OCT在视网膜中央动脉阻塞中的应用及意义

目的：探讨光学相干断层扫描(optical coherence tomography,OCT)在视网膜中央动脉阻塞疾病中的应用及内层视网膜厚度与患者治疗前后视力是否存在相关性。

方法：回顾性分析视网膜中央动脉阻塞患者11例,收集患者发病至入院时间、初始视力、治疗后视力,行黄斑OCT测量黄斑区视网膜厚度,进行定量测定和分析黄斑中心凹、距中心小凹3mm及6mm上、下、鼻、颞侧扇形面积下视网膜全层的平均厚度。内层视网膜厚度采用人工手动测量。距黄斑中心小凹1mm处内层视网膜,鼻侧记为N1,颞侧记为T1,距黄斑中心小凹3mm处内层视网膜,鼻侧记为N3,颞侧记为T3。

结果：8/11的患者视力均有不同程度的提高; 患眼黄斑中心凹及鼻侧3mm扇形面积下视网膜全层厚度比健眼增厚(P<0.05),余各区域面积下视网膜全层厚度与健眼相比无统计学差异(P>0.05); 患眼N1、N3及T3均比健眼增厚(P<0.05); 黄斑中心凹厚度患眼与健眼的差值与治疗后视力呈负相关,r=-0.740(P<0.05); 患眼与健眼N1、T1、T3的差值与治疗后视力呈负相关,r_N1=-0.692,r_T1=-0.754,r_T3=-0.657(P<0.05)。

结论：OCT检查对视网膜中央动脉阻塞患者治疗后视力的恢复有提示作用。     

OCTA characteristics in non-arteritic central retinal artery occlusion and correlation with visual acuity

AIM: To observe the retinal and choroidal circulations in patients with non-arteritic permanent central retinal artery occlusion (NA-CRAO) via optical coherence tomography angiography (OCTA) and analyze their correlation with visual acuity. METHODS: Sixty-two eyes with clinically confirmed acute NA-CRAO were included in the study and divided into: A type (mild n=29), B type (moderate n=27) and C type (severe n=6) based on the degree of visual loss, retinal edema, and arterial blood flow delay in fundus fluorescence angiography (FFA). Contralateral healthy eyes were used as the control group. Best-corrected visual acuity (BCVA), slit lamp microscopy, indirect ophthalmoscopy, fundus color photography, OCTA, and FFA were performed. Spearman’s correlation analysis was used to determine the correlations between retinal and choroidal vessels and visual acuity. RESULTS: There were no statistically significant differences in age, gender, and intraocular pressure among the three types and the control group (P>0.05). Vessel density in deep capillary plexus (VD-DCP) significantly decreased (P<0.05) in all three types of NA-CRAO patients compared to the control group. Vessel density in superficial vascular plexus (VD-SVP) significantly decreased (P<0.05) in type A patients and choriocapillaris flow area significantly decreased (P<0.05) in type B and type C patients compared to the control group; while outer retinal flow areas significantly increased in the type A (P<0.05) and decreased in type C patients (P<0.05). The retinal thickness significantly increased in type C group (P<0.05). The VD-SVP at fovea in the type A was significantly lower than both of type B and C. The VD-SVP at nasal parafovea in type A and B was significantly lower than type C (P<0.05). The logMAR BCVA of type A was significantly better than that of type B and C groups (P<0.05). Spearman’s correlation analysis showed that the logMAR BCVA was positively correlated with VD-SVP at fovea (r=0.679, P=0.031) and nasal parafovea (r=0.826, P=0.013). CONCLUSION: OCTA is valuable for assessing retinal ischemia, and evaluating visual impairment. Deep retinal vasculature is commonly affected in all NA-CRAO types. VD-SVPs at fovea and nasal parafovea can serve as reliable markers of visual impairment in NA-CRAO.     

A review of central retinal artery occlusion: clinical presentation and management

Central retinal artery occlusion (CRAO) is an ophthalmic emergency and the ocular analogue of cerebral stroke. Best evidence reflects that over three-quarters of patients suffer profound acute visual loss with a visual acuity of 20/400 or worse. This results in a reduced functional capacity and quality of life. There is also an increased risk of subsequent cerebral stroke and ischaemic heart disease. There are no current guideline-endorsed therapies, although the use of tissue plasminogen activator (tPA) has been investigated in two randomized controlled trials. This review will describe the pathophysiology, epidemiology, and clinical features of CRAO, and discuss current and future treatments, including the use of tPA in further clinical trials.     

Combined central retinal vein and cilioretinal artery occlusion

We present a case of combined central retinal vein and cilioretinal artery occlusion which, due to the absence of the temporal branch retinal artery, was initially misdiagnosed as a combined central retinal vein occlusion and temporal branch retinal artery occlusion. Given that – in contrast to cases of combined central artery and central retinal vein occlusion – the prognosis for cilioretinal artery occlusion with central retinal vein occlusion is quite good, this case illustrates the importance of suspecting an unusual condition in the presence of a combined occlusion.     

视网膜中央动脉阻塞早期眼动脉溶栓治疗前后视力改变

目的 选择性眼动脉溶栓治疗早期视网膜中央动脉阻塞患者治疗前后视力变化的临床研究.方法 收集2006年9月至2009年7月经确诊并在发病12h内进行溶栓的视网膜中央动脉阻塞患者.所有患者均记录年龄、性别、全身病史、发病至溶栓时间、眼底镜检查、眼底荧光血管造影(fundus fluorescein angiography,FFA)、术后48 h复查视力、眼底镜检查、眼底荧光血管造影,术后1月复查,记录视力及眼底检查,并进行对比.结果 24例患者发病至溶栓的平均时间(8.39±3.24)h,溶栓治疗前臂一视网膜动脉显影时间明显延长,平均(29.34±7.83)s,治疗48 h后眼底血管造影显示,臂一视网膜动脉充盈时间明显缩短,平均(15.48±4.33)s,与治疗前对比差异显著有统计学意义;治疗后1月,复查荧光血管造影,臂一视网膜动脉显影时间平均为(15.76±3.12)s,与治疗48 h对比无差异.发病时视力低于0.05患者20例占83.3％,0.05～0.1者4例占16.7％,治疗48 h后视力低于0.05患者7例29.2％,0.05～0.1,6例占25％,高于0.1者11例占45.8％,其中2例高于0.5,占8.3％;治疗前及治疗后48 h患眼视力获得提高的病人数量对比变化显著有统计学意义P＜0.01,治疗后1月视力低于0.05患者5例占20.8％,0.05～0.1者6例占25％,超过0.1患者13例占54.2％,与治疗前患者视力相比差异显著有统计学意义.结论 局部动脉溶栓治疗视网膜中央动脉阻塞,可及时有效恢复早期阻塞的视网膜神经组织的血流灌注,改善早期视网膜中央动脉阻塞患者的视力,但此研究缺乏与传统治疗方法对照研究,同时该治疗方法还需要多中心大样本的临床对比.     

白内障超声乳化吸出术后视网膜中央动脉阻塞风险因素分析

目的　探讨白内障超声乳化吸出术后发生视网膜中央动脉阻塞（ｃｅｎｔｒａｌｒｅｔｉｎａｌａｒｔｅｒｙｏｃｃｌｕｓｉｏｎ,ＣＲＡＯ）的风险因素及相关预后情况。方法　本研究为病例对照研究。收集２００９年１月至２０１５年１２月在郑州大学第二附属医院眼科行白内障超声乳化吸出术的连续病例８３６５例,纳入７２８３例（９１００眼）,统计ＣＲＡＯ例数７例（即ＣＲＡＯ组）,利用随机数列法,以１８比例在纳入病例中随机选取５６例（５６眼）作为对照组,若入选者为ＣＲＡＯ患者则剔除,继续选择。统计白内障核硬度、术前最佳矫正视力、眼压、麻醉方式、术中后囊膜破裂情况、全身疾病等,采用Ｆｉｓｈｅｒ确切概率法、ｔ检验、Ｌｏｇｉｓｔｉｃ回归等统计学方法分析ＣＲＡＯ的风险因素。结果　球后麻醉（风险比３．３０７,Ｐ＝０．０１２）、后囊膜破裂（风险比４．２８７,Ｐ＝０．０３４）是术后ＣＲＡＯ发生的危险因素,高血压、颈动脉斑块患者ＣＲＡＯ发生率与对照组相比差异均有统计学意义（均为Ｐ＜０．０１）,是危险因素。而术前最佳矫正视力（≤０．０１）、高度近视、青光眼病史、糖尿病病史等差异对于ＣＲＡＯ发生并无统计学意义（均为Ｐ＞０．０５）。结论　高血压、颈动脉斑块、球后麻醉及后囊膜破裂均为白内障超声乳化吸出术后ＣＲＡＯ发生的危险因素。     

吗来酸桂哌奇特治疗视网膜中央动脉阻塞的疗效观察

目的 探讨吗来酸桂哌奇特治疗视网膜中央动脉阻塞(CRVO)的疗效.方法 64例CRAO患者随机(随机数字表)分成2组.对照组:给予吸氧、降眼压及扩张血管等常规治疗;实验组除上述治疗外,加用吗来酸桂哌奇特240 mg静脉滴注,每日1次,14 d.记录治疗前及治疗3个月后患者的最佳矫正视力、视觉电生理oPS波、荧光素眼底血管造影(FFA)动脉充盈时间.结果 实验组和对照组的视觉电生理oPS波,FFA的动脉充盈时间,治疗后比治疗前均有改善且有统计学差异(P＜0.05).治疗有效病例数实验组、对照组分别为(28例,18例),临床有效率分别为(82.35％,56.25％),实验组比对照组高且有统计学差异(P＜0.05).结论 吗来酸桂哌奇特治疗视网膜CRAO安全且有较好的临床疗效.     

创伤性视网膜中央动脉阻塞1例报告

本文报告1例钝器眼伤后出现的视网膜中央动脉阻塞,这种病症比较稀少,文献报告中也不多见。视网膜中央动脉阻塞尽管少见但对视力影响非常大,在对急性创伤性视力减退进行鉴别诊断时应考虑到这种情况。     

复方樟柳碱治疗视网膜中央动脉阻塞40例

目的比较复方樟柳碱球后注射联合颞浅动脉旁注射与单纯颞浅动脉旁注射治疗视网膜中央动脉阻塞对其视力、视野等影响的差别,评价其对视网膜中央动脉阻塞的疗效。方法观察2005年10月至2007年10月20例20眼采用复方樟柳碱球后注射联合颞浅动脉旁注射的治疗组与20例20眼单纯颞浅动脉旁注射治疗的对照组视网膜中央动脉阻塞患者的视力、视野变化,并进行对照分析。结果复方樟柳碱球后注射联合颞浅动脉旁注射与单纯颞浅动脉旁注射有效率进行比较分析,用药后7 d和用药后14 d治疗组与对照组比较,差异有统计学意义,在提高视力,改善视野上,2组差异有统计学意义。结论应用复方樟柳碱球后注射联合颞浅动脉旁注射治疗视网膜中央动脉阻塞是一种有效的治疗方法。     

复方樟柳碱联合尼莫地平治疗视网膜中央动脉阻塞疗效观察

目的探讨应用复方樟柳碱和尼莫地平等综合治疗视网膜中央动脉阻塞的疗效。方法随机将31例（31只眼）视网膜中央动脉阻塞患者分为治疗组18例（18只眼）和对照组13例（13只眼）。对照组采用硝酸甘油、654-2、醋氮酰胺、复方丹参和水蛭地龙治疗,同时输氧等常规治疗;治疗组除应用同对照组相同的药物外,另予复方樟柳碱作患侧颞浅动脉旁皮下注射,全身应用尼莫地平治疗。以视力、视野、眼底改变为疗效判断指标。结果对照组有效率为53．85％,观察组有效率为88．89％。其差异具有显著性意义（P〈0．05）。结论应用复方樟柳碱和尼莫地平等综合治疗视网膜动脉阻塞能够取得较好的疗效。     

超选择眼动脉溶栓介入治疗视网膜中央动脉阻塞

目的评价超选择动脉介入溶栓治疗视网膜中央动脉阻塞的初步疗效。设计回顾性病例系列。研究对象21例(21眼)视网膜中央动脉阻塞患者。主要指标视力及手术并发症。方法经检眼镜检查及荧光素眼底血管造影检查证实为视网膜中央动脉阻塞患者21例,通过Seldinger技术经微导管超选择眼动脉推注尿激酶溶栓治疗。结果21例患者中10例经超选颈内动脉造影显示眼动脉主干狭窄和阻塞,11例眼动脉主干显影,全部患者均成功进行了溶栓治疗。溶栓治疗前、治疗后3天视网膜中央动脉显影时间分别为(38.18±10.86)秒、(12.65±3.30)秒(t=-11.89,P=0.000)。平均随访(3.23±1.26)个月。治疗后4例患者视力>0.25,9例视力不同程度改善,8例视力无变化。结论超选择眼动脉溶栓介入治疗视网膜动脉阻塞可改善患者视力,但需迅速完成内科、神经科及眼科诊断.尽快治疗。     

Branch retinal artery occlusion in a child

Background: Retinal artery occlusive events are unusual in the paediatric population. The average age of their occurence is 60 years and the aetiology most often related to cardiovascular disease.
Case Report: A healthy 11-year-old white girl developed permanent unilateral visual field loss as a result of a branch retinal artery occlusion. An extensive work-up included transthoracic and transoesophageal echocardiograms, routine haematological and biochemical testing including serum lipids, screening for thrombophilia and thrombolysis, as well as autoantibodies, all of which proved to be within normal limits.
Conclusions: Recognition of the underlying aetiology is not always possible, but should be sought as prognosis for vision or survival may rest upon these findings.     

视网膜中央动脉阻塞的荧光血管造影特征

目的 探讨视网膜中央动脉阻塞（ｃｅｎｔｒａｌ ｒｅｔｉｎａｌ ａｒｔｅｒｒｙ ｏｃｃｌｕｓｉｏｎ,ＣＲＡＯ）,患者眼荧光血管造影（ｆｕｎｄｕｓ ｆｌｕｏｒｅｓｃｅｉｎ ａｎｇｉｏｇｒａｐｈｙ,ＦＦＡ）的特征。方法 观察２６例２６眼ＣＲＡＯ患者荧光片的眼底血管充盈情况。结果 ＣＲＡＯ患者ＦＦＡ示：（１）动脉前期明显延长;（２）视网膜动脉完成充盈循环时间延长;（３）视网灾光素充盈前峰;（４）静脉回流迟     

无早期症状的视网膜分支静脉阻塞临床特点

目的观察视网膜分支静脉阻塞(BRVO)中,因不参与引流黄斑区血液,而阻塞早期无症状病例的临床及荧光素眼底血管造影(FFA)特点。方法回顾性分析BRVO病例中因合并玻璃体积血就诊及FFA检查时偶然发现的66例(70只眼)临床资料。结果 66例BRVO病例中,右眼26例,左眼36例,双眼4例。颞上周边支阻塞45只眼,占68.18%;颞下周边支5只眼,占7.58%;鼻上支8只眼,占12.12%;鼻下支12只眼,占18.18%。FFA检查时偶然发现17例,占25.76%;继发玻璃体积血49例,占74.24%。70只眼均发现大小、数量不等的视网膜新生血管。伴增生膜5只眼,占7.58%。合并视盘新生血管3只眼,占4.55%。黄斑前膜4只眼,占6.06%;视网膜裂孔、并继发视网膜脱离6只眼,占8.57%。结论无早期症状BRVO病例,均为BRVO后期并发症,与其它类型BRVO有所不同。     

Bilateral arteritic central retinal artery occlusion in a Chinese patient

Purpose: To report the first case of bilateral central retinal artery occlusion caused by giant cell arteritis in a Chinese patient
Methods: We studied a Chinese patient who had a history of weight loss, calf claudication and sequential right and left central retinal artery occlusion.
Results: The erythrocyte sedimentation rate was greater than 150 mm/h. Temporal artery biopsy confirmed the diagnosis of giant cell arteritis. Systemic steroid prevented further visual loss in the second eye.
Conclusions: We believe that this is the first report in literature on the ophthalmological presentation of giant cell arteritis in a Chinese patient Giant cell arteritis as a cause of central retinal artery occlusion should always be on the list of differential diagnosis, as early diagnosis and treatment may help to salvage the first eye and prevent blindness from developing in the second eye.     

40岁及以下人群视网膜中央静脉阻塞的研究

目的研究≤40岁视网膜中央静脉阻塞（CRVO）患者的临床表现及预后。方法对≤40岁的CRVO患者15例15眼的临床特征进行观察分析,对患眼治疗前后的最佳矫正视力和荧光素眼底血管造影（FFA）不同血管充盈期的臂-视网膜循环时间进行比较,此外对患者的临床表现,包括全身病史和相关的实验室检查进行分析。结果≤40岁的患者发生CRVO具有起病急、视力急剧下降、视网膜出血明显、治疗后患者视力提高显著的特点。患者治疗2个月后对数视力较治疗前明显改善（4.97±0.16vs3.56±0.14）,差异有统计学意义（t=24.912,P〈0.01）。FFA检查显示,动静脉期、静脉期以及静脉晚期的臂-视网膜循环时间治疗前分别为（21.68±2.97）s、（25.12±2.81）s和（28.13±4.37）s,治疗后分别为（13.51±1.87）s、（14.91±2.55）s和（19.10±3.02）s,治疗后较治疗前明显缩短,差异均有统计学意义（t=13.612、t=18.939、t=9.699,P〈0.01）。≤40岁的CRVO患者的原发病包括高血压、糖尿病,精神紧张是主要的发病诱因。无严重并发症。结论≤40岁的CRVO患者挽救视力的关键在于早期发现和及时治疗。     

视网膜分支静脉阻塞的临床分析

目的 为了了解视网膜分支静脉阻塞患者的合并症发生的情况。 方法 回顾性地分析本院1995年10月到1999年10月277例（277只眼）视网膜分支静脉阻塞的病例。 结果 70%以上的病例发病年龄均在55岁以上，81.58%的分支静脉阻塞发生于颞上及颞下象限。分支静脉阻塞合并症的发生率与阻塞的位置密切相关，愈大的分支静脉阻塞，其无灌注区及新生血管的发生率也就愈高。 结论 视网膜分支静脉阻塞黄斑水肿发生在发病的早期，无灌注区的出现多在7～12个月，而新生血管的出现，多半在一年以后，因此对这些患者应当有更长期的追踪观察。 （中华眼底病杂志，2002，18：17-19）     

Delayed filling of retinal and ciliary circulation after central retinal artery occlusion

The filling times of the retinal and choroidal circulation were evaluated in 17 patients with central retinal artery occlusion by means of fluorescein angiography. A correlation between the filling times of the two circulations was found. However, two filling patterns were seen: first, both fillings delayed; second, both fillings normal. It is probable that in the former case an obstructive disease of the carotid arteries exists, while in the latter case an important pathology of the carotid arteries is lacking, favouring a rapid restoration of the retinal circulation. This hypothesis seems to be confirmed by the results of the Doppler velocimetry of the carotid arteries.     

改进型前房穿刺术治疗视网膜中央动脉阻塞临床研究

目的评价随机采用传统治疗方式与改进方式对视网膜中央动脉治疗效果的差异。方法对确诊为视网膜中央动脉阻塞（CRAO）54例（54只眼）患者给于吸氧、局部及全身改善循环治疗,并给予静脉大剂量尿激酶治疗。传统组患者采用常规前房穿刺,改进组采用改进型前房穿刺治疗患眼。观察治疗前后视力变化,进行眼压监测以及荧光素眼底血管造影（FFA）检查。结果对治疗后视力变化分类统计,应用Wilcoxon等级资料秩和检验分析,传统改良组视力较传统改良组视力提高有统计学意义（P〈0．01）。传统改良组前房穿刺后未见并发症增多。治疗后1周进行FFA检查,传统组2只眼,传统改良组5只眼,显示视网膜血管充盈正常。结论改进型前房穿刺术在CRAO的综合治疗中拥有经济,简便,高效的特点。