视网膜分支静脉并同组分支动脉阻塞一例

视网膜分支静脉阻塞(branchretinalveinocclusion,BRVO)是常见的视网膜血管病,但视网膜分支动脉阻塞(branchretinalarteryocclusion,BRAO)的发生率较少,BRVO合并同组BRAO则尚未见报道。我院眼科经眼底荧光血管造影(fundusfluorescenceangiography,FFA)检查诊断一例,具有典型的临床症征,现报道如下:患者女60岁主因右眼突然视物模糊15d,于2006年1月10日来我院眼科门诊。既往高血压病12y,口服药物治疗,血压控制在140/90mmHg左右,无糖尿病,心脏病及肝肾疾病史。视力:右眼0.2,左眼0.5。双眼外眼正常,角膜透明,前房清,深度正常,双侧瞳孔…     

视网膜分支动脉阻塞1例

患者男性,63岁。因右眼突发无痛性视力下降3天,于2006年8月29日就诊于我院,门诊以“右眼颞下支视网膜动脉阻塞”收入院。患者既往高血压史2年,未系统治疗。否认既往眼病史。入院检查:血压135/75mmHg(1mmHg=0.133kPa),实验室检查:甘油三酯1.09mmol/L,总胆固醇1.04mmol/L,葡萄糖5.19mmol/L,均在正常值范围内。眼科查体:视力:右眼0.05,左眼1.0,眼压:右眼14mmHg,左眼15mmHg。右眼:角膜透明,瞳孔圆,直径约3mm,对光反应存在,晶状体密度高。眼底检查:视盘边界清楚,色泽正常,颞下方视网膜横行羽毛状灰白色水肿区,累及黄斑区,颞下方视网膜动脉及…     

视网膜分支动脉阻塞视力预后相关因素分析

目的：研究视网膜分支动脉阻塞(branch retinal artery occlusion,BRAO)患眼视力预后的相关因素分析。

方法：选取2015-06/2017-06来我院就诊并诊断为视网膜分支动脉阻塞的患者68例。收集患者的年龄、性别、发病时间等基本信息及初诊时最佳矫正视力、眼底彩色照相、频域OCT及OCTA等眼科检查结果。OCTA检查采用RTVue XRAVANTI仪进行。选择视网膜血流成像扫描模式,扫描区域分别为黄斑区3mm×3mm。随访时间为6mo,随访时检查最佳矫正视力。

结果：患者就诊时基线视力：轻度视力损害(≥0.5)为69%,中度视力损害(0.1～0.4)为24%,重度视力损害(<0.1)为7%; 随访预后视力的轻、中、重度损害分别为75%、19%、6%。影响预后视力的相关因素分析：就诊时基线视力(r=0.776,P<0.001)、浅层视网膜毛细血管黄斑区拱环存留度(r=-0.003,P<0.001)、深层视网膜毛细血管黄斑区拱环存留度(r=-0.003,P<0.001)、黄斑区浅层毛细血管密度(r=-0.034,P=0.029)及黄斑区深层毛细血管密度(r=-0.014,P=0.012)与预后视力密切相关。性别、年龄、就诊时间、黄斑中心凹厚度、视网膜动脉受阻位置(颞上或颞下)以及是否发现明确视网膜血管动脉栓子与预后视力无相关性(r=-0.273、0.01、0、0.82、0.41、0.109,均P>0.05)。

结论：BRAO患眼黄斑拱环存留度、黄斑区毛细血管密度和发病早期视力与预后视力密切相关。     

成功抢救视网膜分支动脉阻塞1例

1、病历摘要 患者，男，59岁，因“右眼视力骤降半天，伴上方视野缺损”于2005年3月29日入院。入院检查：右眼上方1／2视力为弱光感，下方1／2视力为0．1，右眼压正常，眼前节正常，瞳孔圆，对光反射迟钝。右眼扩瞳后眼底示：视乳头边界清，色正常，A：V≈1：（2-3），呈银丝状，右眼视网膜颞下支动脉闭塞，可见栓子，后极部视网膜水肿，色灰白，黄斑区暗红色水肿（见图1）。     

吸食冰毒致视网膜分支动脉阻塞

患者男性,35岁。吸食冰毒后左眼上方幕状黑影3天来诊。视力：双眼0.4,J1,矫正视力1.0。双眼前节未见异常,左眼视盘鼻侧视网膜水肿,呈灰白色（图1）。Octopus视野检查示左眼颞侧跨水平中线暗点（图2）。荧光素眼底血管造影检查示左眼视网膜动脉鼻侧分支充盈迟缓,     

视网膜分支动脉阻塞合并毛细血管前小动脉阻塞治疗一例

患者，女，54岁。因左眼突然视物不清3d，于2001年2月2日来诊。全身体检未见异常。眼部检查：右眼视力1．0，左眼0．03，不能矫正。双眼前节未见异常。右眼底仅视网膜动脉稍细、反光增强。左眼屈光问质清，视盘边界模糊，色泽蜡黄。视网膜静脉轻度怒张，动脉细，黄斑部及后极部网膜较多“棉絮斑”，视网膜苍白水肿。化验检查：肝肾功能、血糖和血脂均正常。荧光素眼底血管造影：右眼正常。左眼ARCT15．6S仅颞上动脉主干充盈，16，8s伴行静脉出现层流，其他动脉充盈延迟达39s，静脉充盈迟缓。黄斑雾样水肿，早期荧光透见度降低。视盘晚期高荧光。诊断：左眼视网膜分支动脉阻塞合并毛细血管前小动脉阻塞。     

视网膜分支静脉阻塞61例临床分析

目的 分析视网膜分支静脉阻塞的临床特点。方法 回顾性分析本院1994年4月至2004年2月61例(61只眼)视网膜分支静脉阻塞的病例。结果 81．97％的病例发病年龄≥50岁,91．8％的分支静脉阻塞发生于动静脉交叉点为正交叉者,67．21％的病例发生于视网膜颞上分支静脉。视网膜分支静脉阻塞合并症的发生率与阻塞部位密切相关。结论 视网膜分支静脉阻塞患者的预后取决于其并发症的程度和范围。     

视网膜黄斑分支静脉阻塞

本文报告黄斑分支静脉阻塞４４例，分析了该病的临床表现和视力预后。黄斑分支静脉阻塞与主干分支静脉阻塞相同，恒发生在动，静脉交叉处。本组阻塞点处动脉位于静脉之上者占９３．０２％，阻塞部位以位于黄斑等第二分支者最多占５９．１％，。     

视网膜分支静脉阻塞合并视网膜脱离的临床分析

目的 分析视网膜分支静脉阻塞(BRVO)合并视网膜脱离(RD)的临床特征及有效的治疗方法.方法 收集2004年11月至2007年10月治疗的有完整随访观察资料的18例(18只眼)BRVO合并RD的病例,采用常规三通道闭合式玻璃体切割手术,其中6例联合白内障超声乳化吸出术,合并黄斑裂孔的患眼行内界膜剥离,术后1、2周,1、2、3、6月随访,平均随访4.8月,观察患者的视力、眼底、眼压、玻璃体后脱离,术中术后并发症、及术后视网膜复位等情况.结果 全部病例于术中均发现裂孔,单个孔、多发孔各9例,孔源性视网膜脱离17例,牵引性视网膜脱离1例,黄斑孔5例,黄斑孔中合并黄斑囊样水肿1例,合并黄斑前膜2例.18例中发现纤维血管膜生长的15例,玻璃体不完全性后脱离粘连牵拉视网膜的12例,黄斑水肿6例,其中合并黄斑前膜2例.BRVO发生于颞上的6例,鼻上6例,上半侧3例,颞下2例,颢上合并颞下1例.18例中术后视力提高12例,视力稳定3例,视力下降3例,术后最佳矫正视力HM3例、0.1-0.39例、0.3以上6例.一次手术视网膜复位的16例,2例于硅油取出时发现局限性视网膜脱离,再次填充C3F8后视网膜复位.结论 视网膜分支静脉阻塞合并视网膜脱离的临床表现较复杂,术前眼底情况不明确,视网膜裂孔及多发性裂孔的发生率较高,多数病例玻璃体后脱离不完全粘连牵拉视网膜,且合并纤维血管膜的增生,玻璃体手术或联合手术是适合的治疗方法,可取得较好的临床疗效.     

多阻塞点视网膜分支动脉阻塞一例

视网膜分支动脉阻塞（branch retinal artery obstruction,BRAO）中老年人多发,多为单一阻塞点,国内尚未见发生多个阻塞点BRAO的报道。成都中医药大学附属医院眼科收治1例26岁的多个阻塞点BRAO患者,较为罕见,患者发病2d后就诊,错过了最佳治疗时机,但通过中西医结合治疗取得了较好的疗效,报告如下。     

前部缺血性视神经病变并发视网膜分支动脉阻塞1例

目的:报告1例前部缺血性视神经病变(anterior ischemicoptic neuropathy,AION)并发视网膜分支动脉阻塞(branchretinal artery obstruction,BRAO)。方法:患者,女,42岁,因视力障碍进行如下眼科检查:眼底照相、荧光血管造影(fluorescent angiography,FAG)和视野测试。结果:第一次就诊时,患者视盘肿胀,动脉循环完整,发病1wk后,视网膜下支动脉开始萎缩并火焰状出血加剧。16mo后,视盘呈萎缩性改变,此外,发现视网膜下分支动脉血管影一条。结论:AION并发BRAO可造成动脉循环的机械性压迫。     

A case of branch retinal artery obstruction complicated after anterior ischemic optic neuropathy

AIM: To report a case of branch retinal artery obstruction (BRAO) complicated after anterior ischemic optic neuropathy (AION). METHODS: A 42 year-old woman who complained of visual disturbance was performed ophthalmological examinations such as fundus photography, fluorescent angiography (FAG) and visual field test. RESULTS: At first visit, disc swelling was noted and arterial circulation was intact, however, 1 week after onset, the inferior branch retinal artery began to shrink and the flame hemorrhage intensified. Sixteen months later, the optic disc evidenced an atrophic change; additionally, a ghost vessel in the inferior branch retinal artery was found. CONCLUSION: We report a case of complications of BRAO arising after AION which caused the mechanical compression on the arterial circulation.     

Treatment of neovascularization secondary to branch retinal vein obstruction

Fifty patients who developed preretinal or papillary neovascularization following tributary vein occlusion were treated by laser photocoagulation. Areas of non-perfused retina within the distribution of the obstructed vein were identified by fluorescein angiography and ablated using moderately intense laser photocoagulation burns. In forty-six patients there was satisfactory atrophy of both prerentinal and papillary neovascularization without further complication or vitreous haemorrhage. Four patients who responded poorly to laser photocoagulation did so either because areas of ischaemic retina were inadequately treated or because they were unamenable to laser photocoagulation e.g., sited in the parafoveal region. Ablation of ischaemic perimacular retina together with associated intraretinal microvascular abnormalities aided the resolution of macular oedema in 19 patients. No post-operative complications could be attributed to laser photocoagulation excepting the development of fine perimacular retinal folds in one patient.     

Central retinal vein obstruction and carotid artery disease

Thirty-seven consecutive patients (39 eyes) with a central retinal vein obstruction (CRVO) were studied in a cross-sectional fashion with intravenous fluorescein angiography and digitial subtraction carotid angiography. Among the 35 patients (37 eyes) with acceptable studies, 24 eyes, (64%) had an ischemic CRVO, 12 (33%) demonstrated a nonischemic CRVO, and one (3%) was indeterminate. A 17% incidence of ipsilateral atherosclerotic carotid artery obstruction greater than or equal to 50% was associated with both the ischemic (4/24 eyes) and nonischemic (2/12 eyes) groups. Overall, 13 of 35 (37%) patients with CRVO had demonstrable common or internal carotid artery atherosclerosis, an incidence no higher than found in a historical control sample studied postmortem. However, this incidence rose to 50% in patients with an ischemic CRVO and decreased to 17% in those with the nonischemic variety.     

Combined central retinal artery-central vein obstruction

The cases of 23 patients with unilateral combined central retinal artery-central retinal vein obstruction are described. Criteria for the abnormality included: a history of relatively sudden visual loss; superficial retinal whitening in the posterior pole in combination with a cherry spot; and intraretinal blood, generally associated with dilated and/or tortuous retinal veins. In five instances (22%) the obstructions developed after retrobulbar injection. Among the 21 patients with followup for at least 6 months, or until the onset of neovascularization of the iris, 17 (81%) developed rubeosis iridis.Late histopathology was obtained in two eyes. Hemorrhagic necrosis of the retina was observed in some areas of the posterior pole and attenuation of the inner retinal layers, similar to that seen with late central retinal artery obstruction, was noted elsewhere. Periphlebitis of the central retinal vein within the optic nerve was found in each case.     

Combined occlusion of branch retinal artery and vein secondary to prepapillary arterial loops

A middle-aged diabetic and hypertensive man presented with diminished vision in the left eye. Fundus examination revealed prepapillary arterial loops, but with features of venous rather than arterial occlusion. Fluorescein angiography and optical coherence tomography confirmed the presence of a branch retinal vein occlusion along with two branch retinal artery occlusions. The resultant macular edema responded well to intravitreal triamcinolone and laser photocoagulation though the visual improvement was moderate.     

The relationship between the visual prognoses of branch retinal artery obstruction and foveal thickness on OCT

Purpose

To determine the correlation between the prognosis of branch retinal artery obstruction (BRAO) and the foveal thickness or outer nuclear layer (ONL) thickness on optical coherence tomography (OCT).

Methods

Twenty-one eyes (21 patients) in patients with resolved, non-complicated BRAO and a normal control of 10 eyes (10 volunteers) were used in this study. The average macular thickness, foveal thickness and ONL thickness at central fovea were measured in both the patients and the control group using spectral domain OCT. The thickness between the patient group and the control group were compared and correlation between the best corrected visual acuity (BCVA) and each thickness was determined.

Results

The average age of the patients was 52 ± 5.8 years. The average macular thickness, foveal thickness and ONL thickness at the central fovea of the patients were significantly (p < 0.001, p = 0.023, p = 0.021, respectively) thinner than that of the control group. Both the foveal thickness (r_s = 0.56, p = 0.008) and ONL thickness (r_s = 0.86, p < 0.001) were significantly correlated with BCVA. There was no significant correlation between the average macular thickness and BCVA.

Conclusions

The foveal thickness and ONL thickness at the fovea was positively correlated with the BCVA in patients with resolved BRAO.     

Digital subtraction carotid angiography and retinal arterial obstruction

Thirty-one consecutive patients with retinal arterial obstruction were studied with digital subtraction angiography (DSA). Among the 29 patients in whom DSA was technically acceptable, 45% (13/29) demonstrated evidence of carotid stenosis or an atherosclerotic plaque ipsilateral to the eye with the retinal arterial obstruction. In 21% of cases (6/29 patients) the stenosis was 60% or greater. The incidences of carotid atherosclerosis were similar among the central and branch retinal arterial groups.