视网膜动脉阻塞的综合治疗

视网膜动脉阻塞(RAO)是眼科急症,患者视网膜由于缺血、缺氧而视细胞迅速死亡,如未能接受及时而有效的治疗,可能导致不同程度的视力损伤.RAO的传统治疗方法包括扩张血管和降低眼压治疗,前者包括药物治疗及气体吸入,后者包括前房穿刺术或青光眼降眼压药物治疗.除此之外,RAO现有的治疗方法还包括调节植物神经治疗、激光、手术等.溶栓治疗也是各类血管阻塞的治疗方法之一,有研究显示对RAO的患者在一定的时间窗内进行溶栓治疗可以提高视力预后,但同时溶栓治疗也存在诱发脑出血的风险,所以应谨慎选择.另外应注意视网膜中央动脉阻塞患者卒中风险增加的可能,研究显示视网膜中央动脉阻塞风险因素与脑卒中和心血管疾病动脉粥样硬化风险因素基本一致,因此应同时管理有可能引起其他血管疾病的风险因素,必要时应对其进行神经科评估及预防性治疗.     

外伤所致视网膜动脉阻塞的临床特征和疗效观察

外伤致视网膜动脉阻塞(RAO)临床上较少见.由于视网膜动脉阻塞严重程度不一,临床表现复杂多样,容易误诊和漏诊.为了探讨外伤致RAO的临床特征和治疗效果,我们对一组外伤致RAO患者的临床资料进行了回顾分析,现将结果报道如下.     

高血压相关眼病

高血压病对眼部有一系列影响,除直接导致高血压视网膜病变(hypertensive retinopathy,HR)外,还是发生视网膜静脉阻塞(retinal vein occlusion,RVO)、视网膜动脉阻塞(ret-inal artery occlusion,RAO)、缺血性视神经病变(ischaemic optic neuropathy,ION)等其他眼部血管病变的重要危险因素,并增加糖尿病视网膜病变(diabetic retinopathy,DR)发生发展的危险性,而且与青光眼及年龄相关性黄斑变性(age related macular degeneration,AMD)的发病有关。全面认识血压对眼部的影响有助于更好地诊治与高血压相关的眼部疾病。本文对高血压病与这些疾病的关系展开讨论。     

眼底炫彩成像联合光相干断层扫描对视网膜动脉阻塞快速诊断及分类

目的:探讨眼底炫彩成像(MCI)联合光相干断层扫描成像(OCT)在视网膜动脉阻塞(RAO)的快速诊断及分类中的应用。方法:对本院2018-02/2020-07诊断为RAO的患者19例19眼进行回顾性研究。所有患者在经过眼科检查后确诊为RAO,均为单眼发病,其中视网膜中央动脉阻塞(CRAO)13眼,视网膜分支动脉阻塞(BRAO)5眼,睫状视网膜动脉残留的CRAO 1眼。所有患者行最佳矫正视力、裂隙灯、OCT、MCI、FFA及视野检查及分析。结果:经裂隙灯检查,12眼(63%)出现瞳孔对光反射迟钝或消失,16眼(84%)可发现全部或部分后极部视网膜苍白水肿,10眼(53%)可发现视网膜动脉变细。行FFA检查的患者为10例(53%),其余9例未行检查,其中6例患有严重的系统性疾病,2例拒绝检查、1例有药物过敏史。所有患者经MCI及OCT检查可发现特征性眼底表现,OCT特征性改变为弥漫性内层视网膜反射增强与MCI图像绿色缺血区域形成严密的一对一关系。结论:联合MCI及OCT检查可快速确诊RAO,而且结合两者的图像特征可更精确辨认出视网膜缺血区域,有助于疾病分类及预后判断。     

儿童眼球钝挫伤后发生视网膜中央动脉阻塞一例

视网膜动脉阻塞(retinal artery occlusion,RAO)多发生于60岁以上,并多伴有高血压、糖尿病、心脏病、颈动脉粥样硬化的老年人~([1]).     

介入溶栓治疗视网膜血管阻塞性疾病

视网膜血管阻塞性疾病,包括视网膜动脉阻塞(retinalarteryocclusion,RAO)和视网膜静脉阻塞(retinalveinocclusion,RVO)是临床上常见的眼底疾病,很多患者因此丧失视力,严重影响生活质量。以往的传统治疗效果往往不甚理想。近年来,视网膜血管介入溶栓疗法给此类疾病的治疗带来新的希望。1953年,Seldinger创立经皮血管穿刺技术奠定了现代介入诊疗技术的基石。今天,介入治疗已发展到能对内、外、妇、儿、心血管、神经科等诸多疾病的治疗。它是在医学影像设备的引导下,结合临床治疗学原理,通过导管等器材对各种病变所进行的一系列治疗技术,具…     

视网膜中央动脉阻塞诊疗规范:2021美国心脏协会指南解读

美国心脏协会近期发布的2021年“视网膜中央动脉阻塞诊疗规范”，对视网膜中央动脉阻塞的定义、流行病学、危险因素、病理生理、诊断与治疗等做了详细介绍，本文将对该指南进行全面解读。     

急性视网膜动脉缺血的防治研究进展

急性短暂性或永久性视网膜动脉缺血是需要及时诊断和治疗的眼部和全身急症。单眼一过性黑矇属于短暂性视网膜动脉缺血,并不会遗留永久性视功能损害。视网膜中央动脉阻塞和视网膜分支动脉阻塞在大部分患者均会遗留永久性视功能损害。目前的治疗方式包括降眼压、扩血管、高压氧、经静脉或动脉溶栓治疗等,但仍缺乏标准治疗方案。对高危人群应早期一级预防。急性视网膜动脉缺血患者发生继发卒中和不良心血管事件的风险高,应及时发现相关危险因素,积极治疗原发病,采取适当的二级预防措施改善预后。本文对急性视网膜动脉缺血事件的治疗和预防研究进展进行综述,以便为该类疾病的防治和研究提供参考。     

激光击栓术联合尿激酶溶栓法治疗视网膜半侧及分支动脉阻塞

目的 观察Nd:YAG激光击栓术联合尿激酶静脉溶栓治疗半侧及分支视网膜动脉阻塞(RAO)的治疗效果.方法 伴有黄白色栓子的半侧及分支RAO患者34例34只眼纳入本研究.患者临床表现典型,经眼底检查和荧光素眼底血管造影(FFA)检查确诊,病程12 h～9 d.采用美国科以人公司Lumenis调Q Nd:YAG激光器,在O...     

视网膜动脉阻塞传统疗法与新疗法的应用现状

视网膜动脉阻塞(retinal artery occlusion,RAO)是眼科中的一种急症、重症,视力预后较差,致盲率高。有研究表明视网膜组织在缺血缺氧后90min左右可发生不可逆的损害。因此发病后及早就诊、明确诊断、合理治疗及采用先进治疗技术是成功抢救视力的关键。近年来,随着国内外临床实践的研究,出现了许多新的治疗技术,在临床治疗中与传统方法结合发挥了巨大作用,在很大程度上挽救了患者的视力。现我们就临床中出现的视网膜动脉阻塞新治疗技术及与传统方法结合的应用作一综述。     

Circadian incidence of non-inflammatory retinal artery occlusions

Background and Purpose  Myocardial infarction and stroke tend to occur in the morning. We were interested in discovering when the onset of visual loss occurred in patients with retinal artery occlusion (RAO). Assuming that the therapeutic time slot is about 2 to 6 hours, a cumulated incidence during the night might have therapeutic implications. Methods  We retrospectively evaluated the data of 266 patients (175 male and 91 female patients) with non-inflammatory RAO: 211 patients with central retinal artery occlusion (CRAO), 36 patients with branch retinal artery occlusion (BRAO), and 19 patients with hemi-central retinal artery occlusion (hemi-CRAO). Results  Nocturnal visual loss occurred in 25 patients (9.4%). Ocular deterioration during the day was recorded in 173 patients (65.1%). Visual loss at waking was recorded in 59 patients (22.2%). In most patients with short-term latency (≤ 6 hours), RAO also occurred in the daytime (62%). Conclusions  Visual loss due to ocular arterial occlusions can occur at any time. Visual deterioration has been recorded more often during the day than during the night.     

Subject index

Purpose: To investigate the role of inflammation in acute retinal artery occlusion (RAO). Methods: Levels of interleukin (IL)-6, IL-8, and tumor necrosis factor alpha (TNF-α) were measured in serum (n = 14) and aqueous humor (AqH) (n = 8) samples from patients with RAO. Findings were compared with 24 age- and disease-matched patients, 10 healthy subjects (serum), and 16 patients undergoing cataract surgery (AqH). Results: Patients who arrived early (within 4–6 hours of occlusion) had higher serum IL-8 and IL-6 levels than controls; the IL-6 level in the AqH was lower than that of controls, while the IL-8 level was higher. In seven patients for whom both serum and AqH samples were available, serum IL-6 levels were higher than their corresponding AqH levels in most patients arriving within 10 hours of occlusion, and AqH IL-8 levels were higher than the corresponding serum levels in all but one. TNF-α levels were consistently higher in the serum than in the AqH at all time points. Conclusions: Serum IL-8 and IL-6 and AqH IL-8 are elevated immediately following acute RAO. The early local suppression of IL-6 may be related to ocular immune mechanisms.     

炎症与视网膜动脉阻塞的关系

目的 分析白细胞计数和眼部以外的炎症与视网膜动脉阻塞之间的关系。方法 对94例视网膜中央或分支分动脉阻塞患者进行回顾性分析。将患者分为伴有炎症组和不伴有炎症组，并设立年龄和性别配对的对照组。 结果 54例(58%)伴有炎症性疾病，其中只有14例(26%)炎症直接侵犯眼部。白细胞计数在2组视网膜动脉阻塞组中均显著高于对照组(p<0.05)。 结论 眼部以外组织的炎症可能是视网膜动脉阻塞的诱发因素之一。白细胞计数在视网膜动脉阻塞患者中的升高可能是对视网膜缺血性损害的炎症性反应。(中华眼底病杂志,1998,14:159-161)     

Correlation of the history of stroke and the retinal artery occlusion: a nested case-control study

AIM: To investigate the promotion effect and explore its potential mechanism of leucine-rich α-2-glycoprotein-1 (LRG1) on corneal angiogenesis and lymphangiogenesis. METHODS: Corneal neovascularization and lymphatics were induced by establishing alkali burn mouse model. Immunofluorescence staining was performed to detect the location of LRG1 in cornea tissues and to verify the source of LRG1-positive cells. Corneal whole-mount staining for CD31 (a panendothelial cell marker) and lymphatic endothelial hyluronan receptor-1 (LYVE-1; lymphatic marker) was performed to detect the growth of blood and lymphatic vessels after local application of exogenous LRG1 protein or LRG1 siRNA. In addition, expressions of the proangiogenic vascular endothelial growth factor (VEGF) related proteins were detected using Western blot analysis. RESULTS: LRG1 was dramatically increased in alkali burned corneal stroma in both the limbal and central areas. LRG1-positive cells in the corneal stroma were mainly derived from Vimentin-positive cells. Local application of exogenous LRG1 protein not only aggravated angiogenesis but also lymphangiogenesis significantly (P<0.01). LRG1 group upregulated the levels of VEGF and the VEGF receptor (VEGFR) family when compared with the phosphate-buffered saline (PBS) control group. We also found that LRG1-specific siRNA could suppress corneal angiogenesis and lymphangiogenesis when compared with the scramble siRNA-treated group (P<0.01). CONCLUSION: LRG1 can facilitate corneal angiogenesis and lymphangiogenesis through heightening the stromal expression of VEGF-A, B, C, D and VEGFR-1, 2, 3; LRG1-specific siRNA can suppress corneal angiogenesis and lymphangiogenesis in corneal alkali burn mice.     

Traumatic endophthalmitis and the outcome after vitrectomy in young children

AIM: To explore the traumatic endophthalmitis in young children and the outcome of pars plana vitrectomy (PPV). METHODS: Twenty-two eyes of 22 cases of young children consecutive pediatric traumatic endophthalmitis treated and followed up between September 2014 and May 2018 were included. Aqueous humor or vitreous samples were taken for bacterial culture and sensitivity tests. Intravitreal antibiotics (norvancomycin and ceftazidime) injection, combined with 23-gauge PPV, were administered in 22 eyes. Silicone oil (SO; 5000 centistoke) tamponade or perfluoropropane gas (C3F8) was used in all patients. Main outcome measures were best-corrected visual acuity (BCVA) and retinal attachment, the ratio of penetrating injury, and the existence of intraocular foreign body. RESULTS: The mean age of patients was 6.9±2.2 (range, 3-10)y. All injured eyes suffered from penetrating ocular injury with retained intraocular foreign body in one eye. Bacterial culture was positive in only 2 eyes. The mean follow-up time was 21.1±4.7 (range, 12-30)mo. In the primary PPV, intravitreal antibiotics was administrated in all eyes, SO in 18 eyes, and C3F8 in 4 eyes. The secondary operation of SO removal and C3F8 endotamponade was performed in 16 eyes and a second SO endotamponade due to emulsification of the oil and retinal detachment (RD) was operated in 7 eyes underwent 3 to 11.5mo after primary PPV. A third operation was done in 7 eyes. The final intraocular pressure (IOP) was 8.9±1.8 (range, 6.9-11.4) mm Hg. The final BCVAs were 20/200 or better in 5, counting fingers in 2, and light perception to hand movement in 8 eyes. Whose (66.7%) had retinal injury exhibited worse BCVA (P=0.019, Fisher’s exact test). Eyes underwent SO tamponade exhibited worse final BCVA than that with C3F8 in the primary PPV (P=0.026, Fisher’s exact test). CONCLUSION: Traumatic endophthalmitis in children is generally more severe and associated with more complicated surgical procedures. Most patients have retinal injury need multiple operations and the final BCVA is poor. Prevention of ocular trauma, especially in children, is still critical.     

Workup following retinal artery occlusion—experience from an outpatient retina clinic and the delay in workup

Graefe's Archive for Clinical and Experimental Ophthalmology - Acute retinal artery occlusion (RAO) is an urgent ophthalmic condition often indicative of future ischemic pathology. Patients...     

Retinal arterial occlusions in the young: systemic associations in Indian population

Purpose:

To determine the systemic associations in retinal arterial occlusions (RAO) in young Indian individuals less than 40 years of age.

Materials and Methods:

Case records of 32 patients (35 eyes) of less than 40 years, with non-traumatic RAO were analysed. All patients underwent detailed ophthalmic and systemic evaluation including hemogram, lipid profile, coagulation profile, vasculitis screening, carotid Doppler, echocardiogram.

Results:

In the study 21 were males and 11 were females. The age ranged from 11-39 years (Mean 27.6 ± 8.43). Nine (28%) patients were below 20 years of age. Among 35 eyes, 28 (80%) had central retinal artery occlusion (CRAO), three (8.6%) had branch retinal artery occlusion (BRAO), two (5.7%) each had cilio-retinal (CLAO) and hemi-retinal artery occlusion (HRAO). Vision ranged from no perception of light to 20/20. On systemic evaluation, in 21 (65.6%) patients a hypercoagulable state was responsible for the RAO. Conditions leading to a hypercoagulable state included hyperhomocysteinemia (21.9%), hyperlipidemia (15.6%), anticardiolipin antibody (6.2%), antiphospholipid antibody (6.2%), polycythemia, thrombocytosis, protein S deficiency, use of oral contraceptives and renal disorder (3.1% each). Six (18.7%) patients had cardiac valvular defects. Vasculitis screening was positive in three (9.4%) patients. Two (6.2%) had isolated systemic hypertension. In two (6.2%) patients no abnormality could be detected.

Conclusion:

The systemic associations of RAOs in the Indian population were distinctly different from those reported in the Western population. Hyperhomocysteinemia was the commonest association found. Whereas associations reported in the Western population such as cardiac abnormalities, coagulation disorders, hemoglobinopathies and oral contraceptive use were uncommon.     

视网膜急性缺血后神经细胞损伤治疗的时间窗

目的:观察中西医结合综合疗法治疗发病时间较长的视网膜动脉阻塞的临床疗效,并探讨视网膜动脉阻塞治疗的时间窗。方法:采用常规疗法、联合中药、神经修复的综合方法治疗14例15眼连续就诊于中国中医科学院眼科医院一病区的患者,并对其进行回顾性研究,比较并分析治疗后7,14,30d视力结果及治疗前后视野结果。结果:患者13例14眼完成14d治疗,11例12眼完成30d治疗。治疗7d后15眼中有11眼(73.33%)视力改善,14d后14眼中11眼(78.57%)视力改善,治疗30d后12眼中有11眼(91.67%)视力改善。治疗7d与治疗前比较(P<0.01)、治疗14d与7d比较(P<0.05)、治疗30d与14d比较(P<0.05)视力均有显著的提高。14例中12例完成视野检查,治疗后视野平均敏感度较治疗前显著意义的改善(P<0.05)。结论:常规疗法、联合中药、神经修复的综合方法治疗视网膜动脉阻塞有较好疗效,尤其对发病后视网膜水肿未消失之前治疗价值更高,同时治疗时机也不应拘泥在传统概念的发病3d内,或许更长,比如60d。