视神经挫伤后的眼底血管造影

目的：用荧光素眼底血管造影（Fundus fluorescein angiography,FFA)和吲哚青绿血管造影（Indocyanine green angiography,IGGA)探讨视神经挫伤后，视神经及周围视网膜，脉络膜的循环改变。方法：对30例（30只眼）不同程度的眼球挫伤致视神经损伤的患者进行FFA与ICGA同步检查，并对它们的图像进行分析（本组除外脉络膜破裂）。结果：除1例视盘及周围视网膜，脉络膜荧光大致正常外，其余29例均出现了异常的荧光表现。FFA主要表现为：在造影早期视盘呈象限性或全视盘性的荧光充盈不良，后期荧光素渗漏或始终不能充盈，ICGA主要表现为：在FFA显示的视盘象限性弱荧光区的相邻区域脉络膜充盈时间明显延迟；FFA显示的全视盘性的弱荧光，盘周的脉络膜充盈时间明显延长，在局限性脉络膜灌注不良的对应区均出现了视网膜色素上皮（Retinal pigment epithelium,RPE)的损害，而盘周脉络膜灌注不良的区域，有9例相应区视网膜并未出现RPE的损害；有2例合并视网膜分支动脉阻塞；有19例视盘缺血的部分正是“分水区”的位置，占63.3%，本组病例中有80%视力在0.1以下。结论：眼球挫伤不仅可使视神经损伤，其周围的视网膜，脉络膜均可受到损害，应尽早施行FFA与ICGA检查，它可以详细观察，正确判断视神经挫伤后的视盘缺血情况及周围视网膜，脉络膜损害的范围和程度，及时正确地指导治疗。

Angiographic Changes in Optic Disc and Its Surrounding Choroid after Contusion of Optic Nerve

Purpose: To study the angiographic changes in the optic disc and its surrounding choroidoretina after optic nerve contusion with fundus fluorescein angiography(FFA), and indocyanine green angiography(ICGA).Methods: Thirty patients(30 eyes) with various degree of optic nerve damage caused by ocular contusion were examined with FFA and ICGA. (The choroidal rupture were excluded in this study).Results: All patients present some abnormal angiography except one case. The main findings in FFA were hypofluorescein on quadrantal or entire disc in the early phase and leakage or persistent nonperfusion in the late phase. Meanwhile, the choroid surrounding disc was clearly delayed in its choroidal filling time. The retinal pigment epithelium (RPE) damage was observed over the localized abnormally perfused choroid. However, the RPE above the circular area around the disc which was hypofluorescein in ICGA showed no RPE damage in 9 cases. There are 2 cases combined with branche retinal vein occlusion and 19(63% ) cases showed ischemic changes exactly on the location of so-called water separating zone . The visual acuity was not more than 0. 1 in 80% ofthe patients in this study.Conclusions: There is severe optic nerve lesion in the strong ocular contusion, in which the choroidal and retinal arterial circulation has also been seriously damaged. The FFA and ICGA should be conducted in time in order to judge the injury correctly and allow the clinician to better manage the cases.