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1.
AIMS: To evaluate the ocular axial length as a risk factor for development of central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO). METHODS: Ocular axial lengths were measured, by A-scan ultrasonography, in 17 patients with CRVO and 41 patients with BRVO and compared with those of contralateral unaffected eyes and 66 age matched controls. RESULTS: In 17 patients with CRVO the mean axial length of affected eyes was 22.25 (SD 0.19) mm and of unaffected eyes was 22.61 (0.13) mm. In 41 patients with BRVO the mean axial length of affected eyes was 22.89 (0.11) mm and of unaffected eyes was 22.99 (0.12) mm. CONCLUSION: These findings confirm that the axial lengths in CRVO and BRVO were significantly shorter than in the controls. This significant difference may be a risk factor in the development of CRVO and BRVO.  相似文献   

2.
We performed a prospective study in order to elucidate thepredisposing role of axial length and hyperopia in retinal veinocclusions. The study group comprised 39 patients with unilateralcentral retinal vein occlusion (CRVO), 50 patients with unilateralbranch retinal vein occlusion (BRVO), 13 patients with unilateralhemispheric retinal vein occlusion (HRVO) and 45 controleyes.The axial length of affected eyes was compared to fellow eyesand control eyes in each subgroup of patients with retinal veinocclusion. No statistical difference was noted for any of thesubgroups (p > 0.05). Hyperopia was detected in 12 of 39 eyes(31%) with CRVO, 14 of 50 eyes (28%) with BRVO, 4 of 13 eyes(31%) with HRVO and 15 of 45 eyes (33%) in the control group.No statistically significant difference was discovered (p> 0.05).In the light of our study, we believe that axial length andhyperopia may not be risk factors in retinal vein occlusions, incontrast to common belief.  相似文献   

3.
眼压和轴长在视网膜中央静脉阻塞中的意义   总被引:1,自引:0,他引:1  
目的 探讨眼压和轴长在视网膜中央静脉阻塞中的意义。方法 应用TX- 10眼压计对4 6例(46只眼) CRVO患者的眼压进行测量。并使用A型超声仪对其中16例CRVO眼轴进行测量,对照组与病例组年龄和性别相配,例数相等。结果 36例CRVO阻塞眼眼压较对侧眼有不同程度降低。CRVO阻塞眼眼压显著低于对侧眼及正常对照眼(P <0 .0 1)。CRVO阻塞眼轴长显著短于对侧眼及正常对照眼(P <0 .0 1)。结论 CRVO可引起眼压降低,短眼轴是CRVO的危险因素。  相似文献   

4.
PURPOSE: To evaluate the association of axial length and posterior segment length with central retinal vein occlusion (CRVO) using optical coherence interferometry. METHODS: The study group consisted of 29 patients (13 female and 16 male) with unilateral CRVO who were referred to Farabi Eye Hospital. Patients with macular edema were excluded. The mean keratometry (mean K), axial lengths (AL), anterior chamber depths (ACD), and posterior segment lengths (PSL, defined by AL - ACD) of affected and fellow eyes were measured using optical coherence interferometry. RESULTS: Age range was 45 to 74 years (mean 59.2 +/- 7.5 years). The mean K of affected eyes was not statistically significantly lower than that of unaffected eyes in the CRVO group. This was also true for ACD. Although affected eyes had shorter axial length (23.26 mm vs 23.33 mm), the difference was not significant. There was a statistically significant difference in PSL affected and unaffected eyes (20.15 mm vs 20.26 mm) (p=0.008). CONCLUSIONS: Posterior segment length of eyes with CRVO may be shorter than unaffected eyes. This may predispose them to more crowding of central retinal vein and artery in lamina cribrosa, and developing CRVO.  相似文献   

5.
Shi A  Chen S 《中华眼科杂志》2001,37(5):373-374
目的探讨眼球轴长与视网膜中央静脉阻塞(centralreinalveinocclusion,CRVO)的相关关系.方法采用A超测量30例CRVO患者及120例年龄匹配的正常人及白内障摘除患者眼球轴长.结果CRVO组患眼平均轴长(22.54±0.74)mm,对侧眼平均轴长(22.95±0.92)mm;经统计学处理,差异无显著性(t=2.94,P>0.05).对照组右眼平均轴长(23.45±0.66)mm,左眼平均轴长(23.56±0.95)mm,左右眼比较差异无显著性(t=1.96,P>0.05).CRVO组患眼与对照组轴长比较,差异有显著性(t=4.09,P<  相似文献   

6.
金昕  谭薇  李燕 《国际眼科杂志》2021,21(4):711-714
目的:应用光学相干断层扫描血管成像技术(OCTA)测量视网膜静脉阻塞(RVO)患者黄斑区血流密度、黄斑中心凹无血管区(FAZ)面积和黄斑中心凹视网膜厚度。方法:选取RVO患者30例30眼,视网膜中央静脉阻塞(CRVO)和视网膜分支静脉阻塞(BRVO)患者各15例,双眼接受OCTA检查,获取黄斑中心3mm×3mm大小范围的血流密度、FAZ面积、黄斑中心凹视网膜厚度,以及双眼最佳矫正视力(BCVA)。比较患眼与健眼上述指标的变化及其与BCVA的相关性。结果:CRVO患者患眼黄斑区视网膜浅层毛细血管网(SVN)、深层毛细血管网(DVN)总血流密度较健眼降低[SVN:(43.07±4.95)%vs(50.09±2.86)%,DVN:(45.89±4.12)%vs(53.29±2.62)%,均P<0.01],与BCVA呈负相关(rs=-0.6、-0.5,均P<0.05)。BRVO患者患眼SVN、DVN总血流密度较健眼降低[SVN:(45.62±3.04)%vs(52.10±2.98%),DVN:(49.21±3.80)%vs(55.52±3.33%),均P<0.01],与BCVA呈负相关(rs=-0.5、-0.5,均P<0.05)。BRVO患眼病变区域与患眼未病变区域、健眼对应区域比较,SVN、DVN血流密度均下降(均P<0.01);患眼未病变区域DVN血流密度较健眼相应区域下降[(56.86±1.95)%vs(58.15±2.24)%,P=0.02];患眼病变区域DVN血流密度与BCVA呈负相关(rs=-0.6,P=0.01)。CRVO、BRVO患眼SVN的FAZ面积较健眼明显扩大(CRVO:0.515±0.26mm2vs 0.27±0.08mm2,P<0.01;BRVO:0.376±0.12mm2vs 0.261±0.07mm2,P<0.01),且均与BCVA呈正相关(CRVO:rs=0.6,P=0.01;BRVO:rs=0.5,P=0.01)。CRVO、BRVO患眼黄斑中心凹视网膜厚度均较健眼增加(CRVO:431.2±191.3μm vs 235.5±18.2μm,P<0.01;BRVO:373.2±188.7μm vs 233.8±13.7μm,P=0.01),均与BCVA呈正相关(CRVO:rs=0.9,P=0.01;BRVO:rs=0.6,P=0.01)。结论:OCTA可作为测量RVO患者黄斑区血流密度、FAZ面积及黄斑中心凹视网膜厚度的有效工具。  相似文献   

7.
轴长在视网膜分支静脉阻塞中的意义   总被引:2,自引:0,他引:2  
目的评价眼轴长度(简称轴长)在视网膜分支静脉阻塞(branch retinal vein occlusion,BRVO)中的意义。方法34例BRVO和34例选自白内障摘除而年龄和性别相配的对照病例,做了轴长的对比研究,轴长应用A型超声测量。结果BRVO组患眼和对侧眼的轴长比较无统计学差异(P>0.20);BRVO组患眼轴长平均(23.16±0.82)mm,对照组眼的轴长平均(23.78±1.06)mm,两者差异无显著(P>0.10)。结论作为远视眼依轴长测定结果并不是BRVO发病的一种危险因素。(中华眼底病杂志,1998,14:12-13)  相似文献   

8.
目的 分析视网膜中央静脉阻塞(central retinal vein occlusion,CRVO)和视网膜分支静脉阻塞(branch retinal vein occlusion,BRVO)的危险因素;并对CRVO和BRVO危险因素进行直接比较.方法 对46例CRVO(CRVO组)、33例BRVO(BRVO组)与79例老年性白内障或屈光不正患者(对照组)行危险因素和血脂谱分析,并对比观察.结果 多元线性回归分析结果显示:高同型半胱氨酸血症(P<0.000 1)、高总胆固醇(P=0.003 0)、高脂蛋白a(P =0.027 0)、高血压(P =0.022 0)、短眼轴(P <0.000 1)与CRVO显著相关;而高同型半胱氨酸血症(P<0.0001)、高总胆固醇(P =0.008 0)、高血压(P=0.002 0)、高体质量指数(P=0.004 0)、短眼轴(P=0.001 0)与BRVO相关.一元线性回归分析示CRVO和BRVO上述危险因素比较没有明显差别.结论 CRVO、BRVO危险因素包括系统(高血脂、高血压、高同型半胱氨酸)和眼部(短眼轴)的多种因素,但是这些危险因素在CRVO和BRVO之间没有显著差异.  相似文献   

9.
PURPOSE: To evaluate ocular parameters that may predispose to the development of branch retinal vein occlusion (BRVO). METHODS: This prospective study included patients with unilateral BRVO evaluated in the authors' clinic. The mean period from the acute phase was 2.29 +/- 1.57 years (range 1-6 years). All patients underwent a complete ophthalmologic examination including subjective refraction, axial length measurements, and keratometry readings. The fellow eye served as a control in each patient. The variables of interest were compared between the affected eye and the fellow eye using the parametric t-test and the nonparametric Wilcoxon test. RESULTS: Twenty-four consecutive patients (14 women, 10 men, mean age 62.4 years) were included in the study. The mean axial length in the affected eye was significantly shorter compared to the mean fellow eye length. No difference was found between the two eyes in mean subjective refraction or mean keratometry readings. CONCLUSIONS: The authors found that eyes with BRVO have a shorter axial length compared to the fellow eye in the same patient.  相似文献   

10.
The photopic negative response (PhNR) has recently been shown to be severely affected in central retinal artery occlusion (CRAO), despite relative preservation of the cone b-wave compared to that in the healthy unaffected fellow eye. The aim of this study was to test how the PhNR of the flash electroretinogram (ERG) is affected in human retinal vein occlusion. PhNR was elicited with red stimuli (1 cd s/m2, 5 cd s/m2, and 7 cd s/m2 with 4 ms duration) and blue background (10 cd/m2). Standard Ganzfeld flash ERG was produced according to the ISCEV standard for the clinical electroretinogram (2004). Sixteen patients with central retinal vein occlusion (CRVO), 14 patients with branch retinal vein occlusion (BRVO), and 16 controls were analyzed. The amplitude of the PhNRs was significantly smaller in the CRVO and BRVO eyes than those in the unaffected fellow or control eyes (p = 0.000). There was a significantly greater reduction of PhNR amplitudes than that of other waves including the OPs, rod b-wave, combined a-wave and b-wave, cone a-wave and b-wave, and 30 Hz flicker ERG. Thus, PhNR amplitude in retinal vein occlusion is severely affected. There is a potential role for PhNR in assessing inner retinal damage and evaluating the effect of treatment.  相似文献   

11.
视网膜电图明视负向反应在视网膜静脉阻塞中的变化   总被引:1,自引:0,他引:1  
目的 观察视网膜静脉阻塞(RVO)患者视网膜电图(ERG)明视负向反应(PhNR)的变化特点.方法 对间接检眼镜、荧光素眼底血管造影(FFA)检查确诊的RVO患者30例30只患眼以及对侧健康眼进行视力、视野、闪光ERG(FERG)检查,同时选取与其性别、年龄相匹配的正常人25例50只眼作为正常组进行FERG检查.所有检查均按常规方法进行.RVO患者中,视网膜中央静脉阻塞(CRVO)患者14例14只眼、视网膜分支静脉阻塞(BRVO)患者16例16只眼.根据其病史及FFA检查结果,将其按病程时间划分为小于1个月、1~3个月、大于3个月组;另外再根据RVO分型标准及具体检查结果,将RVO患者分为缺血型和非缺血型.对比分析RVO患眼与对侧健康眼以及正常眼PhNR振幅变化及ERG其他参数指标,包括振荡电位(Ops),视锥细胞反应(Cone-a、Cone-b),视杆细胞反应(Rod-b),暗适应眼的最大反应(Max-a、Max-b),30 Hz闪烁光反应(30 Hz)的差异以及PhNR振幅变化与RVO疾病缺血类型、病程的关系.结果 PhNR振幅在CRVO患眼为(28.20±5.80)μV,BRVO患眼为(36.96±4.71)μV,对侧健眼为(61.25±3.93)μV,正常眼为(59.33±16.92)μV.CRVO组与对侧健眼、正常组比较,差异有统计学意义(F=10.69,9.80;P<0.001),BRVO组与对侧健眼、正常组比较,差异有统计学意义(F=9.69,9.75;P<0.001).CRVO组中缺血型PhNR值为(22.77±5.73)μV,非缺血型为(36.63±12.91)μV,二者差异有统计学意义(t=6.54,P<0.01);BRVO组缺血型PhNR值为(32.39±13.22)μV,非缺血型为(46.73±10.43)μV,二者差异无统计学意义(t=2.12,P<0.05);病程小于1个月组CRVO与BRVO分别为(24.58±4.60)、(27.94±15.73)μV,1~3个月组分别为(50.39±13.80)、(58.69±12.43)μV,大于3个月组为(25.40±19.94)、(34.48±16.72)μV,CRVO中1~3个月组与大于3个月组差异有统计学意义(F=4.30,P<0.01).结论 RVO患眼的PhNR振幅较对侧健康眼以及正常对照眼明显降低,缺血型较非缺血型降低,随病程变化呈现下降、上升、下降的变化趋势.  相似文献   

12.
目的探讨眼压和眼轴长与视网膜静脉阻塞(RVO)的关系。方法应用CanonTX-F型眼压计对56例RVO患者的眼压进行测量,并用A超对其眼轴进行测量,对照组为年龄、性别相匹配的98例白内障摘除患者。结果视网膜中央静脉阻塞(CRVO)阻塞眼眼压显著低于对测眼及正常对照眼(P〈0.01);视网膜分支静脉阻塞(BRVO)阻塞眼眼压与对测眼及正常对照眼比较差异无显著性(P〉0.05)。CRVO阻塞眼眼轴长与对照眼比较差异有显著性(P〈0.01);BRVO阻塞眼眼轴长与对照眼比较差异无显著性(P〉0.05)。结论眼轴长偏短是CR-VO的危险因素,CRVO可引起眼压降低;眼轴长偏短不是BRVO的危险因素,BRVO不能引起眼压降低。  相似文献   

13.
The fellow eye in retinal vein occlusive disease   总被引:2,自引:0,他引:2  
Bilateral occurrence of retinal vein occlusive disease is relatively uncommon. In this retrospective review of 157 patients with retinal vein occlusion, 74 had unilateral major trunk occlusion (MTO), i.e., either central (CRVO) or hemicentral (hemi-CRVO) retinal vein occlusion, 12 had MTO in both eyes, and two had MTO in one eye and branch retinal vein occlusion (BRVO) in the other. In 69 patients there was unilateral BRVO. Thus, 8.9% of the patients had bilateral retinal vein occlusive disease of any type. Of the 88 patients with MTO in at least one eye, 13.6% had MTO disease in the fellow eye as well and only 2.3% had BRVO in the fellow eye. Major trunk occlusion in one eye thus appears to be a greater risk factor than BRVO for the bilateral occurrence of retinal vein occlusive disease. Another factor predisposing to bilateral occurrence in the group of patients with MTO was the coexistence of diabetic retinopathy (P less than 0.05).  相似文献   

14.
Purpose: To evaluate pseudoexfoliation (PE) and pre-existent glaucoma in eyes with branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO). Methods: Consecutive eyes with a diagnosis of BRVO (73 eyes of 70 patients) and CRVO (53 eyes of 49 patients) examined between July and December 1998 comprised the study eyes. Age-matched control group consisted of 384 eyes of 192 outpatients. The prevalence of PE and glaucoma were determined and appropriate statistical tests were performed. Results: PE was present in six of 73 eyes with BRVO (8.2%), 11 of 53 eyes with CRVO (20.8%) and 20 of 384 control eyes (5.2%). Two of 73 eyes with BRVO (2.7%) and 10 of 53 eyes with CRVO (18.9%) had glaucoma. Compared with the control eyes, PE was significantly more common in eyes with CRVO and coexistent glaucoma was significantly more common both in eyes with CRVO and in eyes with BRVO. Conclusion: While glaucoma seems to be a risk factor both for BRVO and CRVO, PE is a likely risk factor for CRVO.  相似文献   

15.
目的 研究视网膜中央静脉阻塞(central retinal vein occlusion,CRVO)和视网膜分支静脉阻塞(branch retinal vein occlusion,BRVO)继发黄斑水肿(ME)患者黄斑中心凹下脉络膜厚度(subfoveal choroidal thickness,SFCT)的变化情况,并探讨单次玻璃体内注射康柏西普后的短期反应。方法 回顾性病例对照研究。选取2019年6月至2020年6月在我院接受治疗的31例视网膜静脉阻塞继发ME的初治患者,根据发病类型分为CRVO组(16例16眼)和BRVO组(15例15眼)。所有患者在确诊后均接受玻璃体内注射康柏西普治疗。分别在康柏西普注射前和注射后2周测量两组SFCT并比较。结果 CRVO组注射前患眼的SFCT为(319.73±19.28)μm,较对侧健眼[(255.13±16.15)μm]明显增厚,差异有统计学意义(P=0.000);注射后2周患眼的SFCT迅速降为(283.33±21.61)μm,与注射前相比差异具有统计学意义(P=0.000)。BRVO组注射前患眼SFCT为(310.31±19.41)μm,较对侧健眼[(255.31±21.69)μm]明显增厚;注射后2周患眼的SFCT迅速下降为(266.56±16.30)μm,与注射前相比差异具有统计学意义(P=0.000)。康柏西普注射前后CRVO组患眼和BRVO组患眼之间的SFCT变化值差异无统计学意义(P=0.210)。结论 CRVO和BRVO继发ME患眼的SFCT均明显比对侧健眼增厚,并在玻璃体内注射康柏西普后短时间内明显变薄。  相似文献   

16.
目的:用视网膜电图评估视网膜血管阻塞的功能改变。方法:30例视网膜中央静脉阻塞,15例视网膜分支静脉阻塞,7例视网膜中央动脉阻塞和6例视网膜分支动脉阻塞按照ISCEV的ERG标准进行全视野网膜电图的检测。用I1蓝光、I16红光和I16白光估计暗视ERG,用I16红光和I8白光估计明视ERG。记录a波和b波的振幅和潜伏期及震荡电位。结果:视网膜血管阻塞的震荡电位异常率最高,其次为b波;ERG的异常率  相似文献   

17.
目的:观察单眼视网膜静脉阻塞(RVO)患者对侧眼黄斑区血流密度和黄斑中心凹无血管区(FAZ)面积。方法:回顾性病例对照研究。2018年5~11月在长沙爱尔眼科医院临床确诊为单眼RVO的78例患者78只对侧眼纳入研究。其中,男性44例,女性34例;平均年龄(53.17±10.12)岁。视网膜中央静脉阻塞(CRVO)42例(CRVO组),视网膜分支静脉阻塞(BRVO)36例(BRVO组)。选取年龄和性别与RVO患者相匹配的33名正常健康者42只眼作为对照组。其中,男性17例22只眼,女性16例20只眼;平均年龄(53.48±10.84)岁。3组受检眼均行OCT血管成像检查,以仪器自带软件自动识别以黄斑中心凹为中心的直径6 mm区域及FAZ,自动测量黄斑区浅层和深层血流密度及FAZ面积。对比分析3组受检眼黄斑区浅层、深层血流密度和FAZ面积。结果:与对照组比较,CRVO组(t=-4.26、-4.93)、BRVO组(t=-4.79、-4.74)受检眼黄斑区浅层及深层血流密度均降低,差异均有统计学意义(P<0.05)。CRVO组、BRVO组受检眼黄斑区浅层及深层血流密度降低幅度分别为4.13%、5.51%及3.50%、4.58%,深层血流密度的降低幅度较浅层更大。CRVO组受检眼FAZ面积较对照组减小,差异有统计学意义(t=-3.43,P<0.05)。BRVO组与对照组受检眼FAZ面积比较,差异无统计学意义(t=-0.10,P>0.05)。结论:单眼RVO患者对侧眼黄斑区血流密度较正常健康眼降低,黄斑区深层血流密度的降低幅度较浅层更大。与正常健康眼比较,单眼CRVO患者对侧眼FAZ面积减小,单眼BRVO患者对侧眼FAZ面积无明显变化。  相似文献   

18.
AIMS: To determine whether an increase in vascular resistance in the central retinal and ophthalmic arterial circulations contributes to the development of central retinal vein occlusion (CRVO), or haemodynamic alterations in central retinal and ophthalmic arteries occur secondary to the vein occlusion as increased intravascular pressure is transferred through the capillary bed to the arterial side and the effect of panretinal photocoagulation treatment on these circulations in ischaemic cases. METHODS: The ophthalmic and central retinal arteries of the affected and non-affected eyes of 20 patients with non-ischaemic CRVO, 13 patients with ischaemic CRVO, and 22 control subjects were investigated by colour Doppler imaging. Panretinal photocoagulation (PRP) treatment was applied to the eyes with ischaemic CRVO. Maximum and minimum blood flow velocities, and resistivity indexes were calculated in the affected and healthy eyes of patients and in the control eyes. RESULTS: Average blood flow velocity in the central retinal and ophthalmic arteries of patients with non-ischaemic CRVO did not differ from their fellow eyes, but a significantly lower average blood flow velocity was found in the ophthalmic and central retinal arteries of the patients with ischaemic CRVO compared with their fellow eyes. Patients with ischaemic CRVO had significantly lower blood flow velocities in their ophthalmic and central retinal arteries than non-ischaemic cases that were further reduced following PRP treatment. CONCLUSION: This study suggests that impaired arterial blood flow observed in patients with CRVO may be partly related to secondary changes in the retrobulbar arterial circulation as a result of enhanced arterial resistance following CRVO. These data also demonstrate that PRP treatment decreases retinal and ophthalmic blood flow velocities in patients with ischaemic CRVO.  相似文献   

19.
The retinal vessel calibre responses to systemic autonomic stimulation were studied in fellow eyes of 11 patients with central retinal vein occlusion (CRVO) and 10 patients with branch retinal vein occlusion (BRVO), using sustained isometric muscle contraction as the stimulus. These vessel responses were compared to those of a control group of 11 subjects of similar ages. The changes in retinal vessel calibre were measured using the Quantimet Image Analyser. There was no significant difference in mean arteriolar constriction during isometric muscle contraction (mean ± SEM) between the CRVO group (6.0 ± 1.34%) and the BRVO group (5.4 ± 0.31%), (p > 0.05), and between either of these groups compared with the control group (7.4 ± 1.20%), (p > 0.50). Similarly there was no significant difference in mean venule responses between the groups (CRVO 4.9 ± 0.48%; BRVO 4.6 ± 0.63%; control subjects 3.8 ± 0.90%;p > 0.05). The diastolic blood pressure responses were similarly not significantly different between the 3 groups (CRVO 22.3 ± 1.27, range +17 to 29mmHg; BRVO 25.8 ± 2.9mmHg, range 18 to 45mmHg; control subjects 21.3 ± 1.7mmHg, range 16 to 35mmHg), (p > 0.10). The implications of the results are discussed.  相似文献   

20.
A prospective natural history study was conducted in 721 eyes with various types of retinal vein occlusion (RVO) to determine the incidence of various types of ocular neovascularization (NV) and the factors that influence the development of ocular NV. The material was 360 eyes with central retinal vein occlusion (CRVO), 97 eyes with hemi-CRVO, and 264 eyes with branch retinal vein occlusion (BRVO); these cases were further subdivided into six groups for logical data analysis: nonischemic CRVO (venous stasis retinopathy-VSR, 282 eyes), ischemic CRVO (hemorrhagic retinopathy-HR, 78 eyes), hemi-VSR (66 eyes), hemi-HR (31 eyes), major BRVO (191 eyes) and macular BRVO (73 eyes). Ocular NV attributable to RVO was seen only in HR, hemi-HR, and major BRVO. In HR the anterior segment was the major site of NV, with iris and angle NV and neovascular glaucoma (NVG), while in hemi-HR and major BRVO the retina and optic disc were the major sites of NV. The principal factor influencing the development of ocular NV in RVO seems to be the severity and extent of retinal ischemia, while duration of follow-up since onset also plays an important role in determining the incidence of ocular NV. The findings and subject of ocular NV in RVO are discussed in detail along with a review of the pertinent literature.  相似文献   

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