main outcome measures were VA and clinical changes in fundus appearance of CRVO evaluated with fundus photography and fluorescein angiography. Results: Radial optic neurotomy was successfully performed in all 12 patients without serious complications. All patients were of clinical improvement of fundus findings. In 11 (92%) patients, a visual improvement of at least 2 lines was observed. After mean follow-up of 9.3 months, mean improvement in VA was 5.1 ± 3.1 lines (range, 2–14 lines). Cystoid macular oedema and degeneration were observed in 8 (67) patients. Four patients, two of whom had preoperative ocular hypertension had raised intraocular pressure controlled with topical antiglaucoma medication. In late postoperative period, one ischemic eye developed vitreous haemorrhage necessitating vitrectomy and endolaser photocoagulation. Automated perimetry revealed segmental visual field defects in all the examined eyes. Conclusions: Radial optic neurotomy in CRVO yields clinical and visual improvement in majority of the patients. Cystoid macular oedema and degeneration are the major factors responsible for restriction of VA improvement. Further randomised and controlled studies with longer follow-up are essential to establish the appropriate timing and indications of RON in CRVO. This study was presented in part at The 3rd Euretina Congress, Hamburg, Germany, 15–17 May 2003     

Radial optic neurotomy as treatment for central retinal vein occlusion

PURPOSE: To review our initial experience with radial optic neurotomy as treatment for retinal vein occlusion. DESIGN: Interventional case series. METHODS: Patient population: five patients (four with central retinal vein occlusion and one with hemiretinal vein occlusion). INTERVENTION: Pars plana vitrectomy with radial optic neurotomy was performed in each case. MAIN OUTCOME MEASURES: Best-corrected visual acuity, presence of macular edema, perfusion status, and time to venous phase of the angiogram were reviewed retrospectively. RESULTS: Mean preoperative visual acuity was 4/200. Preoperatively, the vein occlusion was perfused in one (20%), nonperfused in one (20%), and indeterminate in three (60%). Mean follow-up time was 4.5 months. Mean postoperative visual acuity was 20/400 at last follow-up. Four patients (80%) had improvement in visual acuity and one (20%) worsened. Two patients (40%) improved to 20/80 postoperatively. In four cases (80%), disk congestion improved and intraretinal hemorrhage reabsorbed more quickly than would be expected without treatment. Time to the venous phase of fluorescein angiography improved slightly in three cases (60%) postoperatively. Perfusion status as determined by fluorescein angiography was not significantly altered postoperatively. One patient (20%) had resolution of macular edema postoperatively as shown by volumetric optical coherence tomography. One patient developed choroidovitreal neovascularization and one developed iris neovascularization postoperatively, both of which responded to panretinal photocoagulation. CONCLUSIONS: Radial optic neurotomy may improve visual acuity in eyes with central retinal vein occlusion, although choroidovitreal neovascularization from the neurotomy site can occur. Further study is needed to determine its role in the management of central vein occlusion.     

A pilot study of pars plana vitrectomy,intraocular gas,and radial neurotomy in ischaemic central retinal vein occlusion

BACKGROUND/AIMS: There is no effective treatment for ischaemic central retinal vein occlusion (CRVO). The two major negative outcomes are neovascular glaucoma (NVG) and severe central visual loss. In this study pars plana vitrectomy (PPV), mild panretinal photocoagulation, and intraocular gas injection were employed to prevent NVG. The potential role of incision of the lamina cribrosa (radial neurotomy) for visual recovery was examined. METHODS: Eight eyes of seven patients with ischaemic CRVO had PPV, mild panretinal photocoagulation, and intraocular perfluoropropane gas injection. Four eyes had radial neurotomies performed. The patients were examined by fundus photography, fundus fluorescein angiography, optical coherence tomography, and Goldmann visual field analysis. RESULTS: No patients suffered from neovascular glaucoma. Visual recovery was seen in patients with and without neurotomy but some patients had cataract extraction to allow visualisation for PPV. Fundus photography demonstrated reduced engorgement of retinal veins in two of the patients with neurotomy and one with PPV alone. Optical coherence tomography demonstrated macular oedema in three patients with neurotomy and all patients with PPV alone. Segmental visual field loss was seen in one patient with neurotomy suggesting damage to the optic nerve head. CONCLUSIONS: PPV is safe in ischaemic CRVO. Combined with mild PRP and intraocular gas injection the risk of neovascular glaucoma is low. Neurotomy can be added to try to improve the chances of recovery of central vision but may cause additional peripheral visual field loss.     

Radial optic neurotomy for ischaemic central vein occlusion

BACKGROUND/AIMS: Ischaemic central retinal vein occlusion (CRVO) accounts for 20-50% of all CRVO. No treatment has been proved to be effective. The efficacy of radial optic neurotomy (RON) was evaluated in eyes with ischaemic CRVO. METHODS: 10 patients with ischaemic CRVO underwent RON. After pars plana vitrectomy, a microvitreoretinal blade was used to incise the scleral ring, cribriform plate, and adjacent sclera at the nasal edge of the optic disc. Best corrected visual acuity (BCVA), intraocular pressure (IOP), fluorescein angiography (FA), multifocal electroretinography (mfERG), and optical coherence tomography (OCT) were measured preoperatively and at 1, 3, and 6 months postoperatively. RESULTS: No visual improvement was noted in the eyes that underwent RON. FA and mfERG showed no increase in retinal perfusion or retinal function postoperatively. Mean macular central thickness changed from 841 (SD 170) mum preoperatively to 162 (SD 34) microm at the sixth postoperative month. One patient had retinal central artery perforation intraoperatively. One patient developed neovascular glaucoma. CONCLUSION: RON in ischaemic CRVO did not improve visual function (by mfERG) or visual acuity although macular thickness did improve. This technique may be associated with potential risks. Randomised studies are needed to corroborate these results.