眼球缺血综合征临床特点观察

目的探讨眼球缺血综合征(OcularischemicsyndromeOIS)患者眼部表现、眼底荧光血管造影临床特点及血流动力学改变。方法OIS患者眼部检查、眼底荧光素血管造影检查,彩色多谱勒超声检查对比研究OIS患者组和正常对照组颈总动脉、颈内动脉、眼动脉、视网膜中央动脉收缩期血流峰速(PSV)值。结果①共观察OIS患者22例22眼。21例(95%)患者以不同程度的视力下降为主要表现。6眼(27%)出现虹膜新生血管。眼底改变:16眼(73%)视网膜静脉扩张,20眼(90%)有中周部视网膜点状出血。2眼(9%)见到视网膜动脉搏动。②眼底荧光素血管造影臂-视网膜循环时间、视网膜动-静脉循环时间延长,15例(68%)视网膜血管着染,有2只眼发现视网膜动-静脉交通支形成。③OIS患者患侧眼动脉、视网膜中央动脉PSV降低。结论①眼球缺血综合征临床表现复杂,FFA及彩色多谱勒超声检查是诊断该病的重要手段。     

低灌注视网膜病变并发新生血管性青光眼的临床特征

目的 探讨颈内动脉狭窄引起的低灌注视网膜病变并发新生血管性青光眼的临床特征.方法 回顾性系列病例研究.收集18例(18只眼)颈内动脉狭窄引起的低灌注视网膜病变并发新生血管性青光眼患者的一般情况、视力、眼压、眼底改变、荧光素眼底血管造影、颈动脉超声多普勒、磁共振血管造影、数字减影血管造影等临床检查资料,进行回顾性分析,从中探寻低灌注视网膜病变并发新生血管性青光眼的临床特征.结果 18例低灌注视网膜病变并发新生血管性青光眼患者中,男性15例,女性3例;年龄18～78岁,平均40岁.患者就诊时视力为光感至0.8.眼压＞21 mm Hg(1 mm Hg=0.133 kPa)的有14只眼,眼压≤21 mm Hg的有4只眼.18只眼均可见虹膜、前房角新生血管.眼底检查:视网膜动脉细;静脉不规则扩张,但不扭曲;视网膜赤道部有点片状出血,可见微动脉瘤,后极部有棉絮状斑.影像学检杳均显示有颈内动脉狭窄和阻塞表现.结论 新生血管性青光眼是低灌注视网膜病变少见而严重的并发症.其眼底表现及青光眼体征具有特征性.眼底病变以单眼为主,视网膜静脉扩张,但不扭曲,出血主要在赤道部.大部分患眼眼压高,视盘有凹陷性萎缩,虹膜及前房角有新生血管,可见各种形态的视野缺损.     

荧光素虹膜血管造影联合眼底血管造影在DR合并新生血管性青光眼中的应用

背景 新生血管性青光眼(NVG)是由视网膜缺血缺氧继发的眼病.荧光素虹膜血管造影(IFA)可早期诊断NVG,但其不能全面反映眼底血管情况.IFA联合荧光素眼底血管造影(FFA)可全面检测视网膜及虹膜新生血管情况,但目前国内关于糖尿病视网膜病变(DR)合并NVG患者中此方法的应用研究较少. 目的 探讨IFA联合FFA检查在增生性糖尿病视网膜病变(PDR)患者合并新生血管性青光眼的临床应用.方法 采用回顾性研究方法.纳入2013年2月至2016年1月在河南省立眼科医院接受IFA和FFA联合检查的PDR患者79例133眼,其中无虹膜病变100眼,I期青光眼红变期21眼,Ⅱ期开角型NVG 12眼.所有患眼均行视力、眼压、裂隙灯显微镜、IFA联合FFA检查.采用McNemar非参数检验法对比分析裂隙灯显微镜和IFA检查在I期青光眼红变期患眼检出率的差异. 结果 IFA检查显示100眼无虹膜病变患者无异常虹膜荧光素渗漏,FFA检查显示接受全视网膜激光光凝术(PRP)治疗的32眼未发现视网膜新生血管,68患眼存在视网膜新生血管;早期IFA检查显示,21眼I期青光眼红变期患者瞳孔缘或虹膜表面新生血管荧光素渗漏,FFA检查显示均存在视网膜新生血管;早期IFA检查显示12眼NVG患者虹膜表面新生血管荧光素渗漏,FFA检查显示均存在视网膜新生血管.I期青光眼红变期患眼中IFA检查的检出率为100％(21/21),明显高于裂隙灯显微镜检查的71.43％(15/21),2种检测方法检出率的比较差异有统计学意义(P=0.03). 结论 IFA联合FFA检查可以及早发现PDR合并青光眼红变期,有助于及时指导治疗.     

眼部缺血综合征的临床及荧光素眼底血管造影特征

目的探讨眼部缺血综合征(ocularischemicsyndrome,OIS)的临床及荧光素眼底血管造影(FFA)的表现特征。方法收集经临床及FFA确诊的OIS患者8例8眼,分析总结其临床表现和FFA表现。结果8例患者年龄38-69岁,男性5例,女性3例。所有病变眼均表现为视网膜动脉狭窄,静脉扩张但不纡曲,均可见多少不一的视网膜棉絮斑,FFA表现为臂-视网膜循环时间延长,视网膜血管及视盘渗漏。虹膜细小新生血管2眼。结论OIS多发于中老年人群,眼底表现为视网膜动脉狭窄及棉絮斑,FFA表现为视网膜动脉充盈时间延长,视网膜血管及视盘渗漏。多与全身疾病有关联。     

非动脉炎性视网膜中央动脉阻塞伴同侧颈内动脉闭塞患者的眼底影像特征

目的 探讨非动脉炎性视网膜中央动脉阻塞(NA-CRAO)伴同侧颈动脉闭塞患者的眼底影像特征。方法 回顾性研究。选择2019年11月至2021年11月在西安市人民医院(西安市第四医院)眼科住院治疗的NA-CRAO伴同侧颈内动脉闭塞患者32例32眼为颈内动脉闭塞组,选择同期住院治疗的NA-CRAO不伴有颈内动脉闭塞患者32例32眼为对照组。采用国际标准视力表检测患者最佳矫正视力(BCVA);对患者行瞳孔、眼球运动、裂隙灯显微镜、眼底彩色照相、OCT、荧光素眼底血管造影(FFA)、颈部血管超声多普勒、颅脑磁共振(MRI)、磁共振血管成像(MRA)检查。比较两组患者的臂-视网膜循环时间(A-Rct)、主干-末梢荧光素充盈时间(FT)、FFA特征、BCVA、眼底彩色照相、虹膜新生血管以及黄斑OCT特征。结果 颈内动脉闭塞组和对照组患者年龄、性别、眼别、发病时间以及高血压、糖尿病、高脂血症、高同型半胱氨酸血症患病率差异均无统计学意义(均为P>0.05);颈内动脉闭塞组患者A-Rct和FT较对照组均显著延长,差异均有统计学意义(P=0.016、0.003);颈内动脉闭塞组与对照组患者BCVA差...     

Bevacizumab联合视网膜光凝治疗虹膜和视网膜新生血管

目的:观察Bevacizumab玻璃体腔注射联合视网膜光凝治疗虹膜和视网膜新生血管的疗效和安全性。方法:回顾分析虹膜和视网膜新生血管患者13例13眼玻璃体腔注射Bevacizumab联合视网膜光凝治疗的临床随访资料。13眼中视网膜新生血管9眼(其中继发于视网膜分支静脉阻塞的2眼,增生型糖尿病视网膜病变的6眼,Eales病的1眼),虹膜新生血管4眼(均继发于视网膜中央静脉阻塞)。13眼全部行玻璃体腔注射1.25mg/0.05mL的Bevacizumab,术前或术后分次补充完成视网膜光凝。随诊3～18mo,随访期间发现新生血管复发者,再行同样方法的注射和光凝治疗。观察治疗前后最佳矫正视力、眼压、眼底荧光血管造影。结果:经治疗后,13眼中8眼(61.5%)视力提高,4眼(30.8%)视力保持不变,1眼(7.7%)视力下降;6例合并玻璃体积血,术后均明显吸收;13眼视网膜及虹膜新生血管均消退,随诊期间复发2眼,行第二次注射和光凝治疗后新生血管无复发。虹膜新生血管(新生血管性青光眼)4眼中2眼治疗后眼压下降,随访期间均控制正常,另2眼联合青光眼阀植入后眼压控制正常。随诊期中,其余9眼眼压无升高。1例患者注药后结膜下出血,其余患者未出现其他并发症。结论:Bevacizumab玻璃体腔注射联合视网膜光凝治疗虹膜和视网膜新生血管在短期内能促进玻璃体积血吸收和新生血管萎缩,副作用少;但尚需进一步大样本、多中心的临床随机对照研究。     

荧光素眼底血管造影对视网膜静脉阻塞分型及预后评估的作用分析

目的 分析荧光素眼底血管造影(FFA)对视网膜静脉阻塞(RVO)分型及预后评估的作用.方法 96例(96只眼)RVO患者进行FFA及眼科常规检查,并进行随访.结果 28只眼视网膜中央静脉阻塞(CRVO)中5只眼为缺血型,23只眼为非缺血型,其中有3只眼转化为缺血型.有新生血管5只眼.伴有黄斑水肿18只眼,黄斑缺血1只眼;68只眼视网膜分支静脉阻塞(BRVO)中缺血型40只眼,非缺血型28只眼,有2只眼转化为缺血型.有新生血管14只眼.伴有黄斑水肿30只眼,黄斑缺血29只眼.结论 FFA检查不仅能给RVO分型,而且能很好地判断患者视网膜血管的改变,可以起到推断预后的作用,并作为选择治疗和观察疗效的依据.     

小梁切除术联合视网膜光凝术治疗新生血管性青光眼

目的 探讨复合小梁切除术联合视网膜光凝术治疗新生血管性青光眼的疗效.方法 回顾性分析视网膜中央静脉阻塞继发新生血管性青光眼患者9例,行复合小梁切除术,术后1周予全视网膜光凝术.记录术前及术后3个月、12个月患者视力、眼压、虹膜及房角新生血管检查,眼底视网膜新生血管消退及无灌注区情况.结果 术后12个月患者视力提高8眼,1眼无明显提高.术后眼压：5例患者眼压控制在21mmHg以下;4例眼压控制欠佳,需要局部使用降眼压药物,其中2例使用一种局部降眼压药物后眼压控制在21mmHg以下,另外2例眼压不能控制.虹膜及房角新生血管消退.眼底3个月和12个月后行荧光血管造影显示新生血管消退,无水肿,毛细血管无灌注区消失.结论 复合小梁切除术联合全视网膜光凝术是一种治疗视网膜中央静脉阻塞继发的新生血管性青光眼的有效的方法.     

玻璃体内注射Bevacizumab联合全视网膜光凝及复合式小梁切除术治疗新生血管性青光眼

目的 探讨玻璃体内注射Bevacizumab(商品名Avastin)联合全视网膜光凝及复合式小梁切除术治疗新生血管性青光眼的临床疗效.方法 收集2008年1月至2009年5月就诊于我院的新生血管性青光眼患者30例(30眼),随机分为2组.A组18例(18眼)行玻璃体内注射Bevacizumab 25 mmol·L-1联合全视网膜激光光凝及复合式小梁切除术.B组12例(12眼)行全视网膜光凝联合Ahmed青光眼阀植入术.2组术中均应用0.4 g·L-1丝裂霉素C.观察2组患者手术前后的视力、眼压及虹膜新生血管的变化.前房角镜检查前房角结构变化.结果 A组玻璃体内注射Bevacizumab 2～3 d后,所有患者的虹膜新生血管消失.4周内完成全视网膜光凝:注射2个月后,18眼眼压大于30 mmHg(1 kPa=7.5 mmHg),前房角为关闭状态;复合式小梁切除术后1周,眼压为7～12 mmHg;术后1个月,眼压为10～37 mmHg.B组4周内完成全视网膜光凝,虹膜新生血管部分消退.Ahmed青光眼阀植入术后1周,眼压为10～16 nnnHg;术后1个月,眼压为10～35 mmHg;术后6个月随访,2组患者在眼压控制、视力等方面差异均无统计学意义(均为P>0.05).手术成功率:A组(83.33%)高于B组(66.67%).A组未见虹膜新生血管复发.B组6眼虹膜新生血管复发,差异有统计学意义(P<0.05).结论 玻璃体内注射Bevacizumab 联合全视网膜光凝及复合式小梁切除术治疗新生血管性青光眼成功率高,并发症少,疗效显著.     

玻璃体切除治疗增生性糖尿病视网膜病变保留晶状体前囊膜的临床观察

目的 探讨保留晶状体前囊膜技术在增生性糖尿病视网膜病变(PDR)手术治疗中的临床效果.方法 系列病例研究.对伴有晶状体混浊和累及眼底后极部的牵拉性视网膜脱离或牵拉-孔源性视网膜脱离的51例(58只眼)PDR患者,在行玻璃体切除手术中,采用经睫状体平坦部切除或超声粉碎吸出晶状体核及皮质并保留前囊膜的技术,处理混浊的晶状体,完成玻璃体手术后给予硅油充填.术后对晶状体前囊膜照相,并对其透明度进行分级评价,对与手术相关的并发症及其处理方法、患者视力和眼压、视网膜复位情况进行分析.结果 玻璃体切除硅油充填并保留晶状体前囊膜的58只眼中,晶状体前囊膜透明度:A级26只眼(44.8%),B级20只眼(34.5%),C级7只眼(12.1%);D级5只眼(8.6%).46只眼(79.3%)术后最佳矫正视力≥0.05,21只眼接受二期人工晶状体植入术.最终7只眼因视网膜不能复位,黄斑裂孔未闭合,而未行硅油取出术.手术并发症:误切虹膜1只眼,硅油进入前房7只眼,虹膜新生血管形成及新生血管性青光眼各1只眼,术后高眼压4只眼,继发性黄斑和视网膜前膜11只眼,黄斑裂孔2只眼.结论 保留晶状体前囊膜,酌情行二期人工晶状体植入术,是处理严重PVR眼的一种较好方法.晶状体上皮细胞残留和积血的长期存在是晶状体前囊膜混浊的主要原因,硅油进入前房是玻璃体切除术中应用保留晶状体前囊膜技术的主要并发症之一.     

Successful treatment of the ocular ischemic syndrome with panretinal photocoagulation and cerebrovascular surgery

The ocular ischemic syndrome is a manifestation of chronic vascular insufficiency. The natural history is for progressive visual loss. The authors describe 12 patients (13 eyes) who presented with at least one asymmetric ocular finding, including midperipheral dot and blot hemorrhages (hypoperfusion retinopathy) (in 8), iris neovascularization (in 7), neovascular glaucoma (in 3) and vitreous hemorrhage (in 1). Cerebral angiography revealed stenosis or occlusion of the ipsilateral carotid artery in all cases. The treatment was panretinal photocoagulation (in four cases), cerebrovascular surgery (in three) or both (in six). All but one patient showed stabilization of visual acuity (20/60 or better in nine cases) and regression of proliferative retinopathy and of iris neovascularization. The results underline the importance of early recognition and treatment of the ocular ischemic syndrome.     

Intravitreal Bevacizumab (Avastin) Treatment of Neovascular Glaucoma in Ocular Ischemic Syndrome

We report a case of ocular ischemic syndrome accompanied by neovascular glaucoma that was successfully treated with Bevacizumab. A 70-year-old male patient diagnosed with neovascular glaucoma of the left eye 3-4 years prior complained of continuous left eye pain and declining visual acuity despite receiving the latest treatment methods. At the time of admission the patient had no light perception in the left eye and his intraocular pressure was 30 mmHg. Anterior segment and fundus examinations revealed neovascularization of the iris and stenosis of the retinal vessel. Hypofluorescence of the choroid and retinal vessels was observed on fluorescence fundus angiography. Left internal carotid artery stenosis was observed on a brain MRI. Despite being treated with eye solution and oral medication, intraocular pressure was not controlled. After 7 days, we performed an intravitreal Bevacizumab 1.25 mg/0.05mL injection. One day after the intravitreal Bevacizumab injection, the neovascularization had nearly regressed and intraocular pressure was 30 mmHg. Intravitreal Bevacizumab injection produced regression of neovascularization and proved effective for treatment of neovascular glaucoma in this case of ocular ischemic syndrome.     

Reverse flow in ophthalmic artery helps protect the cerebrum from ischemic stroke in total carotid artery occlusion

A 62-year-old male developed ocular ischemic syndrome in his right eye. Carotid angiography and magnetic resonance angiography revealed total occlusion of the right internal carotid artery and a 53% occlusion of the left internal carotid artery. The angiographies also revealed a collateral circulation of a rarely seen reversed blood flow in the right ophthalmic artery, which helped spare the patient from cerebral stroke. Nevertheless, retinal infarction and neovascularization of the iris, retina, and optic disc presented with an unrecoverable visual loss. The balance between treating eye ischemia or cerebral ischemia is a challenge, and timely referral to a neuroradiologist and neurovascular specialist is important to avoid further serious life-threatening complications.     

The ocular ischemic syndrome

The records of 43 consecutive patients (51 eyes) with the ocular ischemic syndrome (ocular symptoms and signs attributable to severe carotid artery obstruction) were studied in a retrospective fashion. Men comprised 67% of the group and the mean age at presentation was 64.5 years. In the anterior segment, neovascularization of the iris was observed in 66% of eyes and iritis was noted in 18%. Posterior segment signs included narrowed retinal arteries and dilated, but not tortuous, retinal veins. Mid-peripheral retinal hemorrhages were seen in 80% of eyes, posterior segment neovascularization was observed in 37%, and a cherry red spot was noted in 12%. Fluorescein angiography commonly revealed delayed choroidal and retinal filling, while electroretinography generally demonstrated a reduction in the amplitude of both the a-and b-waves.     

Indications for photocoagulation in idiopathic retinal periphlebitis

Fourteen patients (23 eyes) with idiopathic retinal periphlebitis were followed during a mean time of six years. Argon laser photocoagulation was performed in 18 eyes: in 11 eyes for large retinal ischemic areas, and in 7 eyes for disc or peripheral neovascularization. Beneficial results were obtained in 72.5% of the treated patients. Laser photocoagulation seems to be useful to prevent or reduce ocular neovascularization associated with idiopathic retinal periphlebitis, and to prevent vitreous hemorrhage. Photocoagulation did not increase ocular inflammation and should be limited to ischemic areas.     

Arterial obstruction and ocular neovascularization

A series of 12 patients (13 eyes) with neovascular glaucoma in association with arterial obstructive disease is presented. Appropriately characterized as having an ocular ischemic syndrome, the anterior segment findings in each included aqueous flare and rubeosis iridis. Posterior segment manifestations included midperipheral intraretinal hemorrhages (venous stasis retinopathy), narrowed retinal arteries, often a cherry red spot, and neovascularization of the disc and/or retina. Most eyes with the ocular ischemic syndrome have either ipsilateral common carotid artery obstruction or severe bilateral obstruction of the internal carotid arteries.     

Current concepts in the management of central retinal vein occlusion

The results of the Central Vein Occlusion Study (CVOS) guide the management of macular edema and neovascularization. This study did not show that grid-pattern laser photocoagulation had a significant beneficial effect for the management of decreased visual acuity caused by perfused macular edema in eyes with central retinal vein occlusion (CRVO). Panretinal laser photocoagulation (PRP) was shown to be beneficial for eyes with at least 2 clock hours of iris neovascularization or any angle neovascularization. PRP has not been advocated as prophylaxis for ischemic eyes before the formation of neovascularization. Although treatment of the ocular consequences of CRVO may be guided by the CVOS data, management of the underlying cause of CRVO-the occluded vein itself-was not addressed in the study. Recently, several reports have suggested restoring venous outflow by 1) creating a laser-induced or surgically induced chorioretinal anastomosis, 2) administering recombinant tissue plasminogen activator (rt-PA), 3) cannulating the retinal vein transvitreally, or 4) transecting the posterior scleral ring.     

Ocular ischemic syndrome in diabetic patients

PURPOSE: Diabetes mellitus aggravates carotid occlusive disease, that can manifest as ocular ischemic syndrome (OIS). Ocular manifestations and visual prognosis of OIS in diabetic patients were retrospectively analyzed. METHODS: Twenty-three consecutive diabetic patients with OIS were divided into two groups according to the presence of iris neovascularization, and the clinical features were reviewed. RESULTS: In the first group, 14 eyes of 12 diabetic patients (11 men and 1 woman) had no iris neovascularization. Two patients had bilateral OIS. The ages in this group ranged from 50-75 years. Four eyes with optic atrophy or ischemic optic neuropathy had severe visual loss. Six eyes with hypoperfusion retinopathy or retinal vein obstruction and 2 eyes with cataract had mild visual loss. Each eye with amaurosis fugax or retinal neovascularization had no visual deterioration. Asymmetrical retinopathy was observed in 2 patients. Carotid surgery stabilized and resolved amaurosis fugax and hypoperfusion retinopathy. In the second group, 11 eyes of 11 patients had iris neovascularization. The patients were all male and their ages ranged from 53-77 years. All eyes with iris neovascularization had severe visual deterioration. In 5 patients, asymmetrical ocular manifestation was observed. Carotid reconstruction surgery and ophthalmological treatment were not successful for recovering a satisfactory visual outcome in OIS. CONCLUSION: The features of OIS in diabetic patients mimic diabetic retinopathy and manifest with asymmetrical ocular findings. Iris neovascularization is an indicator of poor visual prognosis. It is essential to recognize the early stages of OIS associated with diabetes mellitus.