视网膜中央动脉阻塞选择性溶栓与常规治疗前后眼底荧光血管造影对比

目的 通过对比选择性眼动脉溶栓及传统常规治疗视网膜中央动脉阻塞.治疗前后眼底荧光血管造影,了解两种治疗方法对视网膜中央动脉血供改善效果.方法 收集病人为非随机对照,根据患者是否同意溶栓或有溶栓禁忌证分为介入溶栓组及常规治疗组,记录所有患者年龄、性别、全身病、发病到治疗时间、患眼眼底检查、治疗前眼底荧光血管造影、治疗48h及1月后的眼底及荧光血管造影结果.对比治疗前后荧光血管造影臂-视网膜显影时间、视网膜动-静脉显影时间.结果 溶栓治疗组发病时臂-视网膜显影时间及视网膜动-静脉显影时间明显延长分别为(28.76±6.81)s及(40.44±8.48)s,治疗48h及1m后复查显示臂-视网膜显影时间(15.36±4.03)s和(15.84±3.42)s,视网膜动-静脉显影时间(22.28±4.63)s和(21.72 4±3.55)s,与治疗前对比显著缩短,差异有统计学意义.常规治疗组发病时臂-视网膜显影时间及视网膜动一静-脉显影时间亦明显延长分别为(29.81±6.08)s及(38.33±7.41)s,治疗48h后臂-视网膜显影时间及视网膜动-静脉显影时间(29.19±6.27)s及(37.85±7.79)s,与治疗前对比差异无统计学意义,治疗1月后臂-视网膜显影时间及视网膜动-静脉显影时间(24.38±6.69)s及(33.56±6.43)s,较治疗前缩短差异有统计学意义,但仍较溶栓组显影时间延长.眼底检查1月复查时均出现视网膜神经纤维层及视盘不同程度萎缩,但常规治疗组损害更重.结论 选择性眼动脉溶栓治疗视网膜中央动脉阻塞可较常规治疗方法更及时有效恢复视网膜血供,缩短眼底荧光血管造影的臂-视网膜显影及视网膜动-静脉充盈时间,但即使迅速恢复了视网膜中央动脉血供,仍可会出现视网膜神经组织不同程度的组织形态学损害.

Comparison of selective intra-arterial fibrinolysis with conventional treatment in patients with acute central retinal artery occlusion by fundus fluorescein angiography

Objective To investigate whether selective intra-arterial fibrinolysis is mort effective in improving retinal circulation than conservative methods in the treatment of acute central retinal artery occlusion (CRAO) by detection method of fundus fluorescein angiography (EVA).Methods In this retrospecrive study,a total of 52 patients with CRAO were divided into two groups according to the different treatment methods.primary study end point was the results of FFA on 48 hours and 1 month after therapy in comparison with those before therapy between two groups.Results In fibrinolysis group,filling time of retinal arterial and venous lamellar filling on FFA 48 hours and 1 month after therapy were significantly shorter than those before therapy,in conventional group,there were no difference in retinal circulation between before and 48h after therapy,however the improvement of retinal circulation was observed at 1 month after therapy.Optic disk and retinal fiber layer damage were present in all patients with CRAO at 1 month follow up visit.Conclusions Selective intra-arterial fibrinolysis can improve retinal circulation significantly compared with conventional management of CRAO,but morphometric damage in all eyes with CRAO are present.