视电生理对视网膜静脉阻塞分型的临床意义

本文观察了３２例视网膜静脉阻塞病人患眼（静脉郁滞性视网膜病变与缺血性视网膜病变）与对侧健眼的暗视ＥＲＧ及振荡电位。发现（１）ｂ波波幅及ｂ／ａ值患眼较对侧眼显著下降，且ｂ波峰时值明显延长。（２）ＯＰＳ各波幅患眼较对侧眼显著下降，Ｏ１，Ｏ２，Ｏ４峰时值明显延长。（３）ＨＲ型较ＶＳＲ型ｂ波波幅及ｂ／ａ波波幅比值显著下降。（４）ＨＲ型较ＶＳＲ型Ｏ１，Ｏ２波幅值显著下降。这些对判断ＲＶＯ分型有价值，对不能行     

视网膜静脉阻塞合并黄斑水肿患者黄斑区微结构改变与视力的相关性分析

目的　观察视网膜静脉阻塞合并黄斑水肿患者黄斑区微结构的光学相干断层扫描（ｏｐｔｉｃａｌｃｏｈｅｒｅｎｃｅｔｏｍｏｇｒａｐｈｙ,ＯＣＴ）特征,探讨黄斑区微结构的改变与视力的关系。方法　采用ＯＣＴ对４６例（４６眼）视网膜静脉阻塞合并黄斑水肿患者进行黄斑区微结构检查,分析黄斑水肿形态,对不同形态黄斑水肿的患者进行比较,以患眼作为黄斑水肿组,对侧眼作为对照组,分析黄斑区微结构各参数与视力的相关性。结果　ＯＣＴ扫描结果显示４６眼视网膜静脉阻塞合并黄斑水肿的患者黄斑区微结构表现为３种形态,１２眼为黄斑囊样水肿,１０眼为浆液性神经上皮层脱离,２４眼为混合型水肿即黄斑囊样水肿伴浆液性神经上皮层脱离。对照组黄斑中心凹视网膜厚度、黄斑中心凹１ｍｍ环平均视网膜厚度及平均视网膜容积分别为（１８０．８１±１３．３５）μｍ、（２３８．７２±１６．７５）μｍ及（０．１７±０．０３）ｍｍ３,而黄斑水肿组分别为（５４１．２６±１２５．６８）μｍ、（４７３．６１±１３３．４２）μｍ及（０．３８±０．１４）ｍｍ３,两组比较差异均有统计学意义（均为Ｐ＝０．０００）。根据患者黄斑区微结构形态表现分组研究发现,浆液性神经上皮层脱离患者ＢＣＶＡ最好,为（０．５３±０．０９）ＬｏｇＭＡＲ,其次为黄斑囊样水肿患者（０．６４±０．１６）ＬｏｇＭＡＲ,而混合型患者最差（１．０２±０．２４）ＬｏｇＭＡＲ,３组之间差异有统计学意义（Ｐ＝０．００８）。浆液性神经上皮层脱离患者中心凹视网膜厚度、黄斑中心凹１ｍｍ环平均视网膜厚度及平均视网膜容积最小,其次为黄斑囊样水肿患者,而混合型患者３个指标均最大,３组之间差异均有统计学意义（均为Ｐ＝０．０００）。对黄斑部微结构的改变与ＢＣＶＡ进行相关性分析发现:黄斑中心凹视网膜厚度、黄斑中心凹１ｍｍ环平均视网膜厚度、黄斑中心凹１ｍｍ环平均视网膜容积、ＩＳ／ＯＳ断裂长度及外界膜断裂长度与ＢＣＶＡ（ＬｏｇＭＡＲ）均呈正相关（ｒ＝０．５４６,Ｐ＝０．０００;ｒ＝０．５８２,Ｐ＝０．０００;ｒ＝０．５２３,Ｐ＝０．０００;ｒ＝０．８３４,Ｐ＝０．０００;ｒ＝０．７５８,Ｐ＝０．０００）。黄斑水肿形态与ＢＣＶＡ呈正相关（ｒ＝０．６４１,Ｐ＝０．０００）,单纯的浆液性神经上皮层脱离患者ＢＣＶＡ最好,混合型的患者病变最重,ＢＣＶＡ也最差。结论　视网膜静脉阻塞所致的黄斑水肿表现形态不同,ＯＣＴ可以对黄斑部微结构改变进行定量分析,黄斑区形态改变与视力密切相关。     

视网膜脱离成功复位1年以上患眼低视力与黄斑区脉络膜厚度的关系

目的　使用深部增强成像频域光学相干断层扫描（ｅｎｈａｎｃｅｄｄｅｐｔｈｉｍａｇｉｎｇｓｐｅｃｔｒａｌｄｏｍａｉｎｏｐｔｉｃａｌｃｏｈｅｒｅｎｃｅｔｏｍｏｇｒａ-ｐｈｙ,ＥＤＩＳＤ-ＯＣＴ）观察孔源性视网膜脱离成功复位１ａ以上低视力患眼黄斑中心凹下脉络膜厚度（ｓｕｂｆｏｖｅａｌｃｈｏｒｏｉｄａｌｔｈｉｃｋｎｅｓｓ,ＳＦＣＴ）,分析其与低视力的关系。方法　将南昌爱尔眼科医院２０１０年１月到２０１４年３月孔源性视网膜脱离成功复位术后１ａ以上最佳矫正视力（ｂｅｓｔｃｏｒｒｅｃｔｅｄｖｉｓｕａｌａｃｕｉｔｙ,ＢＣＶＡ）＜０．３的患者７２例（７２眼）纳入研究。行双眼ＢＣＶＡ及ＥＤＩＳＤ-ＯＣＴ扫描ＳＦＣＴ检查。分析患眼与对侧健眼术后末次随访的ＢＣＶＡ与ＳＦＣＴ的相关性。结果　患眼术后末次随访ＳＤ-ＯＣＴ检查显示,７２眼中,黄斑中心凹正常者３眼（４．２％）;外层视网膜微结构异常者６９眼（９５．８％）。患眼术后末次随访ＢＣＶＡ,转换为５分记录视力为３．５９±０．５１,同期健眼为４．９４±０．１１;患眼术后末次随访ＳＦＣＴ为（１６４．４７±６２．９５）μｍ,对侧健眼ＳＦＣＴ为（２３５．４７±４２．４０）μｍ;患眼与对侧健眼术后末次随访ＢＣＶＡ、ＳＦＣＴ差异均有统计学意义（均为Ｐ＜０．０５）。患眼术后末次随访ＢＣＶＡ与ＳＦ-ＣＴ有相关性（Ｐ＜０．０５）。患眼黄斑区外层视网膜微结构异常眼与正常眼的ＢＣＶＡ、ＳＦＣＴ差异均无统计学意义（均为Ｐ＞０．０５）。结论　孔源性视网膜脱离成功复位术后１ａ以上低视力眼的ＳＦＣＴ薄,且与ＢＣＶＡ存在相关性;其视力的恢复可能要晚于ＥＤＩＳＤ-ＯＣＴ下观察到的外层视网膜微结构的恢复。     

视网膜电图在视网膜中央静脉阻塞分型中的应用价值

我们选择不同的刺激条件，对３２例早期视网膜中央静脉阻塞（ｃｅｎｔｒａｌｒｅｔｉｎａｌｖｅｉｎｏｃｃｌｕｓｉｏｎ，ＶＲＶＯ）患者进行视网膜电图（ｅｌｅｃｔｒｏｒｅｔｉｎｏｇｒａｍ，ＥＲＧ）的检测。缺血型ＣＲＶＯｌ３例的ａ、ｂ波潜伏期延长，ｂ波振幅明显下降；非缺血型ＣＲＶＯ１９例的ａ、ｂ波潜伏期延长，ｂ波振幅表现为轻度降低、升高或正常。提示ｂ波振幅和ｂ／ａ值是区分缺血型与非缺血型ＣＲＶＯ的最敏感指标。我们还探讨了ＥＲＧ在早期ＣＲＶＯ分型中的应用价值。     

彩色多普勒成像技术检测视网膜静脉阻塞眼血流动力学的变化

目的探讨视网膜静脉阻塞（ｒｅｔｉｎａｌｖｅｉｎｏｃｃｌｕｓｉｏｎ，ＲＶＯ）患者视网膜中央动脉（ｃｅｎｔｒａｌｒｅｔｉ－ｎａｌａｒｔｅｒｙ，ＣＲＡ）和视网膜中央静脉（ｃｅｎｔｒａｌｒｅｔｉｎａｌｖｅｉｎ，ＣＲＶ）血流动力学特征及其意义。方法使用ＡＴＬ－ＨＤＩ３０００彩色多普勒诊断仪，检测ＲＶＯ患者患眼４８只、对侧临床健康眼３９只及正常对照眼４０只的ＣＲＡ收缩期峰值血流速度（ｐｅａｋｓｙｓｔｏｌｉｃｖｅｌｏｃｉｔｙ，ＰＳＶ）、舒张末期血流速度（ｅｎｄ－ｄｉａｓｔｏｌｉｃｖｅｌｏｃｉｔｙ，ＥＤＶ）和血管搏动指数（ｐｕｌｓａｔｉｌｉｔｙｉｎｄｅｘ，ＰＩ），ＣＲＶ最大血流速度（ｍａｘｉｍｕｎｖｅｌｏｃｉｔｙ，Ｖｍａｘ）。结果ＲＶＯ患眼、对侧临床健康眼ＣＲＡ的ＰＳＶ和ＥＤＶ均显著低于正常对照眼，ＲＶＯ患眼ＰＩ显著高于正常对照眼；ＲＶＯ患眼ＣＲＡ的ＰＳＶ显著低于ＲＶＯ对侧临床健康眼，ＲＶＯ患眼ＰＩ显著高于ＲＶＯ对侧临床健康眼；ＲＶＯ患眼、对侧临床健康眼ＣＲＶ的Ｖｍａｘ均显著低于正常对照眼。结论ＲＶＯ患眼和对侧临床健康眼血流动力学异常。彩色多普勒成像技术可作为其早期诊断的重要手段     

Lucentis联合视网膜光凝治疗视网膜分支静脉阻塞继发黄斑水肿

目的　观察玻璃体内注射Ｌｕｃｅｎｔｉｓ联合局部视网膜光凝治疗视网膜分支静脉阻塞（ｂｒａｎｃｈｒｅｔｉｎａｌｖｅｉｎｏｃｃｌｕｓｉｏｎ,ＢＲＶＯ）合并黄斑水肿的疗效。方法　回顾性分析我院ＢＲ-ＶＯ合并黄斑水肿的患者２４例２４眼,予以玻璃体内注射１０ｇ?Ｌ－１Ｌｕｃｅｎｔｉｓ０．０５ｍＬ１次,７ｄ后行局部视网膜光凝。观察联合治疗前与治疗后１个月最佳矫正视力、黄斑中心凹区视网膜厚度（ｃｅｎｔｒａｌｍａｃｕｌａｒｔｈｉｃｋｎｅｓｓ,ＣＭＴ）、Ｐ１波的振幅密度及潜伏期的变化。结果　联合治疗前最佳矫正视力为０．１３±０.１０,治疗后１个月为０．２９±０．２１,较治疗前明显提高（Ｐ＜０．０１）,其中１３眼（５４．２％）最佳矫正视力提高３行。联合治疗前黄斑中心凹厚度为（５８５±１５４）μｍ,治疗后黄斑中心凹厚度降为（３８３±１７３）μｍ（Ｐ＜０．０１）。联合治疗后１环、２环、３环Ｐ１波振幅密度均较治疗前明显提高,潜伏期均明显缩短,差异均有统计学意义（均为Ｐ＜０．０５）。玻璃体内注射后３眼出现结膜下出血,１眼白内障加重。结论　玻璃体内注射Ｌｕｃｅｎｔｉｓ联合视网膜局部光凝治疗ＢＲＶＯ合并黄斑水肿,可快速降低ＣＭＴ,提高视力,并发症少。     

视电生理对视网膜静脉阻塞分型的临床意义

本文观察了３２例视网膜静脉阻塞病人患眼（静脉郁滞性视网膜病变与缺血性视网膜病变）与对侧健眼的暗视ＥＲＧ及振荡电位。发现①ｂ波波幅及ｂ／ａ值患眼较对侧眼显著下降，且ｂ波峰时值明显延长。②ＯＰＳ各波幅患眼较对侧眼显著下降，Ｏ１、Ｏ２、Ｏ４峰时值明显延长。③ＨＲ型较ＶＳＲ型ｂ波波幅及ｂ／ａ波波幅比值显著下降。④ＨＲ型较ＶＳＲ型Ｏ１、Ｏ２波幅值显著下降。这些对判断ＲＶＯ分型有价值，对不能行荧光造影者，以及早期治疗、预后判断有重要临床意义。     

相对性传入性瞳孔反应缺陷测定在视网膜中央静脉阻塞分型中的应用

相对性传入性瞳孔反应缺陷（ｒｅｌａｔｉｖｅａｆｆｅｒｅｎｔｐｕｐｉｌｌａｒｙｄｅｆｅｃｔ，ＲＡＰＤ）是视交叉前瞳孔对光反应传入纤维受损的共同特征。我们利用由两片光学偏振片组合而成的衰减器将ＲＡＰＤ检测定量化，对３２例单眼视网膜中央静脉阻塞（ｅｅｎｔｒａｌｒｅｔｉｎａｌｖｅｉｎｏｃｃｌｕｓｉｏｎ，ＣＲＶＯ）患者进行检测。结果表明：１３例缺血型ＣＲＶＯ的ＲＡＰＤ均＞０．７５对数单位，其中１０例（７７％）＞０．９对数单位；１９例非缺血型ＣＲＶＯ的ＲＡＰＤ均＜０．７５对数单位，其中１６例（８４％）＜０．６对数单位，表明ＲＡＰＤ是ＣＲＶＯ分型的敏感指标。     

缺血型与非缺血型视网膜分支静脉阻塞患者黄斑区血流对比

目的　应用光学相干断层扫描血管成像（optical coherence tomography angiography,OCTA）观察缺血型和非缺血型视网膜分支静脉阻塞（branch retinal vein occlusion,BRVO）黄斑区深浅层视网膜血流密度、深浅层血流比（deep-superficial flow ratio,DSFR）及浅层黄斑中心凹无灌注区（foveal avascular zone,FAZ）面积的差异。方法　将临床确诊为颞侧BRVO患者45例45眼纳入研究,依据荧光素眼底血管造影（fundus fluorescein angiography,FFA）结果将患眼分为两组,其中缺血型BRVO 23例23眼（缺血组）、非缺血型BRVO 22例22眼（非缺血组）。另选取与其年龄、性别相匹配的健康22人（22眼）为对照组。对所有入选者均行OCTA检查,扫描以黄斑中心凹为中心3 mm×3 mm的范围,以设备自带软件自动识别并测量此区域内深浅层血流密度及浅层FAZ面积,再计算出DSFR。比较缺血组、非缺血组及对照组各区域内深浅层黄斑区血流密度、DSFR、FAZ面积的差异。结果　三组黄斑区浅层和深层总血流密度、最严重无灌注区DSFR及浅层FAZ面积缺血组分别为（39.82±5.01）%、（41.61±6.28）%、0.95±0.20、（0.30±0.10）mm²,非缺血组分别为（39.26±5.07）%、（42.48±5.77）%、1.11±0.23、（0.32±0.19）mm²,对照组分别为（49.00±2.72）%、（53.05±3.26）%、1.08±0.10、（0.32±0.13）mm²。与对照组相比,缺血组和非缺血组深浅层血流密度均明显降低,差异均有统计学意义（均为P<0.05）,而浅层FAZ面积均无明显差异（均为P>0.05）。非缺血组DSFR与对照组无明显差异;而缺血组最严重无灌注区DSFR较非缺血组和对照组明显下降,差异均有统计学意义（均为P<0.05）。缺血组与非缺血组相比,深浅层血流密度及浅层FAZ均无明显差异（均为P>0.05）。结论　缺血型BRVO较非缺血型BRVO的黄斑区血流缺失更重,且深层较浅层更重;DSFR可作为BRVO血流改变异常新的生物标志物,可反映深浅层血管的相对损伤。     

经颅多普勒超声观察单侧重度颈内动脉狭窄时眼动脉血流改变

目的　通过经颅多普勒超声（ｔｒａｎｓｃｒａｎｉａｌＤｏｐｐｌｅｒ,ＴＣＤ）对单侧重度颈内动脉狭窄（ｉｎｔｅｒｎａｌｃａｒｏｔｉｄａｒｔｅｒｙｓｔｅｎｏｓｉｓ,ＩＣＡＳ）的患者进行眼动脉血流的检测,观察眼动脉血流与眼部缺血性疾病及颈内动脉狭窄程度的关系。方法　将经颈动脉彩色多普勒超声检查确诊为单侧重度ＩＣＡＳ的３１例及颈内动脉完全闭塞的１９例患者纳入研究。利用ＴＣＤ检查ＩＣＡＳ侧眼动脉血流方向、收缩期峰值血流速度（ｐｅａｋｓｙｓｔｏｌｉｃｖｅｌｏｃｉｔｙ,ＰＳＶ）及阻力指数（ｒｅｓｉｓｔａｎｃｅｉｎｄｅｘ,ＲＩ）,对比分析眼动脉逆向血流（ｒｅ-ｖｅｒｓｅｄｏｐｈｔｈａｌｍｉｃａｒｔｅｒｙｆｌｏｗ,ＲＯＡＦ）患眼及对侧眼眼动脉ＰＳＶ及ＲＩ值,同时对眼动脉血流方向与眼部缺血以及ＩＣＡＳ程度的关系进行分析。结果　经ＴＣＤ检查发现ＲＯＡＦ２４眼,其中单侧重度ＩＣＡＳ者９眼,颈内动脉完全闭塞者１５眼,ＲＯＡＦ在颈内动脉完全闭塞组更易出现,差异有统计学意义（χ２＝１１．７６,Ｐ＝０．００１）。２４例ＲＯＡＦ患者的阻塞侧ＰＳＶ值为（３８．６８±１１．５８）ｃｍ?ｓ－１,与健侧的（３３．５３±２．７４）ｃｍ?ｓ－１相比差异有统计学意义（ｔ＝２９．７３,Ｐ＝０．０００）;阻塞侧ＲＩ值为０．６０±０．１０,与健侧的０.７８±０.１０相比差异有统计学意义（ｔ＝－６．２０,Ｐ＝０．０００）。２４只ＲＯＡＦ眼中５８．３％有明确的眼部缺血体征,而２６只正流患侧眼中该比例为１５．４％,ＲＯＡＦ组患眼更容易出现眼部缺血体征（χ２＝９．９９,Ｐ＝０．００２）。利用Ｌｏｇｉｓｔｉｃ回归预测ＲＯＡＦ与眼部缺血的关系:回归系数为０．２１１（χ２＝１２．２６,Ｐ＝０．０００）,ＯＲ值为１．２３５。结论　当出现ＲＯＡＦ时,提示重度ＩＣＡＳ甚至完全闭塞;ＲＯＡＦ的流速越快,提示眼部出现缺血性病变的几率越大。     

Retina tomography after vitrectomy for macular edema of central retinal vein occlusion

PURPOSE AND OBJECTIVE: To report retina tomography after vitrectomy for macular edema in central retinal vein occlusion (CRVO). PATIENTS AND METHODS: Five patients with macular edema caused by CRVO were examined using optical coherence tomography (OCT) through their clinical courses. RESULTS: The retinal thickness through the fixation was reduced in all 5 eyes. Preoperatively, the retina thickness at the foveola was more than 500 microm in three eyes and more than 1000 microm in 2 eyes. The retina thickness was reduced to 311+80 microm within two weeks on average. Visual acuity was improved by two or more lines in 3 of 5 eyes. CONCLUSION: Vitrectomy is worthy of consideration when macular edemas are prolonged in patients of CRVO. OCT is a useful instrument for management and treatment of macular edema.     

曲安奈德玻璃体注射治疗视网膜中央静脉阻塞继发黄斑水肿

目的 观察玻璃体腔曲安奈德注射(intravitreal triamcinolone acetonide,IVTA)治疗视网膜中央静脉阻塞(central retinal vein occlusion,CRVO)继发的黄斑水肿的近期疗效和并发症.方法 对30例(30只眼)CRVO继发的严重黄斑水肿患者,患眼行IVTA 4mg/0.1ml,观察治疗前和治疗后1 d、3 d、1周、1个月、3个月时患者的最佳矫正视力、眼压、眼内炎性反应、晶体、眼底改变,光学相干断层扫描(optic coherenttomography,OCT)测定黄斑区视网膜厚度变化.结果 30只眼中,有22只眼(73%)视力提高,3只眼(10%)视力不变,2只眼(7%)继发性青光眼,2只眼(7%)并发性白内障,1只眼(3%)视网膜脱离.LogMAR视力治疗前为0.78±0.50,治疗后1周、1个月、3个月时分别为0.62±0.48,0.45±0.37,0.31±0.28.黄斑中心凹平均厚度治疗前为(589±132)μm,治疗后1周、1个月、3个月时分别为:(341±122)μm;(201±61)μm;(162±41)μm.治疗前后比较差异有统计学意义(P＜0.01).30只眼中有5只眼(17%)治疗后暂时性眼压轻度升高,经局部药物短期治疗后恢复正常;2只眼(7%)继发性青光眼,给与小梁切除术治疗;2只眼(7%)并发性白内障;1只眼(3%)视网膜脱离,给与激光光凝治疗.结论 IVTA可以在短期内有效地治疗CRVO继发的黄斑水肿,但其并发症不容忽视.     

Central retinal vein occlusion in young adults (papillophlebitis).

We performed a retrospective study of 103 cases of central retinal vein occlusion (CRVO) in young, nondiabetic adults that were followed for at least six months. Of these patients, 64% were men and 36% were women. While visual acuity was usually good, 33 eyes (32%) had a final visual acuity of 20/200 or worse, including 6 eyes (6%) with a final visual acuity of no light perception. Ocular complications included chronic cystoid macular edema, macular pigmentary changes (37%), sheathing of retinal vessels (22%), venous collaterals of the disc (33%), macular hole formation (1%), neovascularization of the disc (1%), retina (1%), and iris (19%), neovascular glaucoma (8%), and vitreous hemorrhage (7%).     

Long-term visual outcomes of vitrectomy for cystoid macular edema due to nonischemic central retinal vein occlusion

PURPOSE: To report the long-term surgical outcome of vitrectomy for cystoid macular edema due to nonischemic central retinal vein occlusion (CRVO). METHODS: A retrospective chart review of 25 consecutive eyes (25 patients) with cystoid macular edema due to nonischemic CRVO treated with vitrectomy was performed. All patients underwent a pars plana vitrectomy with the creation of a posterior vitreous detachment if still attached. Simultaneous phacoemulsification with intraocular lens implantation was also performed in phakic eyes. The main outcome measures were best-corrected visual acuity (BCVA) and changes in macular edema shown by contact-lens biomicroscopy. The mean follow-up time was 49 months (range, 16-108). RESULTS: The median BCVA before surgery was 0.31 and the median BCVA at last follow-up was 0.67. The BCVA at the last follow-up improved at least two Snellen lines in 17 (68%), remained unchanged in 4 (16%), and worsened in 4 (16%). The BCVA was 20/40 or better in 3 eyes (12%) preoperatively and in 18 eyes (72%) at the last follow-up. During the follow-up, four patients progressed to ischemic CRVO; one of them had neovascular glaucoma requiring surgical intervention. CONCLUSION: The data indicate that vitrectomy appears to be a possibly effective treatment in some eyes with cystoid macular edema associated with nonischemic CRVO.     

The capillary blood flow in ischaemic type central retinal vein occlusion: the effect of laser photocoagulation

PURPOSE: To determine the effect of photocoagulation on retinal blood flow (RBF) in eyes with ischaemic type central retinal vein occlusion (CRVO). PATIENTS AND METHODS: Retinal blood flow was measured in 12 eyes with CRVO, 12 fellow eyes and 12 eyes of 12 age-matched healthy subjects using the Heidelberg retinal flowmeter (HRF). Microvascular blood flow values (volume, flow, velocity) were recorded from the upper temporal retina and macula. Eyes were re-examined 1 month after photocoagulation. We investigated whether there was a difference in RBF measurements before and after photocoagulation treatment. RESULTS: In eyes with CRVO, mean RBF values (volume, flow and velocity) obtained from the upper temporal retina increased significantly after treatment (paired t-test, p < 0.05). In contrast, mean RBF values from the macula were unaffected by photocoagulation (paired t-test, p > 0.05). Retinal blood flow values from the upper temporal retina obtained from control subjects were significantly higher than the values in eyes with CRVO before and after photocoagulation (unpaired t-test, p < 0.05), but there was no significant difference between control subjects and CRVO patients in RBF values from the macula (unpaired t-test, p > 0.05). Mean RBF values were significantly higher in CRVO patients' fellow-eyes before photocoagulation in the eyes with CRVO (paired t-test, p < 0.05) but were lower than in age-matched healthy control eyes (unpaired t-test, p < 0.05). Macular blood flow did not differ between the eyes with CRVO and fellow eyes (paired t-test, p > 0.05). CONCLUSION: Laser photocoagulation increased retinal blood flow in eyes with CRVO, but RBF did not reach normal values. Photocoagulation was found to have no effect on RBF in the macular area.     

视网膜中央静脉阻塞黄斑损害的光学相干断层扫描图像观察

目的 观察视网膜中央静脉阻塞(central retinal vein occlusion,CRVO)所致黄斑损害的光学相干断层扫描(optical coherence tomography,OCT)检查的图像特征。 方法 38例经间接检眼镜和荧光素眼底血管造影(fundus fluorescein angiography,FFA)检查确诊的CRVO患者接受了OCT检查。所有操作集中在黄斑区，以通过中心凹的等长度和等角度间隔的4线扫描为基础，并依据个体情况进行改变扫描线长度、角度及扫描方式的附加扫描。 结果 15只眼表现为黄斑中心凹囊泡样改变，6只眼表现为黄斑区神经上皮脱离，11只眼黄斑区神经上皮不同程度增厚，4只眼黄斑中心凹形态大致正常，神经上皮层间有细小液性暗腔，2只眼神经上皮显著增厚，层间大量液性腔隙，黄斑前膜组织增生。 结论 CRVO黄斑损害的主要OCT图像特征为黄斑囊样水肿、神经上皮脱离以及继发黄斑前膜和色素上皮的改变。了解这些特征性改变有助于对CRVO黄斑损害的诊断和评估。 (中华眼底病杂志, 1999, 15: 201-204)     

玻璃体腔注射TA联合激光治疗非缺血型CRVO继发黄斑水肿

目的:评价玻璃体腔注射曲安奈德(intravitreal triamcinolo-ne acetonide,IVTA)联合激光治疗非缺血型视网膜中央静脉阻塞继发黄斑水肿的临床效果。方法:将非缺血型视网膜中央静脉阻塞继发黄斑水肿56眼随机分为两组:IVTA联合532半导体激光黄斑部光凝(治疗组)30眼,单独行532半导体激光黄斑部光凝治疗(对照组)26眼。每组在治疗前后查最佳矫正视力、眼压、眼底荧光血管造影(fluorescein fundus angiography,FFA)了解黄斑部荧光渗漏情况、光学相干断层扫描(optic coher-ent tomography,OCT)测量黄斑区视网膜厚度变化。治疗组为先行黄斑格栅样光凝,2wk后进行IVTA4mg。结果:治疗后3mo时,在治疗组中,23眼(77%)视力提高,7眼(23%)视力不变;FFA示黄斑部荧光渗漏明显减轻;黄斑中心凹平均厚度为(170±32)μm。在对照组中,15眼(58%)视力提高,11眼(42%)视力不变;FFA示黄斑部荧光渗漏减轻;黄斑中心凹平均厚度为(223±57)μm。两组视力变化及黄斑中心凹平均厚度改变比较差异有统计学意义(χ2=4.20,χ2=5.13,P<0.01)。结论:IVTA联合激光治疗非缺血型视网膜中央静脉阻塞继发黄斑水肿效果较好。     

Serous macular detachment in central retinal vein occlusion

PURPOSE: To describe serous macular detachment in patients with central retinal vein occlusion (CRVO) by using optical coherence tomography (OCT). METHODS: This study included 22 eyes of 22 consecutive patients with CRVO. The patients underwent complete ophthalmic examination, including corrected visual acuity measurement, slit-lamp biomicroscopy, indirect ophthalmoscopy, color fundus photography, fluorescein angiography, and OCT. RESULTS: Twenty-two patients (22 eyes) with cystoid macular edema associated with CRVO (10 women and 12 men; age range, 48-75 years [average, 62.5 years]) made up the study population. Angiographically, all patients had typical cystoid macular edema. At the time of initial examination, no patient was suspected of having a serous macular detachment associated with CRVO. The mean foveal thickness as determined by OCT was 567.4 microm. In all cases, the increased thickness of the retina was related primarily to the hyporeflective intraretinal cavities. A serous macular detachment composed of retinal elevation over a nonreflective cavity with minimal shadowing of the underlying tissues was seen in 18 eyes (81.8%). CONCLUSION: OCT findings in this study showed that serous macular detachment in patients with CRVO occurs more often than previously thought. Our data also showed that noncontact fundus ophthalmoscopy and fluorescein angiography were not sufficient to diagnose serous macular detachment in CRVO.     

Patchy ischemic retinal whitening in acute central retinal vein occlusion

OBJECTIVE: To describe a new fundus abnormality in nonischemic central retinal vein occlusion and its pathophysiologic basis. DESIGN: Retrospective, observational case series. PARTICIPANTS: Eleven consecutive patients from a community-based retina referral practice who had central retinal vein occlusion (CRVO) and patchy ischemic retinal whitening (PIRW) and 225 consecutive patients from the same practice with CRVO and no PIRW. RESULTS: Patchy ischemic retinal whitening occurs in younger patients with nonischemic CRVO (P < 0.0003) and is associated with better visual outcomes than without PIRW (P = 0.0201). Patchy ischemic retinal whitening has a perivenular distribution in the macula, has no fluorescein angiographic correlate in milder cases, can occur before any retinal hemorrhages or macular edema, and resolves in 2 to 4 weeks. Cilioretinal arteriolar insufficiency is a common finding associated with PIRW (5/11 cases). The laboratory evaluation of patients with PIRW is generally normal. CONCLUSIONS: Patchy ischemic retinal whitening is a useful fundus sign of nonischemic CRVO that can precede other signs. Familiarity with this sign and its correlates will allow accurate diagnosis and counseling of affected patients.     

Central retinal vein occlusion associated with cilioretinal artery occlusion

PURPOSE: To describe the clinical characteristics and pathogenesis of central retinal vein occlusion (CRVO) associated with cilioretinal artery occlusion (CLRAO). METHODS: The study included 38 patients (38 eyes) who had CRVO associated with CLRAO and were seen in our clinic from 1974 to 1999. At their first visit to our clinic, all patients provided a detailed ophthalmic and medical history and underwent comprehensive ophthalmic evaluation, color fundus photography, and fluorescein fundus angiography. At each follow-up visit, the same ophthalmic evaluations were performed, except for fluorescein fundus angiography. RESULTS: Of 38 eyes, 30 had nonischemic CRVO, 5 had ischemic CRVO, and 3 had nonischemic hemi-CRVO. Patients with nonischemic CRVO were significantly younger (mean age +/- SD: 45.3 +/- 16.0 years) than those with ischemic CRVO (72.3 +/- 9.2 years; P = 0.001) and those with nonischemic hemi-CRVO (64.7 +/- 7.5 years; P = 0.018). At least one third of the patients gave a definite history of episode(s) of transient visual blurring before the onset of constant blurred vision. Initially, the ophthalmoscopic and fluorescein angiographic findings were similar to those seen in CRVO and hemi-CRVO, except that all these eyes had retinal infarct in the distribution of the cilioretinal artery; its size and site varied widely. Fluorescein angiography typically showed only transient hemodynamic block and not the typical CLRAO. During follow-up, visual acuity improved markedly in nonischemic CRVO (P < 0.001) and nonischemic hemi-CRVO but deteriorated in ischemic CRVO. Retinopathy resolved spontaneously in 22 eyes with nonischemic CRVO (mean duration +/- SD: 42.0 +/- 101.0 months), in 2 eyes with ischemic CRVO (15.4 +/- 4.5 months), and in 1 eye with nonischemic hemi-CRVO. Retinociliary collaterals developed in 30% of eyes with nonischemic CRVO, in 40% of eyes with ischemic CRVO, and in 66% of eyes with nonischemic hemi-CRVO. CONCLUSION: CRVO associated with CLRAO constitutes a distinct clinical entity. The pathogenesis of CLRAO in CRVO is due to transient hemodynamic blockage of the cilioretinal artery caused by a sudden sharp rise in intraluminal pressure in the retinal capillary bed (due to CRVO) above the level of that in the cilioretinal artery.