视网膜中央动脉阻塞性缺血对黄斑区视网膜神经上皮的影响

目的:应用光学相干断层扫描(OCT)探讨视网膜中央动脉阻塞(CRAO)性缺血对黄斑区视网膜组织结构的影响。方法:用OCT对单眼CRAO 2-3d,黄斑区视网膜血液循环未完全恢复的患者 14例(14眼 )和 11例(11眼 )对侧健眼进行经中心小凹的水平和垂直扫描,分别测量及计算中心小凹、中心凹及黄斑的平均视网膜神经上皮层(RNL)厚度。结果:正常眼中心小凹、中心凹及黄斑平均RNL厚度分别为(169.91± 10.96) μm、(176.36± 11.74) μm、(256.45± 16.95) μm;CRAO黄斑区RNL明显增厚,中心小凹、中心凹及黄斑平均RNL厚度分别为(235.64± 47.02) μm、(241.84± 49.36) μm、(401.57± 54.53) μm,与正常眼比较有显著性差异(P <0.05,P <0.01)。 结论:CRAO性缺血明显地改变了黄斑区正常视网膜组织结构,使视网膜神经上皮层细胞水肿.     

超选溶栓治疗视网膜中央动脉阻塞12例临床观察

视网膜中央动脉阻塞(central retinal artery occ lusion,CRAO)是由于血管闭塞、栓子栓塞、眼相对灌注压低、血管痉挛等原因造成的一种公认的预后不良的视网膜缺血性病变,导致视力障碍,致残率较高。近年来,我院采取经血管内超选眼动脉溶栓治疗该病,取得一定的疗效,现报道如下。材料和方法1临床资料:对12例患者行超选择眼动脉插管,局部注入尿激酶溶栓治疗。其中男8例,女4例,年龄44~68岁,发病3~7 d。主要表现为视力骤然减退或视野缺损,部分患者患病前有过1次或多次一过性视力障碍,或眼前闪光及黑朦等症状,眼底镜检查可见视乳头颜色变淡,视网…     

疏血通联合马来酸桂哌齐特治疗视网膜中央动脉阻塞的 疗效观察

目的 观察疏血通注射液联合马来酸桂哌齐特注射液治疗视网膜中央动脉阻塞的疗效。方法 本研究回顾性分析天津市静海区医院2012年12月~2017年2月收治的31例（31眼）CRAO患者的病历资料,所有患者均给予疏血通注射液联合马来酸桂哌齐特注射液等药物治疗,分析治疗1疗程（14 d）后视力恢复情况。结果 31眼CRAO中治愈3眼,显效7眼,有效17眼,无效4眼,总有效率87.10%。结论 疏血通具有抗凝、溶栓、清除自由基、减轻组织缺血/再灌注损伤的作用,马来酸桂哌齐特可缓解血管痉挛、降低血管阻力、增加血流量、降低氧耗,二者联合应用治疗CRAO疗效显著。     

头颅CT在缺血性眼病诊疗中的指导作用

目的探讨头颅CT在视网膜中央动脉阻塞（CRAO）、视网膜中央静脉阻塞（CRVO）和缺血性视神经病变（ION）等缺血性眼病（IOP）中应用的临床价值。方法100例IOP患者，其中CRAO20例，CRVO40例，ION40例：男性69例．女性31例，病程为1小时～8周，平均年龄为56．07岁（标准差8．05岁）。对照组为老年性白内障患者60例（60眼）．未发生缺血性眼病，平均年龄55．96岁（标准差7-39岁）．其中男性45例，女性15例。分析了行头颅CT检查的影像结果。结果在IOP患者中应用头颅CT检出颅脑病变18例，鼻窦黏液囊肿3例，上颌窦恶性肿瘤1例。对照组中检出颅脑病变5例，未检出鼻窦病变。IOP组颅脑病变阳性率明显高于对照组（P〈0．01）。IOP中各亚组颅脑病变阳性率均明显高于对照组（P〈0．01）；CRAO亚组、CRVO亚组及ION亚组两两之间颅脑病变阳性率的差异均有统计学意义（P〈0．05）。结论在缺血性眼病患者中应用头颅CT能检出部分颅脑病变和鼻窦病变．对该类疾病的诊疗具有一定指导作用。     

视网膜缺血再灌注损伤机制的研究进展

视网膜缺血再灌注损伤(RIR)是造成视神经损害和致盲的常见眼科临床疾病病理过程。大量学者通过建立不同的实验模型研究视网膜缺血再灌注损伤的机制,研究发现视网膜缺血再灌注损伤的机制与兴奋性氨基酸、氧自由基、一氧化氮、基因调控、钙超载、炎症因子等因素密切相关。对视网膜缺血再灌注损伤机制的深入研究对临床治疗视网膜缺血再灌注损伤造成的眼科疾病具有非常重要的意义。     

实验性急性脑缺血模型及其研究进展

本文介绍了目前国内外建立鼠实验性急性脑缺血模型的各种方法及其优缺点 ,其中四动脉阻断法、插线法和光化学法是常用的方法 ,予以重点说明 ,并初步介绍了该模型的相关研究     

颜面部美容注射引发眼部并发症解剖分析

目的分析颜面部美容注射后引发视网膜中央动脉阻塞或眼动脉阻塞的颜面部血管吻合解剖学特点。方法回顾性分析2010年6月至2015年6月3例因额面部美容后出现视力急剧下降,经眼底检查、荧光素视网膜血管造影检查确诊为视网膜中央动脉阻塞的患者,分析注射部位血管分布及眶周血管吻合特点。结果 3例患眼均无光感并伴有眼痛或(及)眼球转动痛,视网膜血管造影均表现为完全性中央动脉阻塞;面部美容注射压在开始注射2 s后就大大超过眼动脉收缩压(P0.05);鼻背动脉与内眦动脉多有吻合,内眦动脉常与后睫状长动脉的鼻侧分支吻合。填充物进入上述血管后可经吻合动脉分支进入眼动脉,使得填充物阻塞与眼动脉、视网膜中央动脉、睫状后短动脉及其分支内。结论颜面部美容注射时,注射物可能会进入眶周围动脉,逆行流入眼动脉,造成眼动脉阻塞,或经眼动脉流入视网膜中央动脉、睫状动脉,从而造成严重的眼部并发症。     

光化学栓塞法建立缺血性脑卒中动物模型

背景：实验性缺血性脑卒中动物模型是研究缺血性脑卒中病理机制以及研究开发新治疗方案必不可少的工具,光化学栓塞法制作缺血性脑卒中动物模型操作简便,稳定性好,重复性高,可有针对性的控制梗死灶的位置以及大小,是研究缺血性脑卒中病理机制的良好选择。 目的：建立光化学栓塞法缺血性脑卒中动物模型,对比不同性别小鼠缺血性脑卒中后梗死体积以及行为学表现的异同。 方法：62只昆明小鼠依据检测内容分为病理学检测6只、梗死体积测试16只和行为学测试40只。其中病理学检测小鼠分为假手术组和模型组,各3只;梗死体积测试小鼠分为雌性模型组和雄性模型组,各8只;行为学测试小鼠分为雌性模型组、雌性假手术组、雄性模型组和雄性假手术组,各10只。模型组(含雌性模型组和雄性模型组)小鼠采用光化学栓塞法制备局部缺血性卒中模型,假手术组(含雌性假手术组和雄性假手术组)小鼠不注射孟加拉玫瑰红染料。 结果与结论：尼氏染色显示模型组小鼠梗死中心出现神经元变性坏死,空泡样病理改变,Fluoro-Jade C染色可见模型组小鼠梗死中心中出现变性神经元,且雌性小鼠脑梗死体积显著小于雄性小鼠,模型组小鼠行为运动功能受损程度显著大于假手术组小鼠,其中雌性小鼠运动功能受损程度小于雄性小鼠。表明光化学栓塞法可以成功建立缺血性脑卒中动物模型,且相同条件下缺血性脑卒中对于雄性造成的神经功能损伤更为严重。  中国组织工程研究杂志出版内容重点：肾移植;肝移植;移植;心脏移植;组织移植;皮肤移植;皮瓣移植;血管移植;器官移植;组织工程     

碟脉灵注射液治疗视网膜微循环障碍性病变的疗效观察

目的观察中药碟脉灵注射液对视网膜微循环障碍性疾病的治疗效果。方法对视网膜分支静脉栓塞17例、视网膜分支动脉阻塞3例应用碟脉灵注射液30ml/d静脉注射 ,连续2周。结果视网膜分支静脉栓塞视力平均提高2行 ,视网膜分支动脉阻塞病人配合其他药物治疗视力均提高4行以上。结论碟脉灵注射液在一定程度上能改善视网膜微循环障碍性疾病     

眼部缺血综合征的研究现状

颈动脉狭窄或阻塞所致的眼前后节缺血表现,称为"眼部缺血综合征"(OIS),OIS作为潜在的致盲因素越来越受到重视.眼动脉是颈内动脉的第一个分支.任何引起颈内动脉闭塞的疾病都可能会造成眼部的缺血.颈动脉狭窄及阻塞是引起OIS最常见的原因.急性视网膜中央动脉阻塞引起视力骤降相对容易做出诊断.眼动脉慢性缺血引起视网膜中央动脉、睫状体动脉及脉络膜血管供血障碍,由于临床症状多样,容易被误诊.当OIS合并有颈动脉狭窄等疾病时,如果不能及时的发现和处理,就会导致更为严重的后果.早期对OIS患者进行适当的干预,不但有利于挽救视力,而且有利于减少心脑血管事件发生.     

Intra-arterial Thrombolysis for Central Retinal Artery Occlusion: Two Cases Report

Central retinal artery occlusion (CRAO) causes severe visual loss in affected eye and vision does not recover in more than 90% of the patients. It is believed that it occurs by occlusion of the central retinal artery with small emboli from atherosclerotic plaque of internal cerebral artery. Retina is a part of the brain, thus basically CRAO is corresponding to acute occlusion of intracerebral artery and retinal ischemia is to cerebral stroke. Therefore, intra-arterial thrombolysis (IAT) has been considered as a treatment method in CRAO. Recently, we treated 2 patients diagnosed as CRAO and could achieve complete recanalization on fundus fluorescein angiogram with IAT. Of them, one recovered visual acuity to 20/25. We report our 2 CRAO cases treated with IAT and discuss technical aspects for IAT and management of patient. To the best of our knowledge, this is the first Korean report of IAT for CRAO.     

A case of a cilioretinal artery supplying the entire retina

The cilioretinal artery commonly supplies a small area of the retina, usually the macula. It can serve a valuable purpose in preserving the central vision in central retinal artery occlusion. We describe a case, where the total retinal circulation is from the cilioretinal artery in one eye and an abnormal central retinal artery branching in the other eye. The clinical relevance of cilioretinal artery in the eye is discussed.     

急性脑梗塞动脉内溶栓治疗的临床疗效分析

目的 探讨急性脑梗塞动脉内溶栓治疗的临床疗效与影响因素。方法 288例脑梗死患者均在CT检查厦血管造影基础上接受选择性动脉溶栓治疗，其中在发病后6h以内溶栓者76例，6～24h溶栓者212例。统计两组患者的血管再通率和90天后预后情况。结果 脑血管造影发现血管闭塞245例，其中颈内动脉系统闭塞173例，椎基底动脉（VBA）闭塞72例；溶栓后再通分别为112例、38例。治疗后90天恢复良好者180倒，恢复差者108例。溶栓后颅内出血2例；6h内组和6～24h组患者治疗后90天预后良好率分别为80．35％和71．43％，血管再通率分别为67．86％和59．26％，血管再通中位时间分别为67min和73min。结论 局部动脉溶栓可以明显改善脑梗死患者的预后；仅以发病时间不超过6h作为动脉内溶栓治疗标准不够全面，应当根据病情适当放宽溶栓的时间窗。     

Effects of estradiol and raloxifene on arterial thrombosis in ovariectomized mice

OBJECTIVE: The effects of estrogen and selective estrogen receptor modulators (eg, raloxifene) on arterial thrombosis are not well defined. This study assessed the manner and mechanism by which estrogen and raloxifene affect homeostatic pathways in ovariectomized mice after acute arterial injury. DESIGN: Female mice (3 weeks old) underwent ovariectomy or sham operation. Five days after surgery, mice were assigned to treatment with estradiol (5.3 nmol/kg), raloxifene (2.7 micromol/kg), or placebo (n = 10-12/group). The biological effects of both treatments were assessed by measurements of bone mass and the degree of uterine atrophy. After 4 months of therapy, carotid artery thrombosis was induced by photochemical injury, and the time to vascular occlusion was measured. RESULTS: Both treatments increased bone mineral density (4.1%-7.85%). Reversal of macroscopic uterine atrophy was observed only in estrogen-treated mice. Ovariectomized mice had a shorter time to occlusion compared with sham-operated mice (70.8 +/- 7.4 vs 103 +/- 11.3 min), suggesting accelerated thrombosis. Both estradiol and raloxifene significantly inhibited intra-arterial thrombosis in ovariectomized mice, prolonging the time to occlusion to 136.33 +/- 13.5 and 141.43 +/- 9.26 min, respectively. Cyclooxygenase-2 levels in the lung tissue were significantly increased by both raloxifene and estradiol with endothelial nitric oxide synthase expression being unaltered. Platelet adhesion (measured by surface coverage under a shear rate of 1,800 s for 2 min) was significantly reduced in ovariectomized animals, being 4.63% +/- 1.47%, 5.78% +/- 1.58%, and 10.04% +/- 1.33% for raloxifene, estradiol, and placebo, respectively. CONCLUSIONS: Ovariectomy amplifies thrombosis. We found that 4 months of treatment with both estradiol and raloxifene attenuates intravascular thrombosis. The antithrombotic effect was accompanied by increased expression of cyclooxygenase-2 and suppression of platelet surface adhesion.     

Shift-invariant discrete wavelet transform analysis for retinal image classification

This work involves retinal image classification and a novel analysis system was developed. From the compressed domain, the proposed scheme extracts textural features from wavelet coefficients, which describe the relative homogeneity of localized areas of the retinal images. Since the discrete wavelet transform (DWT) is shift-variant, a shift-invariant DWT was explored to ensure that a robust feature set was extracted. To combat the small database size, linear discriminant analysis classification was used with the leave one out method. 38 normal and 48 abnormal (exudates, large drusens, fine drusens, choroidal neovascularization, central vein and artery occlusion, histoplasmosis, arteriosclerotic retinopathy, hemi-central retinal vein occlusion and more) were used and a specificity of 79% and sensitivity of 85.4% were achieved (the average classification rate is 82.2%). The success of the system can be accounted to the highly robust feature set which included translation, scale and semi-rotational, features. Additionally, this technique is database independent since the features were specifically tuned to the pathologies of the human eye.     

Unilateral central retinal artery occlusion following intravenous streptokinase

A 38-year-old male with acute myocardial infraction who had received streptokinase presented with acute painless diminution of vision in the left eye. Examination revealed features of central retinal artery occlusion on the left side with vision of perception of light. Treatment in the form of systemic and local intraocular pressure lowering agents, retrobulbar xanthinol nicotinate and systemic injection of B-complex resulted in improvement of vision to counting fingers up to one meter. In this case thrombolytic therapy itself led to embolism into the left central retinal artery resulting in its occlusion and eventually optic atrophy and blindness.     

Retinal protective effects of topically administered agmatine on ischemic ocular injury caused by transient occlusion of the ophthalmic artery

Agmatine, an endogenous polyamine and putative neuromodulator, is known to have neuroprotective effects on various neurons in the central nervous system. We determined whether or not topically administered agmatine could reduce ischemic retinal injury. Transient ocular ischemia was achieved by intraluminal occlusion of the middle cerebral artery of ddY mice (30-35 g) for 2 h, which is known to also induce occlusion of the ophthalmic artery. In the agmatine group (N = 6), a 1.0 mM agmatine-containing ophthalmic solution was administered four times daily for 2 weeks before occlusion. In the control group (N = 6), a 0.1% hyaluronic acid ophthalmic solution was instilled at the same times. At 22 h after reperfusion, the eyeballs were enucleated and the retinal sections were stained by terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL). Transient ocular ischemia induced apoptosis of retinal cells in the entire retinal layer, and topically administered agmatine can significantly reduce this ischemic retinal injury. The proportion of apoptotic cells was definitely decreased (P < 0.001; Kruskal-Wallis test). Overall, we determined that topical agmatine application effectively decreases retinal damage in an in vivo ocular ischemic injury model. This implies that agmatine is a good candidate as a direct neuroprotective agent for eyes with ocular ischemic diseases.