视网膜动脉阻塞患者视力预后分析

目的研究视网膜动脉阻塞患者视力预后的相关因素。方法回顾性分析62例视网膜动脉阻塞患者的临床资料,观察就诊时间、动脉阻塞类型、是否并发高血压、糖尿病等全身疾病及年龄等因素与视力预后的关系。结果视网膜分支动脉阻塞优于中央动脉阻塞患者的视力;并发高血压等全身疾病会影响患者视力的恢复;年龄在50岁以上的患者预后明显要比年龄≤50岁的患者差。结论根据对患者上述一般情况的分析可以对其视力预后水平进行早期的估测。     

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…     

视网膜静脉阻塞患者视力预后相关因素分析

目的研究各型视网膜静脉阻塞患者的视力预后、并发症及视力降低的相关因素.方法视网膜静脉阻塞患者913例(944只眼),年龄15～89岁,平均(52.8±11.9)岁;平均随访时间20.7个月.患者所有临床资料均输入计算机,应用SPSS软件进行统计学处理.结果 (1)按部位分型总干阻塞406只眼,占43.0%;半侧阻塞60只眼,占6.4%;分支阻塞478只眼,占50.6%.(2)按缺血分型944只眼中,缺血型633只眼,占67.1%;非缺血型311只眼,占32.9%.(3)患者视力预后各型静脉阻塞患者治疗前、后视力比较,总干阻塞和半侧阻塞的差异无显著性(t=1.45,1.62;均P>0.05),分支阻塞的差异有显著意义(t=7.89,P<0.05).(4) 患者初诊视力水平与预后3种类型静脉阻塞患者视力预后均差;患者的初诊视力水平均与视力预后密切相关(χ2=175.261,21.357,106.408;均P<0.01).(5) 静脉阻塞导致的低视力和盲目率各型静脉阻塞患者的低视力与盲目率比较,差异有显著意义(χ2=85.251,P<0.01).(6) 缺血型与非缺血型患者视力预后比较视网膜静脉总干阻塞、半侧阻塞、分支阻塞患者中缺血型与非缺血型比较,差异均有显著意义(χ2=157.819,19.637,56.737;P<0.01).(7)导致静脉阻塞的危险因素高血压占57.8%,动脉硬化占67.4%,血液黏稠度增高占24.6%,原发性青光眼占1.5%,糖尿病占6.2%.(8) 静脉阻塞患者并发症的发生率黄斑囊样水肿占46.7%,视网膜和(或)视乳头新生血管占21.5%,玻璃体出血占11.4%,新生血管性青光眼占4.2%.其中总干阻塞发生新生血管性青光眼39只眼,占总干阻塞的9.6%,占半侧阻塞的1.7%.(9)并发症导致的低视力和盲目率低视力者中,黄斑囊样水肿占37.9%,新生血管占29.9%;盲目者中,黄斑囊样水肿占19.5%,新生血管占23.0%.新生血管性青光眼导致的盲目者中,视力<0.05者占95.0%.结论视网膜静脉阻塞的致盲率较高,影响视力预后的最重要因素是缺血型视网膜静脉阻塞.初诊视力水平与视力预后关系密切,黄斑囊样水肿、新生血管及新生血管性青光眼为致盲的重要原因.     

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…     

相干光断层扫描在诊断视网膜中央动脉阻塞中的应用

目的评价相干光断层扫描(OCT)在诊断视网膜中央动脉阻塞(CRAO)中的诊断价值。方法回顾分析经眼底检查、荧光素眼底血管造影(FFA)、OCT确诊的16例(16只眼)CRAO患者的临床资料,所有患者发病2周内。结果眼底检查呈现黄斑区樱桃红改变者10只眼,FFA检查显示12只眼视网膜动脉充盈迟缓,血流呈节段状,16只眼OCT图像均见不同程度的黄斑区视网膜增厚、反射增强、光感受器暗区宽带增大。结论 CRAO具有特征性的OCT表现,对于眼底检查、FFA表现不典型者OCT检查不失为一个快速有效的辅助工具,为临床诊断提供客观依据。     

视网膜分支静脉阻塞的黄斑血流及结构特征分析

目的:采用光学相干断层扫描血管成像(OCTA)技术观察视网膜分支静脉阻塞(BRVO)患者黄斑区血流及结构特征,并分析视力的危险因素。方法:收集2018-01/2019-06在抚顺市眼病医院经眼底及眼底荧光造影检查确诊的BRVO患者92例92眼为BRVO组,另选取同期基线资料与BRVO组患者相匹配的健康志愿者38例38眼作为对照组。记录两组受检者的基线资料,并采用OCTA技术观察3mm×3mm范围内黄斑区深层和浅层血流密度、深层和浅层中心凹血流密度、黄斑中心凹厚度、神经上皮层厚度、神经上皮层下积液高度。分析BRVO患者上述参数的相关性,并采用多因素Logistic回归法分析影响视力的危险因素。结果:与对照组相比,BRVO患者视力、黄斑中心凹厚度、深层血流密度、浅层血流密度、深层中心凹血流密度、浅层中心凹血流密度均有差异(P<0.01)。多因素Logistic回归分析显示,年龄(P=0.033,OR=1.152,95%CI 1.011~1.312)、浅层中心凹血流密度(P=0.010,OR=1.260,95%CI 1.056~1.504)、黄斑中心凹厚度(P<0.01,OR=1.033,95%CI 1.021~1.045)均是视力的危险因素。BRVO患者深层及浅层血流密度与黄斑中心凹厚度、神经上皮层厚度均呈负相关(P<0.01),黄斑中心凹厚度与神经上皮层厚度、神经上皮层下积液高度均呈正相关(P<0.01)。结论:利用OCTA可以观察BRVO患者视网膜血流状态及视网膜切面结构的变化,将两者结合起来可以更全面地观察BRVO患者黄斑区视网膜的病变特点。年龄、黄斑中心凹厚度、浅层中心凹血流密度为影响视力的危险因素。     

产后视网膜分支动脉阻塞的临床分析

目的:分析产后视网膜分支动脉阻塞(branch retinal artery obstruction,BRAO)的发病原因。方法:对我院收集的3例分娩后出现单眼视力下降的患者,进行眼部检查包括:视力、裂隙灯、视野检查和荧光眼底血管造影及血液学检查。结果:3例产妇荧光眼底血管造影均提示BRAO。1例血液学检查示蛋白C为58U,2例蛋白S分别为40%和35%。结论:3例产后BRAO患者均为抗凝血因子缺乏,导致高血液粘稠度状态所致。对不能解释的年轻人发生BRAO要考虑蛋白C和蛋白S缺乏。     

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）。     

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.     

Microvascular and functional changes according to the fundus location of the affected arteriovenous crossing in patients with branch retinal vein occlusion

Purpose:The aim of this study was to evaluate the structural and functional changes occurring in patients with branch retinal vein occlusion (BRVO) according to the distance of the affected arteriovenous (AV) crossing to the centers of the fovea and optic disc by optic coherence tomography angiography (OCTA).Methods:Forty-five patients with unilateral BRVO and 45 age- and sex-matched healthy controls were included in this retrospective observational study. Images of the macula (3 mm × 3 mm) and affected AV crossing sites were obtained by OCTA. The fovea-AV crossing distance (FAVD), optic disc-AV crossing distance (DAVD), and optic disc-fovea distance (DFD) were measured.Results:The FAVD/DFD ratio was positively correlated with the vessel density in the superficial and deep affected hemifields (r = 0.430, P < 0.05 and r = 0.308, P < 0.05, respectively) and negatively correlated with the superficial foveal avascular zone and logarithm of the minimum angle of resolution (logMAR) visual acuity (r = –0.412, P < 0.05 and r = –0.356, P < 0.05, respectively). The DAVD/DFD ratio was not correlated with the logMAR visual acuity, superficial FAZ area or vessel densities in the affected hemifield (all P > 0.05).Conclusion:The affected AV crossing site that was further away from the fovea had better visual acuity and quantitative microvascular parameters in the affected hemifields. However, this correlation was not observed for the distance between the affected AV crossing site and the optic disc.     

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。     

Optical coherence tomography angiography for macular microvessels in ischemic branch retinal vein occlusion treated with conbercept: predictive factors for the prognosis

AIM: To evaluate the predicative factors of visual prognosis using optical coherence tomography angiography (OCTA) in ischemic branch retinal vein occlusion (BRVO) patients with macular edema (ME) after anti-vascular endothelial growth factor (VEGF) treatment. METHODS: In this retrospective analysis, data from 60 patients (60 eyes) with a definite diagnosis of ischemic BRVO with ME by fundus fluorescein angiography (FFA) were studied. The eyes with ME according to spectral domain optical coherence tomography (SD-OCT) underwent intravitreal conbercept (IVC) and 3+pro re nata (PRN) regimen. The injection times were recorded. Two weeks after injection, fundus laser photocoagulation was performed in the non-perfusion area of the retina. The patients were followed up once a month for 6mo. The best-corrected visual acuity (BCVA), foveal avascular zone (FAZ), and A-circularity index (AI), at 6mo and the baseline were compared. RESULTS: All patients showed significant improvement in BCVA from 0.82±0.32 to 0.39±0.11 logMAR (P<0.001). The mean central macular thickness (CMT) significantly decreased from 476.22±163.54 to 298.66±109.23 μm. Both the FAZ area and AI at 6mo were significantly higher than those at the baseline: the FAZ area increased (0.38±0.02 vs 0.39±0.02 mm², P<0.05); the AI increased (1.27±0.02 vs 1.31±0.01, P=0.000). The baseline BCVA showed a significantly positive correlation with the baseline FAZ area, FAZ perimeter (PERIM) and AI, final visual gain (FVG) and injection times, respectively (P<0.001). FVG showed a significantly negative correlation with the FAZ area, PERIM, AI and injection times, but a significantly positive correlation with vessel densities (VDs) 300 µm area around FAZ (FD-300; P<0.001). Injection times was positively correlated with the baseline FAZ area, and AI, but inversely correlated with the baseline FD-300 (P<0.001). However macular ischemia was noted in 5 cases during follow-up. CONCLUSION: Using OCTA to observe macular ischemia and quantify parameters can better predict the final visual prognosis of patients before treatment. The changes in FAZ parameters may influence the visual prognosis and injection times.     

康柏西普联合激光光凝治疗视网膜分支静脉阻塞继发黄斑水肿患者远期视力恢复的影响因素研究

目的 分析并评估影响康柏西普联合视网膜激光光凝治疗视网膜分支静脉阻塞(BRVO)继发黄斑水肿(ME)远期视力恢复的因素.方法 回顾性病例分析.将2019年1月至2020年1月在我院眼科查确诊的缺血型BRVO继发ME(BRVO-ME)患者30例30眼纳入研究.所有纳入研究患者均进行裂隙灯检查、最佳矫正视力(BCVA)、光...     

Spectral domain optical coherence tomography findings of acute branch retinal artery occlusion from calcific embolus

An 82-year-old female presented with sudden painless decrease in vision in the right eye after awakening. She could see the "superior half" of her vision from the right eye only. On examination, best-corrected vision was 20/300 in the right eye and 20/30 in the left eye. The fundus in the right eye revealed recent superotemporal branch retinal artery occlusion (BRAO) with calcified plaque at the disc. Spectral domain optical coherence tomography (OCT) (OTI Ophthalmic Technologies, Inc.), revealed hyperreflectivity and increased thickness of the inner retinal layers of the superior compared to the inferior retina. Imaging at the optic disc revealed the blocked artery containing a highly reflective material. The high reflectivity of the material and underlying optical shadowing could be characterized as calcific emboli.     

Comparison of retinal thickness values and segmentation performance of different OCT devices in acute branch retinal vein occlusion

Purpose

To compare retinal thickness (RT) measurement and segmentation performance of time domain (TD, Stratus) and spectral domain (SD) optical coherence tomography (OCT) devices (Cirrus, Spectralis) for imaging macular oedema (ME) secondary to branch retinal vein occlusion (BRVO).

Methods

In this study, 20 eyes of 20 consecutive patients with acute BRVO were included. A total of 18 unaffected fellow eyes served as control group. RT measurement was analysed in the five inner fields of the early-treatment diabetic retinopathy grid, and proportional segmentation errors were evaluated.

Results

Central millimetre thickness (CMT) showed a mean difference of −64, −74, and −18 μm (P<0.001) in the control group and −31 μm (P=0.107), −92 μm (P<0.001), and −105 μm (P=0.016) in the BRVO group, between Stratus and Cirrus, between Stratus and Spectralis, and between Cirrus and Spectralis, respectively. Mean RT showed the highest variability between different devices in the area most intensively affected by BRVO-related ME. In eyes with BRVO, 14.6% of Spectralis, 20% of Stratus, and 36.6% of Cirrus scans demonstrated moderate and severe segmentation errors.

Conclusion

RT measurement in eyes with BRVO, by TD and SD OCT, is compromised by a significant rate of segmentation errors. Deviations are most pronounced in the areas most severely affected by ME.     

影响视网膜中央静脉阻塞预后的相关因素研究现状

视网膜中央静脉阻塞(CRVO)是常见的严重影响视力的视网膜血管病。目前雷珠单抗、阿柏西普和地塞米松植入剂等在治疗CRVO相关黄斑水肿(ME)方面取得了成功。但仍有1/3患者治疗后视力无明显改善,30.7%患者治疗后ME消退但易复发,28.1%患者治疗后始终存在ME。如何在起病初期通过患者不同的临床表现来判断其预后,有助于临床医生根据特定的疾病情况更好地为患者选择治疗方案。近年来关于CRVO治疗预后的研究主要集中在影像标志物包括视网膜内层结构紊乱、视网膜高反射灶、视网膜下液、缺血指数、渗漏指数等和生物标志物包括VEGF、白细胞介素(IL)-6、IL-8等方面。本文就影响CRVO预后的相关因素研究进展进行综述,旨在更加精准、有效地治疗、管理和监测CRVO患者。     

光学相干断层扫描血流成像技术(OCTA)在视网膜静脉阻塞中的应用

光学相干断层扫描血管成像技术(optical coherence tomography angiography,OCTA)是一种近年来新兴的无创、快速、高分辨率的眼底血管成像技术.OCTA拥有分层观察不同层面的视网膜血管形态,量化血流灌注的独特优势,现广泛应用于各类眼底血管疾病的诊断及随访.视网膜静脉阻塞是一种常见的眼底血管病变,本文对OCTA在视网膜静脉阻塞的应用进行综述.